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Leiva-Vásquez O, Letelier LM, Rojas L, Viviani P, Castellano J, González A, Pérez-Cruz PE. Is Acetaminophen Beneficial in Patients With Cancer Pain Who are on Strong Opioids? A Randomized Controlled Trial. J Pain Symptom Manage 2023; 66:183-192.e1. [PMID: 37207788 DOI: 10.1016/j.jpainsymman.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/21/2023]
Abstract
CONTEXT Pain is common among cancer patients. The evidence recommends using strong opioids in moderate to severe cancer pain. No conclusive evidence supports the effectiveness of adding acetaminophen to patients with cancer pain who are already using this regime. OBJECTIVES To assess the analgesic efficacy of acetaminophen in hospitalized cancer patients with moderate to severe pain receiving strong opioids. METHODS In this randomized blinded clinical trial, hospitalized cancer patients with moderate or severe acute pain managed with strong opioids were randomized to acetaminophen or placebo. The primary outcome was pain intensity difference between baseline and 48 hours using the Visual Numeric Rating Scales (VNRS). Secondary outcomes included change in morphine equivalent daily dose (MEDD), and patients' perception of improved pain control. RESULTS Among 112 randomized patients, 56 patients received placebo, 56 acetaminophen. Mean (standard deviation [SD]) decrease in pain intensity (VNRS) at 48 hours were 2.7 (2.5) and 2.3 (2.3), respectively (95% Confidence Interval (CI) [-0.49; 1.32]; P = 0.37). Mean (SD) change in MEDD was 13.9 (33.0) mg/day and 22.4 (57.7), respectively (95% CI [-9.24; 26.1]; P = 0.35). The proportion of patients perceiving pain control improvement after 48 hours was 82% in the placebo and 80% in the acetaminophen arms (P = 0.81). CONCLUSION Among patients with cancer pain on strong opioid regime, acetaminophen may not improve pain control, or decrease total opioid use. These results add to the current evidence available suggesting not to use acetaminophen as an adjuvant for advanced cancer patients with moderate to severe cancer pain who are on strong opioids.
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Affiliation(s)
- Ofelia Leiva-Vásquez
- Sección Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Católica de Chile (O.L.V., P.E.P.), Santiago, Chile
| | - Luz M Letelier
- Departamento Medicina Interna, Facultad de Medicina (L.M.L., L.R.), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Rojas
- Departamento Medicina Interna, Facultad de Medicina (L.M.L., L.R.), Pontificia Universidad Católica de Chile, Santiago, Chile; Programa de Farmacología y Toxicología, Facultad de Medicina, Pontificia Universidad Católica de Chile (L.R., J.C., A.G.), Santiago, Chile
| | - Paola Viviani
- Departamento de Salud Pública, Facultad de Medicina (P.V.), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Joel Castellano
- Programa de Farmacología y Toxicología, Facultad de Medicina, Pontificia Universidad Católica de Chile (L.R., J.C., A.G.), Santiago, Chile
| | - Antonio González
- Programa de Farmacología y Toxicología, Facultad de Medicina, Pontificia Universidad Católica de Chile (L.R., J.C., A.G.), Santiago, Chile; Departamento de Hematología Oncología, Facultad de Medicina (A.G.), Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pedro E Pérez-Cruz
- Sección Medicina Paliativa, Facultad de Medicina, Pontificia Universidad Católica de Chile (O.L.V., P.E.P.), Santiago, Chile.
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Paal P, Brandstötter C, Elsner F, Lorenzl S, Osterbrink J, Stähli A. European interprofessional postgraduate curriculum in palliative care: A narrative synthesis of field interviews in the region of Middle, Eastern, and Southeastern Europe and Central and West Asia. Palliat Support Care 2022:1-10. [PMID: 36545761 DOI: 10.1017/s1478951522001651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES In 2018, a study was conducted in the Eastern and South-eastern Europe and Central Asia. National leaders of palliative care were asked to describe developments in postgraduate education in their region. They were asked whether the introduction of a European curriculum would be useful in their country. The aim was to explore the structures of postgraduate education at country level in order to define the barriers and opportunities. METHODS This is an ethnographic study based on semi-structured field interviews. A thematic analysis was chosen for data extraction and a narrative synthesis for the systematic presentation and critical discussion of the results. RESULTS Thirty-two interviews were recorded in 23 countries. The analysis revealed 4 main themes: (1) general barriers to access, (2) necessary to improve palliative care education, (3) palliative care core curriculum - the theoretical framework, and (4) challenges in implementation. These main themes were complemented by 19 subthemes. SIGNIFICANCE OF RESULTS Palliative care is understood as a universal idea, which in practice means accepting social pluralism and learning to respect unique individual needs. This makes teaching palliative care a very special task because there are no golden standards for dealing with each individual as they are. In theory, a European curriculum recommendation is useful to convince governments and other key stakeholders of the importance of postgraduate education. In practice, such a curriculum needs to be adapted to the constraints of health services and human resources. Validated quality assessment criteria for palliative care education are crucial to advance postgraduate education.
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Affiliation(s)
- Piret Paal
- WHO Collaborating Centre at the Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Cornelia Brandstötter
- WHO Collaborating Centre at the Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Frank Elsner
- Department of Palliative Medicine, RWTH Aachen University, Aachen, Germany
| | - Stefan Lorenzl
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
- Department of Neurology, Hospital Agatharied, Hausham, Germany
| | - Jürgen Osterbrink
- WHO Collaborating Centre at the Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
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Takahashi R, Miyashita M, Murakami Y, Oba MS. Trends in strong opioid prescription for cancer patients in Japan from 2010 to 2019: an analysis with large medical claims data. Jpn J Clin Oncol 2022; 52:1297-1302. [PMID: 35907780 DOI: 10.1093/jjco/hyac122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/14/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Consumption of opioids, essential drugs for pain relief, has seen rapid growth worldwide. In Japan, where total opioid consumption still remains low among developed countries, little is known about trends in the clinical patterns of opioids in terminally ill cancer patients. METHODS Patients who died of cancer from 2010 to 2019 were included in this study. Morphine, oxycodone, fentanyl, tapentadol, methadone and hydromorphone were examined as opioids for cancer pain. We calculated the prevalence of prescribed opioids prior to death by year and age group and the average opioid dose 30 days before death. RESULTS The total number of patients was 221 598. We found that the prescription prevalence of opioids increased from 60.8 to 65.9% (5.1%). Morphine was most prescribed in 2010 but had decreased prevalence (-9.0%) during the 10-year period. Oxycodone had the highest increase in prescription prevalence (13.7%), and fentanyl prevalence decreased (-4.9%). In the subgroup comparison, the prescription prevalence of opioids in the elderly was lower than that in the younger group; however, the increasing trend in the elderly was greater than that in the younger group. The percentage of patients prescribed low-dose opioids (<60 mg/day) during the 30 days before death increased by 4.9% and was the highest throughout the study period. CONCLUSION The prevalence of opioid prescriptions for terminally ill cancer patients has increased from 2010 to 2019 in Japan. The opioid-specific trends were similar to the global trend but differed by palliative care specialty.
