Optimizing cancer pain management in resource-limited settings

We developed practical evidence-based cancer pain management algorithms to support healthcare providers in tailoring treatment according to availability of and access to resources

Sam H. Ahmedzai

2018

Scholarcy highlights

  • Pain is one of the most prevalent consequences of cancer affecting up to 70% of all patients with cancer over the course of their disease
  • Impediments to opioid availability and accessibility in resource-limited settings include restrictive opioid formularies, over-regulation related to licensing and prescription, fear of opioid diversion to illicit channels, issues related to supply and distribution, cultural attitudes towards pain, patients and healthcare provider concerns over addiction, and restricted financial resources
  • To support the effective translation of these algorithms into clinical practice, the Steering Committee deliberated on the importance of education in achieving the aims of the initiative, ways to optimize the use of available analgesics, and strategies to advocate for improved availability and accessibility of opioids
  • To achieve the goal of our initiative, we have developed a structure that encompasses two main elements—(1) cancer pain management management algorithms and a proposed framework for an educational program and pilot implementation, incorporating an advocacy plan
  • Using a multimodal approach based on literature reviews and our clinical experience, we have developed four management algorithms, as a starting point for tackling some of the most problematic areas in CPM, to support optimal outcomes from using locally available analgesics: first-line treatment of cancer pain, management of breakthrough cancer pain, opioid rotation in CPM, and management of refractory cancer pain
  • To demonstrate the utility of the algorithms developed above, we propose a theoretical implementation framework that is based on strong evidence-based principles, includes essential elements in education and advocacy to ensure effective implementation, and can be utilized or adapted by any groups or institutions to improve CPM in their own settings based on their available resources
  • Define current gap and its consequence ○ Opioids are unavailable and inaccessible for cancer pain management in resource-limited settings; lack of education of healthcare providers renders suboptimal management of pain in patients with cancer ○ At least one-third of patient with cancer pain do not receive analgesics proportional to their pain intensity

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