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Affiliation(s)
- Eduardo Bruera
- The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
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Goodman-Meza D, Medina-Mora ME, Magis-Rodríguez C, Landovitz RJ, Shoptaw S, Werb D. Where Is the Opioid Use Epidemic in Mexico? A Cautionary Tale for Policymakers South of the US-Mexico Border. Am J Public Health 2018; 109:73-82. [PMID: 30495992 DOI: 10.2105/ajph.2018.304767] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In North America, opioid use and its harms have increased in the United States and Canada over the past 2 decades. However, Mexico has yet to document patterns suggesting a higher level of opioid use or attendant harms.Historically, Mexico has been a country with low-level use of opioids, although heroin use has been documented. Low-level opioid use is likely attributable to structural, cultural, and individual factors. However, a range of dynamic factors may be converging to increase the use of opioids: legislative changes to opioid prescribing, national health insurance coverage of opioids, pressure from the pharmaceutical industry, changing demographics and disease burden, forced migration and its trauma, and an increase in the production and trafficking of heroin. In addition, harm-reduction services are scarce.Mexico may transition from a country of low opioid use to high opioid use but has the opportunity to respond effectively through a combination of targeted public health surveillance of high-risk groups, preparation of appropriate infrastructure to support evidence-based treatment, and interventions and policies to avoid a widespread opioid use epidemic.
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Affiliation(s)
- David Goodman-Meza
- David Goodman-Meza and Raphael J. Landovitz are with Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles (UCLA). Raphael J. Landovitz is also with Center for Clinical AIDS Research and Education, Los Angeles. Maria Elena Medina-Mora is with Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico. Carlos Magis-Rodríguez is with National Center for the Prevention and Control of HIV and AIDS, Mexico City. Steve Shoptaw is with Department of Family Medicine, David Geffen School of Medicine at UCLA. Dan Werb is with Department of Medicine, University of California San Diego, La Jolla
| | - Maria Elena Medina-Mora
- David Goodman-Meza and Raphael J. Landovitz are with Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles (UCLA). Raphael J. Landovitz is also with Center for Clinical AIDS Research and Education, Los Angeles. Maria Elena Medina-Mora is with Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico. Carlos Magis-Rodríguez is with National Center for the Prevention and Control of HIV and AIDS, Mexico City. Steve Shoptaw is with Department of Family Medicine, David Geffen School of Medicine at UCLA. Dan Werb is with Department of Medicine, University of California San Diego, La Jolla
| | - Carlos Magis-Rodríguez
- David Goodman-Meza and Raphael J. Landovitz are with Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles (UCLA). Raphael J. Landovitz is also with Center for Clinical AIDS Research and Education, Los Angeles. Maria Elena Medina-Mora is with Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico. Carlos Magis-Rodríguez is with National Center for the Prevention and Control of HIV and AIDS, Mexico City. Steve Shoptaw is with Department of Family Medicine, David Geffen School of Medicine at UCLA. Dan Werb is with Department of Medicine, University of California San Diego, La Jolla
| | - Raphael J Landovitz
- David Goodman-Meza and Raphael J. Landovitz are with Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles (UCLA). Raphael J. Landovitz is also with Center for Clinical AIDS Research and Education, Los Angeles. Maria Elena Medina-Mora is with Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico. Carlos Magis-Rodríguez is with National Center for the Prevention and Control of HIV and AIDS, Mexico City. Steve Shoptaw is with Department of Family Medicine, David Geffen School of Medicine at UCLA. Dan Werb is with Department of Medicine, University of California San Diego, La Jolla
| | - Steve Shoptaw
- David Goodman-Meza and Raphael J. Landovitz are with Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles (UCLA). Raphael J. Landovitz is also with Center for Clinical AIDS Research and Education, Los Angeles. Maria Elena Medina-Mora is with Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico. Carlos Magis-Rodríguez is with National Center for the Prevention and Control of HIV and AIDS, Mexico City. Steve Shoptaw is with Department of Family Medicine, David Geffen School of Medicine at UCLA. Dan Werb is with Department of Medicine, University of California San Diego, La Jolla