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Affiliation(s)
- Richi Takahashi
- Department of Medical Statistics, Toho University Graduate School of Medicine, Tokyo, Japan.,Yokohama Cancer Chemotherapy & Palliative Care Support Division, Toda Medical Care Group, Kanagawa, Japan.,Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yoshitaka Murakami
- Department of Medical Statistics, Faculty of Medicine, Toda Medical Care Group, Toho University, Tokyo, Japan
| | - Mari S Oba
- Department of Clinical Data Science, Clinical Research & Education Promotion Division, National Center of Neurology and Psychiatry, Tokyo, Japan
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Ju C, Wei L, Man KKC, Wang Z, Ma TT, Chan AYL, Brauer R, Chui CSL, Chan EW, Jani YH, Hsia Y, Wong ICK, Lau WCY. Global, regional, and national trends in opioid analgesic consumption from 2015 to 2019: a longitudinal study. Lancet Public Health 2022; 7:e335-e346. [PMID: 35366408 DOI: 10.1016/s2468-2667(22)00013-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous studies have reported an extremely unbalanced global access to opioid analgesics. We aimed to determine contemporary trends and patterns of opioid analgesic consumption at the global, regional, and national levels. METHODS We analysed the global pharmaceutical sales data of 66 countries or regions from the IQVIA-Multinational Integrated Data Analysis System database on opioid analgesics between 2015 and 2019. Opioid analgesic consumption was measured in milligram morphine equivalent per 1000 inhabitants per day (MME per 1000/day). The global, regional, and national trend changes were estimated using linear regressions. Factors associated with consumption patterns and trend changes were explored in multivariable linear regression analyses. FINDINGS Overall opioid analgesic sales in the 66 countries or regions increased from 27·52 MME per 1000/day (16·63-45·54) in 2015 to 29·51 MME per 1000/day (17·85-48·79) in 2019 (difference per year 3·96%, 95% CI 0·26 to 7·80). Sales reduced yearly in North America (-12·84%; 95% CI -15·34 to -10·27) and Oceania (-2·96%; -4·20 to -1·70); increased in South America (28·69%; 7·18 to 54·53), eastern Europe (7·68%; 3·99 to 11·49), Asia (5·74%; 0·61 to 11·14), and western and central Europe (1·64%; 0·52 to 2·78); and did not differ in Africa or central America and the Caribbean. The global opioid consumption patterns were associated with country-level Human Development Index (p=0·040), cancer death rate excluding leukaemia (p=0·0072), and geographical location (p<0·0001). In 2019, opioid analgesic consumption ranged from 0·01 MME per 1000/day to 5·40 MME per 1000/day in the 17 countries and regions in the lowest consumption quartile, despite high income levels and cancer death rates in some of them. INTERPRETATION Global opioid analgesic consumption increased from 2015 to 2019. The trend changes were distinctive across regions, which could reflect the different actions in response to known issues of opioid use and misuse. Disparities in opioid analgesic consumption remained, indicating potential inadequate access to essential pain relief in countries with low consumption. FUNDING None.
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Affiliation(s)
- Chengsheng Ju
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Li Wei
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kenneth K C Man
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Zixuan Wang
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Tian-Tian Ma
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Adrienne Y L Chan
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Ruth Brauer
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
| | - Celine S L Chui
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Esther W Chan
- Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Groningen Research Institute of Pharmacy, Unit of Pharmacotherapy Epidemiology and Economics, University of Groningen, Groningen, Netherlands
| | - Yogini H Jani
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK
| | - Yingfen Hsia
- School of Pharmacy, Queen's University, Belfast, UK; St George's University of London, London, UK
| | - Ian C K Wong
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Wallis C Y Lau
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK; Laboratory of Data Discovery for Health (D24H), Hong Kong Science Park, Hong Kong Special Administrative Region, China; Centre for Medicines Optimisation Research and Education, University College London Hospitals NHS Foundation Trust, London, UK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
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Kutluk T, Ahmed F, Cemaloğlu M, Aydın B, Şengelen M, Kirazli M, Yurduşen S, Sullivan R, Harding R. Progress in palliative care for cancer in Turkey: a review of the literature. Ecancermedicalscience 2021; 15:1321. [PMID: 35047072 PMCID: PMC8723752 DOI: 10.3332/ecancer.2021.1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The demographic transition in Turkey is shifting the burden of diseases towards non-communicable diseases including cancer. Palliative care (PC) as a component of Universal Health Coverage assures patient and family-centred care provision throughout the spectrum of cancer. OBJECTIVES This study aimed to make a detailed evaluation of the progress achieved since the mid-90s and the current situation of cancer PC in Turkey. METHODS A literature review was conducted in PubMed, Scopus, Embase, ScienceDirect, Web of Science, Google Scholar, The Turkish Academic Network and Information Centre databases, Ministry of Health documents, Council of Higher Education's thesis 01/1995 to 07/2020. The information was categorised into the six domains: history of the cancer PC; law and regulations; education and research; opioid use; patient care and palliative centres; public awareness, psychosocial support and end of life ethics. RESULTS Of 27,489 studies, 331 met the inclusion criteria. The majority were published in the Turkish language and were journal articles. The findings showed that the development of PC in Turkey can be divided into three stages: early initiatives before 2000, the dissemination stage, 2000-2010 and the advanced stage after 2010. There is evidence of progress in terms of legal regulations, opioid use and number of PC services and research output. However, there is still a need for improvement in professional education, public awareness and end of life care. CONCLUSION There is evidence of progress, barriers and opportunities. However, bringing research into practice is needed for scale-up and integration of PC in cancer care in Turkey.
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Affiliation(s)
- Tezer Kutluk
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100 Ankara, Turkey
| | - Fahad Ahmed
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100 Ankara, Turkey
| | - Mustafa Cemaloğlu
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100 Ankara, Turkey
| | - Burça Aydın
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100 Ankara, Turkey
| | - Meltem Şengelen
- Department of Public Health, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey
| | - Meral Kirazli
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100 Ankara, Turkey
| | - Sema Yurduşen
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine and Cancer Institute, 06100 Ankara, Turkey
| | - Richard Sullivan
- King’s College London, Institute of Cancer Policy, Conflict & Health Research Group, London, UK
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King’s College London, London, UK
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Abu-Odah H, Molassiotis A, Liu J. Challenges on the provision of palliative care for patients with cancer in low- and middle-income countries: a systematic review of reviews. BMC Palliat Care 2020; 19:55. [PMID: 32321487 PMCID: PMC7178566 DOI: 10.1186/s12904-020-00558-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 04/06/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite the significant benefits of palliative care (PC) services for cancer patients, multiple challenges hinder the provision of PC services for these patients. Low- and middle-income countries (LMICs) are witnessing a sharp growth in the burden of non-communicable diseases. There is a significant gap between demand and supply of PC in LMICs in current health services. This review aims to synthesise evidence from previous reviews and deliver a more comprehensive mapping of the existing literature about personal, system, policy, and organisational challenges and possible facilitators on the provision of PC services for cancer patients in LMICs. METHODS A systematic review of reviews was performed following PRISMA guidelines. PubMed, EMBASE, SCOPUS, PsycINFO, Web of Sciences, CINAHL, and Cochrane Library databases were searched to identify review papers published between 2000 and 2018 that considered challenges and possible facilitators to PC provision. A modified socioecological model was used as a framework for analysing and summarising findings. RESULTS Fourteen reviews were included. The reviews varied in terms of aim, settings, and detail of the challenges and possible facilitators. The main challenges of personal and health care systems included knowledge deficits and misunderstandings from patients, families, the general public, and health care providers about PC; and inadequate number of trained workforce. Besides, limited physical infrastructure, insufficient drugs for symptom relief and lack of a comprehensive national plan for implementing PC were the core organisational and policy level challenges that were recognised. Furthermore, the main possible facilitators that were identified included provision of adequate training for health care providers and health education for patients, families and the general public to enhance their knowledge, beliefs, and attitudes to PC. Finally, involvement of policymakers and making drugs available for symptom relief should also be in place to improve the health care systems. CONCLUSIONS Understanding challenges to the provision of PC for people with cancer could help in the development of a PC pathway in LMICs. This knowledge could be used as a guide to develop an intervention programme to improve PC. Political influence and support are also required to ensure the sustainability and the provision of high-quality PC.
