The Global Task Force for Improved Access to Cancer Control and Care in Developing Countries today releases its report “Closing The Cancer Divide: A blueprint to expand Access in Low and Middle Income Countries.” It is fitting that the LIFE before Death film today is “Together we are stronger.” As Cynthia Goh indicates in the film, we are really looking at changing the way we practice medicine. We need to work together to close the great divide that exists in cancer pain relief.
Read this report; highlights of which as they pertain to palliative care, are below.
“Pain control, an issue for all cancers and many other diseases, offers the most distressing and insidious example of the cancer divide. Controllable pain is considered unacceptable in most high income countries, at least for the wealthy. Yet, and despite the generally low cost of pain control, many populations lack access to this fundamental health intervention, one that might well be considered a basic human right.” (p9)
“Strengthening health systems to increase access to pain control medicationis essential for cancer, for many other diseases, and for surgery.” (p16)
“For the estimated 5.5 million terminal cancer patients who needlessly suffer moderate to severe pain with no pain control, effective national programs can increase availability and accessibility of this essential and inexpensive intervention.”
“Palliation of pain and suffering from cancer is a basic human right. Such programs should not be based on cost-benefit calculations that are measured in extending life. Dignity and equity are equally as important as efficiency.” (p19)
“The glaring gap in access to pain control and palliation can, and must, be closed. An almost 580 – fold difference exists in opioid consumption per death from HIV/AIDS or cancer in pain, between the 20% poorest countries of the world and the 20% richest. Huge variations in access, even within the 20% richest and poorest, can be reduced by strengthening health systems and regulatory frameworks.” (p33)
“An abyss in the global cancer divide, and perhaps the most striking example of the equity imperative, is pain control and palliation. Even for the cancers where neither treatment nor prevention is possible, a crater of controllable pain and suffering separates the poor and rich. Much can be done to close this most unacceptable of divides.
“Yet, the importance of investing in pain control and palliation is largely missed in the outcome measurements that typically guide health policy-makers. The focus on income, incidence of disease, or mortality as guides and metrics for fairness, equity, and efficiency excludes or severely undervalues the control of pain. This is because neither income nor extension of life are the primary purpose of palliation, and because the impact on productivity and other health outcome measures is assumed to be nil. Yet, in addition to the obvious and tremendously important function of reducing pain, especially at end of life, palliative care has been associated with improved quality of life, reduced symptoms of depression, and longer survival. Palliative care at end of life has, in fact, given insufficient attention in both high and low income countries.
“The lack of access to pain relief, and specifically to opioids, represents one of the most appalling and unnecessary global health disparities between rich and poor countries, and also within countries, including the United States, by socio-economic group. Given the low cost of opiate drugs and other analgesics, perhaps the greatest disparities in cancer control are the immense international differences in the availability of pain relief.”