| | - Dan Werb
- David Goodman-Meza and Raphael J. Landovitz are with Division of Infectious Diseases, David Geffen School of Medicine at University of California Los Angeles (UCLA). Raphael J. Landovitz is also with Center for Clinical AIDS Research and Education, Los Angeles. Maria Elena Medina-Mora is with Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico. Carlos Magis-Rodríguez is with National Center for the Prevention and Control of HIV and AIDS, Mexico City. Steve Shoptaw is with Department of Family Medicine, David Geffen School of Medicine at UCLA. Dan Werb is with Department of Medicine, University of California San Diego, La Jolla
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Inbadas H, Zaman S, Whitelaw A, Clark D. Palliative Care Declarations: Mapping a New Form of Intervention. J Pain Symptom Manage 2016; 52:e7-e15. [PMID: 27401509 PMCID: PMC5026679 DOI: 10.1016/j.jpainsymman.2016.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 05/14/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Hamilton Inbadas
- School of Interdisciplinary Studies, University of Glasgow, Glasgow, United Kingdom
| | - Shahaduz Zaman
- School of Interdisciplinary Studies, University of Glasgow, Glasgow, United Kingdom
| | - Alexander Whitelaw
- School of Interdisciplinary Studies, University of Glasgow, Glasgow, United Kingdom
| | - David Clark
- School of Interdisciplinary Studies, University of Glasgow, Glasgow, United Kingdom
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Cleary J, De Lima L, Eisenchlas J, Radbruch L, Torode J, Cherny N. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Latin America and the Caribbean: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol 2013; 24 Suppl 11:xi41-50. [DOI: 10.1093/annonc/mdt502] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Improving the availability and accessibility of opioids for the treatment of pain: The International Pain Policy Fellowship. Support Care Cancer 2011; 19:1239-47. [DOI: 10.1007/s00520-011-1200-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 05/24/2011] [Indexed: 10/18/2022]
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Leon MX, De Lima L, Florez S, Torres M, Daza M, Mendoza L, Agudelo N, Guerra L, Ryan K. Improving availability of and access to opioids in Colombia: description and preliminary results of an action plan for the country. J Pain Symptom Manage 2009; 38:758-66. [PMID: 19783400 DOI: 10.1016/j.jpainsymman.2009.03.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 02/20/2009] [Accepted: 04/01/2009] [Indexed: 11/28/2022]
Abstract
Latin America consumes less than 2.7% of the morphine in the world, as reported by the governments to the International Narcotics Control Board. Methods to improve access to opioids for the treatment of pain have been developed by the Pain & Policy Studies Group (PPSG), a World Health Organization Collaborating Center at the University of Wisconsin. This article describes the preparation and implementation of an action plan in Colombia as a part of an international fellowship program on opioid policy developed by the PPSG and funded by the Open Society Institute. The action plan for Colombia included three steps: 1) a survey of regulators and health care providers to identify the current situation and their perceptions of opioid availability in the regions of the country; 2) a workshop with representatives of the Ministry of Health, the national and state competent authorities, pain and palliative care physicians, and international leaders; and 3) implementation workshops at the local level throughout the country. For the survey, response rates of 47% and 96% were registered among physicians and competent authorities, respectively. The survey identified significant regional differences in perceived opioid availability between physicians and regulators. Focus group discussions during the workshop identified several reasons leading to limited availability of opioids in the country, including deficiencies in the procurement process, insufficient human resources, excessive bureaucratic tasks, insufficient number of pharmacies authorized to dispense controlled medications in the country, lack of training in the health care professions, and overly restrictive laws and regulations governing opioid availability. The third step of the action plan has not been implemented. Additional and continuous monitoring needs to be implemented to measure the progress of this project.