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Affiliation(s)
- Hammoda Abu-Odah
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Justina Liu
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Schofield G, Baker I, Bullock R, Clare H, Clark P, Willis D, Gannon C, George R. Palliative opioid use, palliative sedation and euthanasia: reaffirming the distinction. JOURNAL OF MEDICAL ETHICS 2020; 46:48-50. [PMID: 31221766 DOI: 10.1136/medethics-2018-105256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/08/2019] [Accepted: 05/12/2019] [Indexed: 06/09/2023]
Abstract
We read with interest the extended essay published from Riisfeldt and are encouraged by an empirical ethics article which attempts to ground theory and its claims in the real world. However, such attempts also have real-world consequences. We are concerned to read the paper's conclusion that clinical evidence weakens the distinction between euthanasia and normal palliative care prescribing. This is important. Globally, the most significant barrier to adequate symptom control in people with life-limiting illness is poor access to opioid analgesia. Opiophobia makes clinicians reluctant to prescribe and their patients reluctant to take opioids that might provide significant improvements in quality of life. We argue that the evidence base for the safety of opioid prescribing is broader than that presented, restricting the search to palliative care literature produces significant bias as safety experience and literature for opioids and sedatives exists in many fields. This is not acknowledged in the synthesis presented. By considering additional evidence, we reject the need for agnosticism and reaffirm that palliative opioid prescribing is safe. Second, palliative sedation in a clinical context is a poorly defined concept covering multiple interventions and treatment intentions. We detail these and show that continuous deep palliative sedation (CDPS) is a specific practice that remains controversial globally and is not considered routine practice. Rejecting agnosticism towards opioids and excluding CDPS from the definition of routine care allows the rejection of Riisfeldt's headline conclusion. On these grounds, we reaffirm the important distinction between palliative care prescribing and euthanasia in practice.
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Affiliation(s)
- Guy Schofield
- Centre for Ethics in Medicine, University of Bristol, Bristol, UK
- Ethics Committee, Association for Palliative Medicine of Great Britain and Ireland, Southampton, UK
| | - Idris Baker
- Ethics Committee, Association for Palliative Medicine of Great Britain and Ireland, Southampton, UK
- Swansea Bay University Health Board, Swansea, Wales
| | - Rachel Bullock
- Ethics Committee, Association for Palliative Medicine of Great Britain and Ireland, Southampton, UK
- Palliative Medicine, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Hannah Clare
- Ethics Committee, Association for Palliative Medicine of Great Britain and Ireland, Southampton, UK
| | - Paul Clark
- Ethics Committee, Association for Palliative Medicine of Great Britain and Ireland, Southampton, UK
- Rowcroft Hospice, Torquay, UK
| | - Derek Willis
- Ethics Committee, Association for Palliative Medicine of Great Britain and Ireland, Southampton, UK
- Chester Medical School, University of Chester Faculty of Medicine, Dentistry and Life Sciences, Chester, UK
| | - Craig Gannon
- Ethics Committee, Association for Palliative Medicine of Great Britain and Ireland, Southampton, UK
- Princess Alice Hospice, Esher, UK
| | - Rob George
- Ethics Committee, Association for Palliative Medicine of Great Britain and Ireland, Southampton, UK
- St Christopher's Hospice, London, UK
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Shen MJ, Prigerson HG, Ratshikana-Moloko M, Mmoledi K, Ruff P, Jacobson JS, Neugut AI, Amanfu J, Cubasch H, Wong M, Joffe M, Blanchard C. Illness Understanding and End-of-Life Care Communication and Preferences for Patients With Advanced Cancer in South Africa. J Glob Oncol 2019; 4:1-9. [PMID: 30241251 PMCID: PMC6223439 DOI: 10.1200/jgo.17.00160] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose The understanding of patients with cancer of their condition and their wishes regarding care as they approach end of life (EoL) have been studied more in high-income countries than in low- and middle-income countries (LMICs). Patients and Methods Data were analyzed from a cohort study (N = 221) of patients with advanced cancer who were recruited from a palliative care center in Soweto, South Africa (LMIC), between May 2016 and June 2017. Patients were asked about their understanding of their illness, estimated life expectancy, EoL care communication, and EoL care preferences. Results Only 13 patients (5.9%) acknowledged that they were terminally ill; nine patients (4.1%) estimated accurately that they had months, not years, left to live. A total of 216 patients (97.7%) reported that they had not had an EoL care discussion with their physician, and 170 patients (76.9%) did not want to know their prognosis even if the doctor knew it. Most patients preferred comfort care (72.9%; n = 161) to life-extending care (14.0%; n = 31), and did not want to be kept alive using extreme measures (80.5%; n = 178) or have their doctors do everything possible to extend their lives (78.3%; n = 173). Finally, 127 patients (57.5%) preferred to die at home, and 51 (23.1%) preferred to die in the hospital. Most patients (81.0%; n = 179) had funeral plans. Conclusion South African patients demonstrated less awareness of the fact that they were terminally ill, were less likely to have discussed their prognosis with their doctor, and more strongly preferred comfort care to life-extending EoL care than US and other LMIC patients in prior research. These differences highlight the need for culturally appropriate, patient-centered EoL care for South African patients with advanced cancer as well as to determine individual preferences and needs in all EoL settings.
