96 Background: The integration of oncology and palliative care (IOP) is an emerging issue that has been encouraged by several agencies, including the American Society of Clinical Oncology. Despite such efforts, clinical implementation of IOP is evolving slowly. One key barrier to implementation is the lack of institutional support; however, recognition of IOP by the heads of hospitals has rarely been investigated. Methods: This was a secondary qualitative analysis of a nationwide survey, which was performed in November 2017 to clarify the current status of IOP in Japan. The questionnaires were distributed to all designated cancer hospitals (DCHs) (n = 399) and randomly sampled non-DCHs (n = 478). This survey included a free text query asking executives or directors of oncology departments at cancer hospitals to describe their opinions about encouragement of IOP in Japan (i.e., importance or challenges of IOP). In total, 174 hospitals (20.2%) responded to the free text query (106 DCHs and 68 non-DCHs). Contents analysis was performed using the free text data. Results: Three major categories emerged from the descriptive data: (1) perceptions and attitudes toward IOP, (2) perceived barriers to IOP, and (3) perceived facilitators of IOP, which possessed two, nine, and eight minor categories, respectively. Of these minor categories, there were both affirmative and contradictory opinions toward IOP. Reluctant attitudes of patients, caregivers, health care professionals, and hospital heads; limited clinical resources, process, and political support; and specific clinical circumstances in Japan were identified as perceived barriers. Education, improvement of clinical resources and process, and political initiatives were identified as perceived facilitators. Conclusions: Comprehensive perceptions, attitudes, challenges, and solutions regarding IOP were proposed. Such data may provide healthcare professionals and policymakers with greater understanding of how to encourage IOP in Japan.