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Affiliation(s)
- Marta Ximena Leon
- Pain and Palliative Care Group, Universidad de la Sabana, Bogota, Colombia.
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Torres-Vigil I, Aday LA, Reyes-Gibby C, De Lima L, Herrera AP, Mendoza T, Cleeland CS. Health Care Providers' Assessments of the Quality of Advanced-Cancer Care in Latin American Medical Institutions: A Comparison of Predictors in Five Countries: Argentina, Brazil, Cuba, Mexico, and Peru. J Pain Palliat Care Pharmacother 2009; 22:7-20. [DOI: 10.1080/15360280801989195] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Isabel Torres-Vigil
- Department of Health Disparities Research, Center for Research on Minority Health, The University of Texas M. D. Anderson Cancer Center,
| | - Lu Ann Aday
- The Division of Management, Policy and Community Health, The University of Texas School of Public Health, Houston
| | - Cielito Reyes-Gibby
- Department of Epidemiology, The University of Texas M.D. Anderson Cancer Center,
| | - Liliana De Lima
- The International Association for Hospice and Palliative Care based in Houston and the Latin American Association for Palliative Care based in Buenos Aires, Argentina
| | - Angelica P. Herrera
- Department of Health Disparities Research Center for Research on Minority Health, The University of Texas M. D. Anderson Cancer Center,
| | - Tito Mendoza
- Department of Symptom Research, The University of Texas M. D. Anderson Cancer Center,
| | - Charles S. Cleeland
- Department of Symptom Research, The University of Texas M. D. Anderson Cancer Center, World Health Organization Collaborating Center for Supportive Cancer Care.,
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Abstract
The global expansion of the modern hospice movement has been fast and impressive, and in developing countries this phenomenon has also been registered, despite the structural and operational difficulties of their health systems. This article will address the scenario of palliative and hospice care in Brazil, pointing to the challenges and difficulties for the implementation of this comprehensive programme within its health system.
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Affiliation(s)
- Ciro Augusto Floriani
- Bioethics Council, Brazilian National Cancer Institute, Ministry of Health, Rio de Janeiro, Brazil
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Clark D. End-of-life care around the world: achievements to date and challenges remaining. OMEGA-JOURNAL OF DEATH AND DYING 2008; 56:101-10. [PMID: 18051023 DOI: 10.2190/om.56.1.i] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
From the moment her interest in terminal care was awakened, Cicely Saunders was alert to the international dimensions of the subject. Her first patient in the late 1940s was an emigré Polish Jew dying alone and in isolation in a busy London hospital. Her letters from the 1950s onwards show an unquenchable thirst for new knowledge and a span of contacts and communications that was global in its reach. By the early 1960s, she was making fact-finding visits to the United States and Europe. Even before it opened to patients, St Christopher's Hospice was a beacon of inspiration to like-minded colleagues from many countries, eager to see how the model of practice was being operationalized and--more important still--how it could be adapted and modified in other settings. In the later years of her life, Cicely Saunders remained in contact with colleagues all over the world. She wrote introductions to numerous textbooks and collections; recorded interviews that were broadcast at international conferences; harnessed her name and energies to major efforts to promote palliative care globally; and, to the very end, served as a source of inspiration to palliative care activists, policy makers, educators, and researchers. As this special issue of the journal demonstrates so eloquently, that legacy lives on.
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Affiliation(s)
- David Clark
- Institute for Health Research, University of Lancaster, United Kingdom.