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Affiliation(s)
- Megan Johnson Shen
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
| | - Holly G Prigerson
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
| | - Mpho Ratshikana-Moloko
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
| | - Keletso Mmoledi
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
| | - Paul Ruff
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
| | - Judith S Jacobson
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
| | - Alfred I Neugut
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
| | - Jamila Amanfu
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
| | - Herbert Cubasch
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
| | - Michelle Wong
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
| | - Maureen Joffe
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
| | - Charmaine Blanchard
- Megan Johnson Shen and Holly G. Prigerson, Weill Cornell Medical College; Judith S. Jacobson and Alfred I. Neugut, Columbia University, New York; Jamila Amanfu, Cornell University, Ithaca, NY; Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Michelle Wong, Maureen Joffe, and Charmaine Blanchard, University of Witwatersrand; and Michelle Wong, Chris Hani Baragwanath Academic Hospital; and Mpho Ratshikana-Moloko, Keletso Mmoledi, Paul Ruff, Herbert Cubasch, Maureen Joffe, and Charmaine Blanchard, Wits Health Consortium, Johannesburg, South Africa
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9
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Esmaili BE, Stewart KA, Masalu NA, Schroeder KM. Qualitative Analysis of Palliative Care for Pediatric Patients With Cancer at Bugando Medical Center: An Evaluation of Barriers to Providing End-of-Life Care in a Resource-Limited Setting. J Glob Oncol 2019; 4:1-10. [PMID: 30084714 PMCID: PMC6223406 DOI: 10.1200/jgo.17.00047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Palliative care remains an urgent, neglected need in the developing world. Global disparities in end-of-life care for children, such as those with advanced cancers, result from barriers that are complex and largely unstudied. This study describes these barriers at Bugando Medical Center, one of three consultant hospitals in Tanzania, to identify areas for palliative care development suitable to this context. Methods In-depth interviews were conducted with 20 caregivers of pediatric patients with cancer and 14 hospital staff involved in pediatric end-of-life care. This was combined with 1 month of participant observation through direct clinical care of terminally ill pediatric patients. Results Data from interviews as well as participant observation revealed several barriers to palliative care: financial, infrastructure, knowledge and cultural (including perceptions of pediatric pain), and communication challenges. Although this study focused on barriers, what also emerged were the unique advantages of end-of-life care in this setting, including community cohesiveness and strong faith background. Conclusion This study provides a unique but focused description of barriers to palliative care common in a low-resource setting, extending beyond resource needs. This multidisciplinary qualitative approach combined interviews with participant observation, providing a deeper understanding of the logistical and cultural challenges in this setting. This new understanding will inform the design of more effective-and more appropriate-palliative care policies for young patients with cancer in the developing world.
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Affiliation(s)
- B Emily Esmaili
- B. Emily Esmaili and Kearsley A. Stewart, Duke University; Kristin M. Schroeder, Duke University Medical Center, Durham, NC; and Nestory A. Masalu, Bugando Medical Center, Mwanza, Tanzania
| | - Kearsley A Stewart
- B. Emily Esmaili and Kearsley A. Stewart, Duke University; Kristin M. Schroeder, Duke University Medical Center, Durham, NC; and Nestory A. Masalu, Bugando Medical Center, Mwanza, Tanzania
| | - Nestory A Masalu
- B. Emily Esmaili and Kearsley A. Stewart, Duke University; Kristin M. Schroeder, Duke University Medical Center, Durham, NC; and Nestory A. Masalu, Bugando Medical Center, Mwanza, Tanzania
| | - Kristin M Schroeder
- B. Emily Esmaili and Kearsley A. Stewart, Duke University; Kristin M. Schroeder, Duke University Medical Center, Durham, NC; and Nestory A. Masalu, Bugando Medical Center, Mwanza, Tanzania
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10
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Jennings N, Chambaere K, Macpherson CC, Deliens L, Cohen J. Main themes, barriers, and solutions to palliative and end-of-life care in the English-speaking Caribbean: a scoping review. Rev Panam Salud Publica 2018; 42:e15. [PMID: 31093044 PMCID: PMC6385807 DOI: 10.26633/rpsp.2018.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 08/09/2017] [Indexed: 11/24/2022] Open
Abstract
Objectives To identify common themes documented in the literature on palliative and end-of-life care in English-speaking Caribbean small island developing states (SIDS), and to describe barriers, improvement strategies, and suggested ways forward. Methods In 2015, we conducted a systematic scoping review of relevant literature identified through the MEDLINE and Web of Science databases. We supplemented that with searches of other electronic and hard-copy sources to map key concepts and summarize themes. Results Primary data and other literature from and about English-speaking Caribbean nations are relatively scarce. The available literature offers an overview of the existing situation in the region and explores why palliative and end-of-life care is limited there. This review identified barriers in five main areas recurring across this literature: i) culture and attitudes of health care providers, patients, and those close to them towards terminal illness and death; ii) opioid availability and use; iii) limited development of palliative care services; iv) unmet palliative care needs; and v) limited research on palliative or end-of-life care. Conclusions Our analysis helps to document the need for palliative and end-of-life care in Caribbean SIDS and highlights suggestions for moving forward with related practice, policy, and research.
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Affiliation(s)
- Nicholas Jennings
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Kenneth Chambaere
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Cheryl C Macpherson
- Bioethics Department, St. George's University School of Medicine and Windward Islands Research and Education Foundation, St. George's, Grenada
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
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11
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Cleary JF, Maurer MA. Pain and Policy Studies Group: Two Decades of Working to Address Regulatory Barriers to Improve Opioid Availability and Accessibility Around the World. J Pain Symptom Manage 2018; 55:S121-S134. [PMID: 28801005 DOI: 10.1016/j.jpainsymman.2017.03.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 03/03/2017] [Indexed: 11/23/2022]
Abstract
For two decades, the Pain & Policy Studies Group (PPSG), a global research program at the University of Wisconsin Carbone Cancer Center, has worked passionately to fulfill its mission of improving pain relief by achieving balanced access to opioids worldwide. PPSG's early work highlighted the conceptual framework of balance leading to the development of the seminal guidelines and criteria for evaluating opioid policy. It has collaborated at the global level with United Nations agencies to promote access to opioids and has developed a unique model of technical assistance to help national governments assess regulatory barriers to essential medicines for pain relief and amend existing or develop new legislation that facilitates appropriate and adequate opioid prescribing according to international standards. This model was initially applied in regional workshops and individual country projects and then adapted for PPSG's International Pain Policy Fellowship, which provides long-term mentoring and support for several countries simultaneously. The PPSG disseminates its work online in several ways, including an extensive Web site, news alerts, and through several social media outlets. PPSG has become the focal point for expertise on policy governing drug control and medicine and pharmacy practice related to opioid availability and pain relief.
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Affiliation(s)
- James F Cleary
- Pain & Policy Studies Group, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, Madison, Wisconsin, USA; World Health Organization Collaborating Center for Pain Policy and Palliative Care, Madison, Wisconsin, USA
| | - Martha A Maurer
- Pain & Policy Studies Group, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, Madison, Wisconsin, USA; World Health Organization Collaborating Center for Pain Policy and Palliative Care, Madison, Wisconsin, USA.
