Cancer pain management in developing countries

Abstract

The World Health Organization estimated that more than 60% of the 14 million new cancer cases worldwide in 2012 were reported in the developing part of the world, including Asia, Africa, Central and South America. Cancer survival rate is poorer in developing countries due to diagnosis at late stage and limited access to timely treatment. Since the disease per se cannot be treated even with the best available treatment modalities, what remains important is symptom management and providing comfort care to these patients. The incidence of pain in advanced stages of cancer approaches 70–80%. Lack of preventive strategies, poverty, illiteracy, and social stigma are the biggest cause of pain suffering and patient presenting in advance stage of their disease. The need for palliative care is expanding due to aging of world's population and increase in the rate of cancer in developed and developing countries. A huge gap remains between demand and current palliative care services. Overcoming barriers to palliative care is a major global health agenda that need immediate attention. Main causes of inadequate pain relief remain lack of knowledge among physician and patients, lack of adequate supply of opioids and other drugs for pain relief, strong bureaucracy involved in terms of procurement, and dispensing of opioids. Beside this, poverty and illiteracy remain the most important factors of increased suffering.

Managing Pain in People with Cancer—a Systematic Review of the Attitudes and Knowledge of Professionals, Patients, Caregivers and Public

“…These findings are consistent with those of recent studies and systematic reviews [12,13,20,26,37,79,80,96]. Thus, it can be argued that due to these negative attitudes and lack of knowledge towards CPM, the management of cancer pain remains a major problem worldwide, especially in countries within Europe, Africa and Asia [13,26,52,75,76,81,92]. These could be due to lack of education and training about CPM among professionals and lack of general awareness and adequate level of knowledge about CPM among patients, caregivers and the public, as these were stated in all of the included studies.…”

Burden of cancer pain in developing countries: a narrative literature review

“…Certain factors such as psychosocial and socio-economical have been associated with cancer-related pain in low- and middle-income countries with inadequate assessment and management of cancer pain. 59 , 60 Limited studies so far have reported a clear understanding of psychosocial factors associated with cancer pain, especially in relation to aging with some studies reporting no relationship with age 61 – 63 and others reporting interference with age. For example, a study in 2012 demonstrated that advancing age results in an increased prevalence of cancer pain.…”

“…While the association of age-related psychosocial factors with pain is more or less prevalent in both developed and low-middle income countries, socio-economic factors such as fear and misconceptions regarding addiction to opioids for palliative care, lack of preventive strategies, poverty, illiteracy, and social stigma over the use of morphine are some of the additional factors associated with an increased prevalence of cancer-related pain in low- and middle-income countries. 59 For example, in India, despite WHO efforts on increasing awareness for analgesic use, little progress has been made in relieving pain in cancer patients (social stigma). 65 In another example in Nigeria, hospitals outside the commercial city of Lagos do not have morphine available and need additional expenses (travel costs) to make morphine accessible to smaller cities/areas; thus, lack of infrastructure and poverty attributes toward cancer-related pain since most of the small hospitals are unable to afford these additional expenses.…”

Challenges of using methadone in the Indian pain and palliative care practice

“…Although opioids are accepted as essential for cancer pain globally,[ 29 30 ] accessibility, and availability remains limited in India[ 2 31 32 ] as in various parts of the developing world. [ 33 34 ] In 2017, the NDPS Amendment of 2014 has not yet been incorporated in all Indian states even though the law simplified the needed laws for each state.…”

“…[ 1 2 26 ] Education of the medical fraternity at every opportunity through workshops and online courses focusing on opioid availability, accessibility, and training for safe use should be widespread and ongoing. [ 1 26 31 37 ] We need to address the poor public awareness of palliative and end of life care,[ 38 ] so that they come to expect high quality of care.…”