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Stjernswärd J, Foley KM, Ferris FD. Integrating palliative care into national policies. J Pain Symptom Manage 2007; 33:514-20. [PMID: 17482040 DOI: 10.1016/j.jpainsymman.2007.02.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Accepted: 02/21/2007] [Indexed: 11/18/2022]
Abstract
Good policies lay the groundwork for an effective health care system and society. They facilitate the implementation of palliative care programs aimed at providing care for all people in need of these services, and they ensure equitable access to affordable medications and therapies. The lack of good policies can lead to unnecessary suffering and costs for patients, families, and society. Three-quarters of cancer patients worldwide are incurable when diagnosed. Because the size of the problem--and the suffering associated with cancer--is enormous, development of a national cancer control policy is an effective point of entry to begin integrating palliative care into a country's health care system. To be comprehensive, every cancer center must include palliative care. Ideally, palliative care is incorporated as a priority within all aspects of each country's national health plan, so that all patients living with or dying from any chronic disease may have their suffering relieved, including children and the elderly. To this end, policies that address essential medicines must include a list of palliative care medications. Supplies of affordable, generic medications that are "equally efficient" must be adequate and available throughout the country wherever patients live (especially opioids for pain control).
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Affiliation(s)
- Jan Stjernswärd
- Cancer Control and Palliative Care, World Health Organization, Open Society Institute, New York, NY, USA.
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Abstract
Palliative care and hospices have developed rapidly since the late 1960s. The pioneering work of Cicely Saunders was instrumental in drawing attention to the end-of-life care needs of patients with advanced malignant disease. Palliative care began to be defined as a subject of activity in the 1970s and came to be synonymous with the physical, social, psychological, and spiritual support of patients with life-limiting illness, delivered by a multidisciplinary team. Palliative care services have developed in many settings and have often been closely related to oncology. The worldwide need for this type of care remains much greater than the available provision, but there are encouraging signs of recognition by policymakers and influential bodies, and interest in palliative care has never been greater. This paper charts the modern history of such care around the world and concludes on some current issues and future challenges.
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Affiliation(s)
- David Clark
- International Observatory on End of Life Care, Institute for Health Research, Lancaster University, Alexandra Square, Lancaster, UK.
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Nayak S, Pradhan JPB, Reddy S, Palmer JL, Zhang T, Bruera E. Cancer patients' perception of the quality of communication before and after the implementation of a communication strategy in a regional cancer center in India. J Clin Oncol 2005; 23:4771-5. [PMID: 16034053 DOI: 10.1200/jco.2005.12.971] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Physician communication is one of the areas that cancer patients have expressed their lowest level of satisfaction. Very few studies have used patient-based outcomes in the Developing world. METHODS We conducted a survey of 400 consecutive patients attending our outpatient clinic (Step I). Survey results were used to make changes in the physical layout of the setting to increase privacy and to educate staff regarding practical techniques on communication (Step II). A second group of 400 patients were interviewed immediately after the implementation of the new communication strategy (Step III). RESULTS Comparing Step I (n = 400) and Step III (n = 400) we observed a favorable response ("yes" v "no") with regard to overall satisfaction with communication in 52 patients (13%) versus 132 patients (33%; P = .0001), privacy in 21 patients (5%) versus 279 patients (70%; P = < .001), no interruptions in 170 patients (42%) versus 330 patients (82%; P = < .001), clear language in 57 patients (14%) versus 227 patients (57%; P = < .001), sufficient time in 88 patients (22%) versus 168 patients (42%; P = < .001), doubts cleared by the doctor in 105 patients (26%) versus 225 patients (56%; P = < .001). Patients older than 65 years and manual laborers were significantly more satisfied compared with younger patients and those patients with nonmanual occupations, during both Steps I and III. CONCLUSION We conclude that cancer patients in Developing countries have many unmet needs regarding communication and that simple changes in the organization of clinics and oncologist education can result in major improvements in satisfaction with the quality of communication.
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Affiliation(s)
- Sukdev Nayak
- Palliative Care Unit, A.H. Regional Cancer Centre, Cuttack, India
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Joranson DE. Improving Availability of Opioid Pain Medications: Testing the Principle of Balance in Latin America. J Palliat Med 2004; 7:105-14. [PMID: 15000794 DOI: 10.1089/109662104322737377] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- David E Joranson
- Pain & Policy Studies Group, University of Wisconsin Medical School, Comprehensive Cancer Center, Madison, Wisconsin 53711-1068, USA.