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12
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Centeno C, Garralda E, Carrasco JM, den Herder-van der Eerden M, Aldridge M, Stevenson D, Meier DE, Hasselaar J. The Palliative Care Challenge: Analysis of Barriers and Opportunities to Integrate Palliative Care in Europe in the View of National Associations. J Palliat Med 2017; 20:1195-1204. [PMID: 28509657 DOI: 10.1089/jpm.2017.0039] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Palliative care (PC) development is diverse and lacks an effective integration into European healthcare systems. This article investigates levels of integrated PC in European countries. METHODS A qualitative survey was undertaken for the 2013 EAPC Atlas of PC in Europe with boards of national associations, eliciting opinions on opportunities for, and barriers to, PC development. ANALYSIS Barriers and opportunities directly related to PC integration were identified and analyzed thematically according (1) to the dimensions of the World Health Organization (WHO) public health model and (2) by the degree of service provision in each country. A frequency analysis of dimensions and level of provision was also conducted. RESULTS In total, 48/53 (91%) European countries responded to the survey. A total of 43 barriers and 65 opportunities were identified as being related to PC integration. Main barriers were (1) lack of basic PC training, with a particular emphasis on the absence of teaching at the undergraduate level; (2) lack of official certification for professionals; (3) lack of coordination and continuity of care for users and providers; (4) lack of PC integration for noncancer patients; (5) absence of PC from countries' regulatory frameworks; and (6) unequal laws or regulations pertaining to PC within countries. Innovations in education and new regulatory frameworks were identified as main opportunities in some European countries, in addition to opportunities around the implementation of PC in home care, nursing home settings, and the earlier integration of PC into patients' continuum of care. With increasing provision of services, more challenges for the integration are detected (p < 0.005). CONCLUSION A set of barriers and opportunities to PC integration has been identified across Europe, by national associations, offering a barometer against which to check the challenge of integration across countries.
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Affiliation(s)
- Carlos Centeno
- 1 ATLANTES Research Programme, Institute for Culture and Society, University of Navarra , Pamplona, Spain .,2 Navarra Institute for Health Research (IdiSNA) , Pamplona, Spain
| | - Eduardo Garralda
- 1 ATLANTES Research Programme, Institute for Culture and Society, University of Navarra , Pamplona, Spain .,2 Navarra Institute for Health Research (IdiSNA) , Pamplona, Spain
| | - José Miguel Carrasco
- 1 ATLANTES Research Programme, Institute for Culture and Society, University of Navarra , Pamplona, Spain .,2 Navarra Institute for Health Research (IdiSNA) , Pamplona, Spain
| | | | - Melissa Aldridge
- 4 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
| | - David Stevenson
- 5 Department of Health Policy, Vanderbilt University School of Medicine , Nashville, Tennessee
| | - Diane E Meier
- 6 Center to Advance Palliative Care and Icahn School of Medicine at Mount Sinai , New York, New York
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13
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14
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Abstract
Purpose Access to opioids for pain control is recognized as an urgent issue in low- and middle-income countries. Here we report temporal and regional trends in morphine use in Kerala, India. Methods Oral morphine use data for the State of Kerala (2012 to 2015) was used to describe temporal trends, regional variation, and provider characteristics. Total morphine use was calculated for each district of Kerala to derive an annual per capita use rate (milligrams per capita). Each provider was classified as government, private, nongovernment organization (NGO), or NGO partnership. Results Oral morphine use for Kerala was 1.32 mg/capita and increased over the study period 27% (from 1.23 mg/capita to 1.56 mg/capita). There was substantial variation in morphine use across districts (range, 0.49 mg/capita to 2.97 mg/capita; six-fold difference). This variation increased over time (19-fold difference in 2015). In 2015, 31% of morphine providers (51 of 167) were government institutions; they delivered 48% of total morphine in Kerala. Corresponding data for other providers are private institutions, 23% of centers and 13% of morphine; NGOs, 41% of centers and 34% of morphine; and NGO partnerships, 5% of centers and 4% of morphine. From 2012 to 2015, the total number of centers increased by 35%, from 124 to 167. Conclusion Oral morphine use has increased over time in Kerala but remains substantially lower than estimated need. There is significant geographic variation of use. Efforts are needed to improve palliative care in Kerala and to reduce regional disparities in access to opioids.
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Affiliation(s)
- M R Rajagopal
- M.R. Rajagopal, Trivandrum Institute of Palliative Sciences and Pallium India, Trivandrum, India; and Safiya Karim and Christopher M. Booth, Queen's University, Kingston, Ontario, Canada
| | - Safiya Karim
- M.R. Rajagopal, Trivandrum Institute of Palliative Sciences and Pallium India, Trivandrum, India; and Safiya Karim and Christopher M. Booth, Queen's University, Kingston, Ontario, Canada
| | - Christopher M Booth
- M.R. Rajagopal, Trivandrum Institute of Palliative Sciences and Pallium India, Trivandrum, India; and Safiya Karim and Christopher M. Booth, Queen's University, Kingston, Ontario, Canada
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15
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LeBaron VT, Palat G, Sinha S, Chinta SK, Jamima BJB, Pilla UL, Podduturi N, Shapuram Y, Vennela P, Rapelli V, Lalani Z, Beck SL. Recommendations to Support Nurses and Improve the Delivery of Oncology and Palliative Care in India. Indian J Palliat Care 2017; 23:188-198. [PMID: 28503040 PMCID: PMC5412128 DOI: 10.4103/ijpc.ijpc_153_16] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Nurses in India often practice in resource-constrained settings and care for cancer patients with high symptom burden yet receive little oncology or palliative care training. AIM The aim of this study is to explore challenges encountered by nurses in India and offer recommendations to improve the delivery of oncology and palliative care. METHODS Qualitative ethnography. SETTING The study was conducted at a government cancer hospital in urban South India. SAMPLE Thirty-seven oncology/palliative care nurses and 22 others (physicians, social workers, pharmacists, patients/family members) who interact closely with nurses were included in the study. DATA COLLECTION Data were collected over 9 months (September 2011- June 2012). Key data sources included over 400 hours of participant observation and 54 audio-recorded semi-structured interviews. ANALYSIS Systematic qualitative analysis of field notes and interview transcripts identified key themes and patterns. RESULTS Key concerns of nurses included safety related to chemotherapy administration, workload and clerical responsibilities, patients who died on the wards, monitoring family attendants, and lack of supplies. Many participants verbalized distress that they received no formal oncology training. CONCLUSIONS Recommendations to support nurses in India include: prioritize safety, optimize role of the nurse and explore innovative models of care delivery, empower staff nurses, strengthen nurse leadership, offer relevant educational programs, enhance teamwork, improve cancer pain management, and engage in research and quality improvement projects. Strong institutional commitment and leadership are required to implement interventions to support nurses. Successful interventions must account for existing cultural and professional norms and first address safety needs of nurses. Positive aspects from existing models of care delivery can be adapted and integrated into general nursing practice.
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Affiliation(s)
- Virginia T LeBaron
- Department of Acute and Specialty Care, University of Virginia School of Nursing, Charlottesville, VA, USA
| | - Gayatri Palat
- Palliative Access Programme, Two Worlds Cancer Collaboration-INCTR, Canada.,Department of Pain and Palliative Care, South Indian Cancer Hospital, India
| | - Sudha Sinha
- Department of Medical Oncology, South Indian Cancer Hospital, India.,Department of Pediatrics, South Indian Cancer Hospital, India
| | | | | | | | | | - Yadamma Shapuram
- Department of Pain and Palliative Care, South Indian Cancer Hospital, India
| | - Padma Vennela
- Department of Pain and Palliative Care, South Indian Cancer Hospital, India
| | - Vineela Rapelli
- Department of Pain and Palliative Care, South Indian Cancer Hospital, India
| | - Zahra Lalani
- Palliative Access Programme, Two Worlds Cancer Collaboration-INCTR, Canada.,Vancouver Hospice Society, British Columbia Cancer Agency, Canada
| | - Susan L Beck
- Division of Acute and Chronic Care, University of Utah College of Nursing, Salt Lake City, Utah, USA
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16
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Cheung CW, Choi SW, Wong SSC, Lee Y, Irwin MG. Changes in Prevalence, Outcomes, and Help-seeking Behavior of Chronic Pain in an Aging Population Over the Last Decade. Pain Pract 2016; 17:643-654. [PMID: 27735140 DOI: 10.1111/papr.12496] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 06/07/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Chronic pain is expected to increase as the population ages. This study aimed to investigate the changes in prevalence, patterns, and help-seeking behavior of chronic pain and prevalence of neuropathic pain of an aging population in Hong Kong. METHODS A cross-sectional, telephone interview with a structured questionnaire was conducted in a randomly selected sample of adults with acute or chronic pain of any kind in the general population to estimate the prevalence of chronic and neuropathic pain, and to describe sociodemographics and help-seeking behavior. Results were compared with a similar study conducted in 1999. RESULTS Totally, 1,570 people were interviewed. Chronic pain was experienced by 28.7% of all respondents, compared to 10.8% in 1999. Joint (45.5%), muscle (27.1%), and back (25.2%) pain were the most common, similar to findings in 1999. Of those with chronic pain, 83.1% reported pain in more than one body site (63.4% in 1999, P = 0.0023). More respondents reported their average pain as being intense (51.57% vs. 33.0% in 2013 and 1999, respectively, P = 0.0098). A downward trend of respondents taking medications for chronic pain (34.9% in 2013 vs. 47.6% in 1999, P = 0.019) was seen. Neuropathic pain was present in 9.03% of the population and 14.7% of chronic pain sufferers. CONCLUSION The prevalence of neuropathic pain in Hong Kong is high and is described here for the first time. The number of chronic pain sufferers has tripled in the past decade. Significant changes in the patterns and help- seeking behavior of chronic pain sufferers are also seen.
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Affiliation(s)
- Chi Wai Cheung
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, The University of Hong Kong, Hong Kong, China.,Department of Anaesthesiology, Queen Mary Hospital, Hong Kong, China.,Research Centre of Heart, Brain, Hormone & Healthy Aging, The University of Hong Kong, Hong Kong, China
| | - Siu Wai Choi
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, The University of Hong Kong, Hong Kong, China
| | - Stanley Sau Ching Wong
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, The University of Hong Kong, Hong Kong, China
| | - Yvonne Lee
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, The University of Hong Kong, Hong Kong, China
| | - Michael Garnet Irwin
- Laboratory and Clinical Research Institute for Pain, Department of Anaesthesiology, The University of Hong Kong, Hong Kong, China.,Department of Anaesthesiology, Queen Mary Hospital, Hong Kong, China.,Research Centre of Heart, Brain, Hormone & Healthy Aging, The University of Hong Kong, Hong Kong, China
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17
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Berterame S, Erthal J, Thomas J, Fellner S, Vosse B, Clare P, Hao W, Johnson DT, Mohar A, Pavadia J, Samak AKE, Sipp W, Sumyai V, Suryawati S, Toufiq J, Yans R, Mattick RP. Use of and barriers to access to opioid analgesics: a worldwide, regional, and national study. Lancet 2016; 387:1644-56. [PMID: 26852264 DOI: 10.1016/s0140-6736(16)00161-6] [Citation(s) in RCA: 377] [Impact Index Per Article: 47.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Despite opioid analgesics being essential for pain relief, use has been inadequate in many countries. We aim to provide up-to-date worldwide, regional, and national data for changes in opioid analgesic use, and to analyse the relation of impediments to use of these medicines. METHODS We calculated defined daily doses for statistical purposes (S-DDD) per million inhabitants per day of opioid analgesics worldwide and for regions and countries from 2001 to 2013, and we used generalised estimating equation analysis to assess longitudinal change in use. We compared use data against the prevalence of some health disorders needing opioid use. We surveyed 214 countries or territories about impediments to availability of these medicines, and used regression analyses to establish the strength of associations between impediments and use. FINDINGS The S-DDD of opioid analgesic use more than doubled worldwide between 2001-03 and 2011-13, from 1417 S-DDD (95% CI -732 to 3565; totalling about 3.01 billion defined daily doses per annum) to 3027 S-DDD (-1162 to 7215; totalling about 7.35 billion defined daily doses per annum). Substantial increases occurred in North America (16,046 S-DDD [95% CI 4032-28,061] to 31,453 S-DDD [8121-54,785]), western and central Europe (3079 S-DDD [1274-4883] to 9320 S-DDD [3969-14,672]), and Oceania (2275 S-DDD [763-3787] to 9136 S-DDD [2508-15,765]). Countries in other regions have shown no substantial increase in use. Impediments to use included an absence of training and awareness in medical professionals, fear of dependence, restricted financial resources, issues in sourcing, cultural attitudes, fear of diversion, international trade controls, and onerous regulation. Higher number of impediments reported was significantly associated with lower use (unadjusted incidence rate ratio 0.39 [95% CI 0.29-0.52]; p<0.0001), but not when adjusted for gross domestic product and human development index (0.91 [0.73-1.14]; p=0.4271). INTERPRETATION Use of opioid analgesics has increased, but remains low in Africa, Asia, Central America, the Caribbean, South America, and eastern and southeastern Europe. Identified impediments to use urgently need to be addressed by governments and international agencies. FUNDING International Narcotics Control Board, UN.
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Affiliation(s)
- Stefano Berterame
- Secretariat of the International Narcotics Control Board, Vienna International Centre, Vienna, Austria.