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De Lima L, Barnard D. Advances in Palliative Care in Latin America and the Caribbean: Ongoing Projects of the Pan American Health Organization (PAHO). J Palliat Med 2001; 4:227-231. [PMID: 11730516 DOI: 10.1089/109662101750290281] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Pan American Health Organization (PAHO) is engaged in field demonstration projects in Latin America and the Caribbean to expand the availability and effectiveness of palliative care services. Workshops and calls for proposals address the multiple causes of inadequate palliative care services that are typical for countries in the developing world. These include regulatory barriers and drug interdiction policies that interfere with the medical use of opioids, lack of education among health professionals, and insufficient palliative care infrastructure.
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Affiliation(s)
- Liliana De Lima
- WHO/PAHO Liaison in Supportive Care and IAHPC, Executive Director, UT MD Anderson Cancer Center, Houston, Texas
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Liliana De Lima MH, Sakowski JA, Stratton Hill C, Bruera E. Legislation analysis according to WHO and INCB criteria on opioid availability: a comparative study of 5 countries and the state of Texas. Health Policy 2001; 56:99-110. [PMID: 11275300 DOI: 10.1016/s0168-8510(00)00130-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Opioids are not always available in many developing countries, including those in Latin America. In this study we analyzed the national laws on opioids and other controlled substances from Argentina, Colombia, Costa Rica, Peru, Mexico, and the state of Texas, according to the principles set by the World Health Organization (WHO) and the International Narcotics Control Board (INCB), as well as to the presence of over-regulations regarding their medical and scientific use. The six main principles outlined by WHO and INCB for opioid availability were analyzed by using a total of 17 criteria as shown in Table 3. The result scores ranged from 17/17 (full compliance with all criteria) to 0/17 (non-compliance). Results showed that with the exception of the state of Texas 16/17 (94%), the countries failed to adequately meet the INCB and WHO criteria: Argentina: 7/17 (41%); Colombia: 9 /17 (53%); Costa Rica: 9/17 (53%); Mexico: 4/17 (24%); and Peru: 7/17 (41%). In all 5 Latin American countries, national laws and regulations imposed limits on the number of days allowed for prescription, the potency of the dosage, and the number of doses allowed per day. In all cases, including Texas, there was confusion on the meaning and utilization of the terms physical dependence, psychological dependence, addiction, tolerance and abuse. In total, combining all cases, only 51% of the criteria were met. Additionally, all laws and regulations, especially in Argentina, include over regulations and statements that may further interfere with patient access to opioids. The prescription criteria were fully met by the state of Texas and all five countries. These results indicate that there is need to revise the existing laws and regulations in countries with opioid availability problems, and identify the potential barriers, which may be playing a significant role in the access to adequate treatment. Such review seeks to carefully consider all possible criteria, since partial resolution of legislative articles will not result in increased opioid availability.
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Affiliation(s)
- M H Liliana De Lima
- WHO/PAHO Liaison in Supportive Care, University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA.
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De Lima L, Bruera E. The Pan American Health Organization: its structure and role in the development of a palliative care program for Latin America and the Caribbean. J Pain Symptom Manage 2000; 20:440-8. [PMID: 11131262 DOI: 10.1016/s0885-3924(00)00216-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In recent years palliative care has emerged as a major public health care issue, both in developed and developing countries. The rising number of cancer deaths as a result of increased tobacco consumption, control of other diseases, lack of preventive programs, and the difficulties of accessing curative treatments in many countries have made palliative care and pain relief the appropriate, and in many cases, the only option for patients with advanced disease. The World Health Organization (WHO) and its Regional Office for the Americas, the Pan American Health Organization (PAHO), have promoted palliative care as a component of their cancer control program. Some health care workers and policy makers are not adequately informed about the role that intergovernmental agencies such as WHO and PAHO play in the health care field. This has led to confusion and, in some cases, misjudgment of the organization. This paper summarizes the structure and role of PAHO and, specifically, its participation in the development of a palliative care program for Latin America and the Caribbean. Many health care professionals, administrators, and policy makers are unaware of the organization 's objectives in this area and the tools available to assist in the implementation and development of national programs to care for patients with advanced cancer: The information in this paper is based on data found in the PAHO and WHO web sites, as well as other technical publications from different sources, including individuals not formally associated with WHO or PAHO.