| | - Juliana Erthal
- Secretariat of the International Narcotics Control Board, Vienna International Centre, Vienna, Austria
| | - Johny Thomas
- Secretariat of the International Narcotics Control Board, Vienna International Centre, Vienna, Austria
| | - Sarah Fellner
- Secretariat of the International Narcotics Control Board, Vienna International Centre, Vienna, Austria
| | - Benjamin Vosse
- Secretariat of the International Narcotics Control Board, Vienna International Centre, Vienna, Austria
| | - Philip Clare
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Wei Hao
- International Narcotics Control Board, Vienna International Centre, Vienna, Austria; Psychiatry, Mental Health Institute, Central South University, Changsha, China
| | - David T Johnson
- International Narcotics Control Board, Vienna International Centre, Vienna, Austria
| | - Alejandro Mohar
- International Narcotics Control Board, Vienna International Centre, Vienna, Austria; Unidad de Epidemiología, Instituto Nacional de Cancerología, Instituto de Biomédicas, Universidad Nacional Autónoma de México, Tlalpan, Distrito Federal, Mexico
| | - Jagjit Pavadia
- International Narcotics Control Board, Vienna International Centre, Vienna, Austria
| | | | - Werner Sipp
- International Narcotics Control Board, Vienna International Centre, Vienna, Austria
| | - Viroj Sumyai
- International Narcotics Control Board, Vienna International Centre, Vienna, Austria; Association of Southeast Asian Nations Institute for Health Development, Mahidol University, Salaya, Nakhonphathom, Thailand
| | - Sri Suryawati
- International Narcotics Control Board, Vienna International Centre, Vienna, Austria; Division of Medicine Policy and Management, Department of Pharmacology and Therapeutics, Faculty of Medicine, GadjahMada University, Yogyakarta, Indonesia
| | - Jallal Toufiq
- International Narcotics Control Board, Vienna International Centre, Vienna, Austria; Faculty of Medicine, University Mohammed V, Rabat, Morocco; Hôpital Universitaire Psychiatrique Arrazi, Salé, Morocco
| | - Raymond Yans
- International Narcotics Control Board, Vienna International Centre, Vienna, Austria
| | - Richard P Mattick
- International Narcotics Control Board, Vienna International Centre, Vienna, Austria; National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Affiliation(s)
- James F Cleary
- Pain and Policy Studies Group, University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
| | - Asra Husain
- Pain and Policy Studies Group, University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Martha Maurer
- Pain and Policy Studies Group, University of Wisconsin Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
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Odonkor CA, Osei-Bonsu E, Tetteh O, Haig A, Mayer RS, Smith TJ. Minding the Gaps in Cancer Pain Management Education: A Multicenter Study of Clinical Residents and Fellows in a Low- Versus High-Resource Setting. J Glob Oncol 2016; 2:387-396. [PMID: 28717725 PMCID: PMC5493248 DOI: 10.1200/jgo.2015.003004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Inadequate pain management training has been reported as a major cause of undertreatment of cancer pain. Yet, past research has not comprehensively compared the quality of cancer pain management education among physicians in training in high-resource countries (HRCs) with those in low-resource countries (LRCs). The purpose of this study was to examine and compare gaps in cancer pain management education among physician trainees in an HRC (United States) versus an LRC (Ghana). Methods A cross section of physicians at four major academic medical centers completed surveys about the adequacy of cancer pain training. Participation in the study was completely voluntary, and paper or online surveys were completed anonymously. Results The response rate was 60% (N = 120). Major gaps were identified in cancer pain management education across the spectrum of medical school training. Training was rated as inadequate (by approximately 80% of trainees), although approximately 10% more trainees in HRCs versus LRCs felt this way; 35% said residency training was inadequate in both settings; and 50% in LRCs versus 44% in HRCs said fellowship training was less than good. On the basis of the lowest group means, the three key areas of perceived deficits included interventional pain procedures (2.34 ± 1.12), palliative care interventions (2.39 ± 1.12), and managing procedural and postoperative pain (2.94 ± 0.97), with significant differences in the distribution of deficits in 15 cancer-pain competencies between LRCs and HRCs (P < .05). Conclusion This study identifies priority areas that could be targeted synergistically by LRCs and HRCs to advance cancer care globally. The findings underscore differential opportunities to broaden and improve competencies in cancer pain management via exchange training, in which physicians from HRCs spend time in LRCs and vice versa.
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Affiliation(s)
- Charles Amoatey Odonkor
- , , and , Johns Hopkins University School of Medicine, Baltimore, MD; , Komfo Anokye Teaching Hospital, Kumasi; and , Korle-Bu Teaching Hospital, Accra, Ghana; and , University of Michigan-Ann Arbor, Ann Arbor, MI
| | - Ernest Osei-Bonsu
- , , and , Johns Hopkins University School of Medicine, Baltimore, MD; , Komfo Anokye Teaching Hospital, Kumasi; and , Korle-Bu Teaching Hospital, Accra, Ghana; and , University of Michigan-Ann Arbor, Ann Arbor, MI
| | - Oswald Tetteh
- , , and , Johns Hopkins University School of Medicine, Baltimore, MD; , Komfo Anokye Teaching Hospital, Kumasi; and , Korle-Bu Teaching Hospital, Accra, Ghana; and , University of Michigan-Ann Arbor, Ann Arbor, MI
| | - Andy Haig
- , , and , Johns Hopkins University School of Medicine, Baltimore, MD; , Komfo Anokye Teaching Hospital, Kumasi; and , Korle-Bu Teaching Hospital, Accra, Ghana; and , University of Michigan-Ann Arbor, Ann Arbor, MI
| | - Robert Samuel Mayer
- , , and , Johns Hopkins University School of Medicine, Baltimore, MD; , Komfo Anokye Teaching Hospital, Kumasi; and , Korle-Bu Teaching Hospital, Accra, Ghana; and , University of Michigan-Ann Arbor, Ann Arbor, MI
| | - Thomas J Smith
- , , and , Johns Hopkins University School of Medicine, Baltimore, MD; , Komfo Anokye Teaching Hospital, Kumasi; and , Korle-Bu Teaching Hospital, Accra, Ghana; and , University of Michigan-Ann Arbor, Ann Arbor, MI
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20
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Larjow E, Papavasiliou E, Payne S, Scholten W, Radbruch L. A Systematic Content Analysis of Policy Barriers Impeding Access to Opioid Medication in Central and Eastern Europe: Results of ATOME. J Pain Symptom Manage 2016; 51:99-107. [PMID: 26386186 DOI: 10.1016/j.jpainsymman.2015.08.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 08/08/2015] [Accepted: 08/20/2015] [Indexed: 11/28/2022]
Abstract
CONTEXT Reliable access to opioid medication is critical to delivering effective pain management, adequate treatment of opioid dependence, and quality palliative care. However, more than 80% of the world population is estimated to be inadequately treated for pain because of difficulties in accessing opioids. Although barriers to opioid access are primarily associated with restrictive laws, regulations, and licensing requirements, a key problem that significantly limits opioid access relates to policy constraints. OBJECTIVES To identify and explore policy barriers to opioid access in 12 Eastern and Central European countries involved in the Access to Opioid Medication in Europe project, funded by the European Community's Seventh Framework (FP7/2007-2013, no. 222994) Programme. METHODS A systematic content analysis of texts retrieved from documents (e.g., protocols of national problem analyses, strategic planning worksheets, and executive summaries) compiled, reviewed, approved, and submitted by either the Access to Opioid Medication in Europe consortium or the national country teams (comprising experts in pain management, harm reduction, and palliative care) between September 2011 and April 2014 was performed. RESULTS Twenty-five policy barriers were identified (e.g., economic crisis, bureaucratic issues, lack of training initiatives, stigma, and discrimination), classified under four predetermined categories (financial/economic aspects and governmental support, formularies, education and training, and societal attitudes). Key barriers related to issues of funding allocation, affordability, knowledge, and fears associated with opioids. CONCLUSION Reducing barriers and improving access to opioids require policy reform at the governmental level with a set of action plans being formulated and concurrently implemented and aimed at different levels of social, education, and economic policy change.
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Affiliation(s)
- Eugenia Larjow
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Evangelia Papavasiliou
- International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom
| | - Sheila Payne
- International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom.
| | | | - Lukas Radbruch
- Palliative Care Centre, Malteser Hospital Bonn/Rhein-Sieg, Bonn, Germany
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21
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Cherny NI. ESMO gave me a chance to help make a difference: a personal reflection on the occasion of receiving the 2015 ESMO Award. ESMO Open 2016; 1:e000061. [PMID: 27843614 PMCID: PMC5070249 DOI: 10.1136/esmoopen-2016-000061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/08/2016] [Indexed: 11/25/2022] Open
Abstract
On the occasion of receiving the ESMO 2015, Prof Nathan Cherny reflects on the potential of the individual clinician to address issues of consequence on a wider scale through the auspices of a professional medical society. He describes his 20 year relationship with ESMO illustrating the potential of harnessing the power of ESMO to influence care, professional behaviours and distributional justice in the provision of care. He urges oncologists to be inspired by the credos that he was nurtured on emphasising professional and personal integrity and the audacity to push boundaries.
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Affiliation(s)
- Nathan I Cherny
- Department of Medical Oncology , Shaare Zedek Medical Center , Jerusalem , Israel
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22
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Vranken MJM, Lisman JA, Mantel-Teeuwisse AK, Jünger S, Scholten W, Radbruch L, Payne S, Schutjens MHDB. Barriers to access to opioid medicines: a review of national legislation and regulations of 11 central and eastern European countries. Lancet Oncol 2016; 17:e13-22. [DOI: 10.1016/s1470-2045(15)00365-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/07/2015] [Accepted: 09/21/2015] [Indexed: 01/09/2023]
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23
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Vranken MJM, Mantel-Teeuwisse AK, Jünger S, Radbruch L, Lisman J, Scholten W, Payne S, Lynch T, Schutjens MHDB. Legal barriers in accessing opioid medicines: results of the ATOME quick scan of national legislation of eastern European countries. J Pain Symptom Manage 2014; 48:1135-44. [PMID: 24780184 DOI: 10.1016/j.jpainsymman.2014.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 02/11/2014] [Accepted: 04/02/2014] [Indexed: 11/23/2022]
Abstract
CONTEXT Overregulation of controlled medicines is one of the factors contributing to limited access to opioid medicines. OBJECTIVES The purpose of this study was to identify legal barriers to access to opioid medicines in 12 Eastern European countries participating in the Access to Opioid Medication in Europa project, using a quick scan method. METHODS A quick scan method to identify legal barriers was developed focusing on eight different categories of barriers. Key experts in 12 European countries were requested to send relevant legislation. Legislation was quick scanned using World Health Organization guidelines. Overly restrictive provisions and provisions that contain stigmatizing language and incorrect definitions were identified. The selected provisions were scored into two categories: 1) barrier and 2) uncertain, and reviewed by two authors. A barrier was recorded if both authors agreed the selected provision to be a barrier (Category 1). RESULTS National legislation was obtained from 11 of 12 countries. All 11 countries showed legal barriers in the areas of prescribing (most frequently observed barrier). Ten countries showed barriers in the areas of dispensing and showed stigmatizing language and incorrect use of definitions in their legislation. Most barriers were identified in the legislation of Bulgaria, Greece, Lithuania, Serbia, and Slovenia. The Cypriot legislation showed the fewest total number of barriers. CONCLUSION The selected countries have in common as main barriers prescribing and dispensing restrictions, the use of stigmatizing language, and incorrect use of definitions. The practical impact of these barriers identified using a quick scan method needs to be validated by other means.
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Affiliation(s)
- Marjolein J M Vranken
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Aukje K Mantel-Teeuwisse
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands.
| | - Saskia Jünger
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany; Centre for Palliative Care, Malteser Hospital Bonn, Bonn, Germany
| | - John Lisman
- Lisman Legal Life sciences, Nieuwerbrug, The Netherlands
| | - Willem Scholten
- Consultant, Medicines and Controlled Substances, Lopik, The Netherlands
| | - Sheila Payne
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Tom Lynch
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Marie-Hélène D B Schutjens
- Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands; Schutjens de Bruin, Tilburg, The Netherlands
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Steedman MR, Hughes-Hallett T, Knaul FM, Knuth A, Shamieh O, Darzi A. Innovation Can Improve And Expand Aspects Of End-Of-Life Care In Low- And Middle-Income Countries. Health Aff (Millwood) 2014; 33:1612-9. [DOI: 10.1377/hlthaff.2014.0379] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Mark R. Steedman
- Mark R. Steedman ( ) is policy fellow for the End of Life Care Forum at the World Innovation Summit for Health (WISH), Qatar Foundation, and Global Health Programme manager of the Institute of Global Health Innovation, Imperial College London, in the United Kingdom
| | - Thomas Hughes-Hallett
- Thomas Hughes-Hallett is chair of the End of Life Care Forum at WISH, Qatar Foundation, and executive chair of the Institute of Global Health Innovation, Imperial College London
| | - Felicia Marie Knaul
- Felicia Marie Knaul is a member of the End of Life Care Forum at WISH, Qatar Foundation; founding president of Tómatelo a Pecho AC; senior economist for the Mexican Health Foundation, in Mexico City; director of the Harvard Global Equity Initiative, Harvard University; and an associate professor at Harvard Medical School, in Boston, Massachusetts
| | - Alexander Knuth
- Alexander Knuth is medical director at the National Center for Cancer Care and Research, in Doha, Qatar
| | - Omar Shamieh
- Omar Shamieh is chair of the Department of Palliative Care at King Hussein Cancer Center, in Amman, Jordan
| | - Ara Darzi
- Ara Darzi is executive chair of WISH, Qatar Foundation, and director of the Institute of Global Health Innovation, Imperial College London
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25
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Hastie BA, Gilson AM, Maurer MA, Cleary JF. An Examination of Global and Regional Opioid Consumption Trends 1980–2011. J Pain Palliat Care Pharmacother 2014; 28:259-75. [DOI: 10.3109/15360288.2014.941132] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Cleary J, Powell RA, Munene G, Mwangi-Powell FN, Luyirika E, Kiyange F, Merriman A, Scholten W, Radbruch L, Torode J, Cherny NI. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Africa: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol 2014; 24 Suppl 11:xi14-23. [PMID: 24285225 DOI: 10.1093/annonc/mdt499] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
With nearly 1.1 billion inhabitants living in more than 50 countries, Africa is the world's poorest and most socioeconomically underdeveloped continent. Despite some advances for individual states, many African countries have very low opioid consumption and, overall, the continent has the lowest consumption per capita of any in the world. This article presents the findings of the first systematic study of the availability and accessibility of opioids for the management of cancer pain across the continent. Data are reported on the availability and accessibility of opioids for the management of cancer pain in 25 of 52 countries, with 744 million of the region's 1127 million people (66%) covered by the survey. Many countries had severely restricted formularies of opioids and only 15 of 25 had morphine available in oral IR, CR and injectable formulations. Even when opioids are on formulary they are often unavailable, and access is significantly impaired by widespread over-regulation that is pervasive across the region.
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Affiliation(s)
- J Cleary
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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27
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Cleary J, Silbermann M, Scholten W, Radbruch L, Torode J, Cherny N. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in the Middle East: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol 2013; 24 Suppl 11:xi51-9. [DOI: 10.1093/annonc/mdt503] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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28
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Cleary J, Radbruch L, Torode J, Cherny N. Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Asia: a report from the Global Opioid Policy Initiative (GOPI). Ann Oncol 2013; 24 Suppl 11:xi24-32. [DOI: 10.1093/annonc/mdt500] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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29
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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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