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Affiliation(s)
- L De Lima
- WHO Collaborating Center in Supportive Care University of Texas M.D. Anderson Cancer Center Houston 77030, USA
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Affiliation(s)
- E Bruera
- Department of Symptom Control and Palliative Care, University of Texas, M.D. Anderson Cancer Center, Houston 77030, USA
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Abstract
Data on pain prevalence and severity were collected prospectively from advanced cancer patients as an integral part of two service evaluations. Six multidisciplinary palliative care teams working in Ireland formed the basis of one study and five teams based in the South of England were included in the second. A total of 695 cancer patients were referred and died in care in a minimum 6-month data collection period. Of these, 70% (486/695) were experiencing pain at referral to the services. After 2 weeks, there was a significant reduction (P < 0.0001) in the levels of pain experienced by patients, and no patient had overwhelming pain. The data emphasize that pain prevalence in advanced cancer patients cared for in the community is as high as that observed in other settings. Multidisciplinary palliative care teams are shown here to be effective in alleviating pain.
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Affiliation(s)
- I J Higginson
- Department of Palliative Care and Policy, King's College School of Medicine and Dentistry, London, United Kingdom
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De Lima L, Bruera E, Joranson DE, Vanegas G, Cepeda S, Quesada L, Wenk R, Pavajeau MC, Derio L, Montejo G, Castillo G, Ruiz F, Pupo AR, Carlés B, Paredes E, Schoeller T. Opioid availability in Latin America: the Santo Domingo report progress since the Declaration of Florianopolis. J Pain Symptom Manage 1997; 13:213-9. [PMID: 9136232 DOI: 10.1016/s0885-3924(96)00325-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The World Health Organization (WHO) has indicated that opioid analgesics are insufficiently available, particularly in developing countries, due to a variety of reasons, including legislative, educational, and policy issues. In its effort to promote the rational use of medical opioids and the adequate treatment of patients with cancer, WHO has sponsored a meeting of Latin American representatives every 2 years, which includes health professionals and government regulators. During March 24-27, 1996, a group of 86 representatives of cancer pain relief and palliative care programs from nine Latin American countries met in Santo Domingo under the auspices of the WHO Palliative Care Program for Latin America. For the first time since the First Latin American Meeting, government regulators were present to help address the issue of opioid availability from their perspective. During the meeting, issues pertaining to cancer pain, opioid availability, and palliative care were discussed. This report summarizes some of the events and presents a summary of the conclusions of an earlier meeting in 1994, as described in the Declaration of Florianopolis, and presents its follow-up, The Santo Domingo Report, generated following the 1996 meeting.
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Affiliation(s)
- L De Lima
- World Health Organization Palliative Care Program for Latin America, Santo Domingo, Dominican Republic
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Abstract
OBJECTIVES To provide a review of the problem of cancer pain and cancer pain management around the world. DATA SOURCES Review articles, World Health Organization reports, guidelines, and personal experience relating to international efforts in the relief of cancer pain. CONCLUSIONS Cancer pain is a worldwide problem that is not even addressed in most countries of the world because of limited options for cancer treatment and scare resources. Yet pain relief for many patients is possible in developing countries with international assistance and support. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses have the ability to advocate for the needs of patients with cancer throughout the world. Oncology nurses can work with nurses in developing countries to enhance pain management through support of existing programs, serving as volunteers, and recruitment of resources to assist nurses in these countries.
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Affiliation(s)
- P J Coyne
- Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond 23298-0007, USA
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