Hundreds of millions of cancer patients are suffering needlessly because governments have failed to ensure access to pain-relieving drugs, according to an international survey released last fall during the 2012 European Society for Medical Oncology (ESMO) Congress held in Vienna, Austria. Unrelieved pain is causing worldwide suffering, not because physicians do not have the ability to treat it but because most patients do not have access to the medication, said the lead author of the report, Nathan Cherny, MD, of the Shaare Zedek Medical Center in Jerusalem, Israel and chair of the ESMO Palliative Care Working Group. ESMO initiated the International Collaborative Project to Evaluate the Availability and Accessibility of Opioids for the Management of Cancer Pain and coordinated with the European Association for Palliative Care, the Pain and Policy Study Group at the University of Wisconsin Carbone Cancer Center, the Union for International Cancer Control, and the World Health Organization.
The data were gathered between December 2010 and July 2012 and included 156 reports submitted by experts in 76 countries and 19 Indian states. The survey found that very few countries provided all 7 of the opioid medications that are considered to be essential for the relief of cancer pain. In many countries, fewer than 3 of the 7 medications are available and, if they are available, they are either unsubsidized or weakly subsidized by many governments. In addition, availability is often limited.
Researchers also learned that many countries have highly restrictive regulations, including those that limit patients' ability to receive prescriptions, limit prescriber privileges, impose limits on the duration of the prescription, restrict dispensing, and increase bureaucracy for the prescribing and dispensing process. The restrictions are particularly severe in Africa, Asia, the Middle East, and Latin and Central America, and researchers note that there is an urgent need to examine drug control policies that impede pain treatment. Studies have shown that pain can affect as many as 64% of patients with metastatic, advanced, or terminal disease and 59% of patients receiving anticancer treatment, says Carla Ripamonti, MD, head of supportive care in the cancer unit of the IRCCS Foundation National Cancer Institute in Milan, Italy.
Dr. Cherny says the ESMO study has provided key information that will be useful in developing national efforts for treating cancer pain. Not only do researchers now know which countries have suboptimal formularies of medication to relieve pain, they also know how much patients pay out-ofpocket for such medications as well as which countries have excessive regulations that limit patients' ability to access vital medications. The presentation of the study at ESMO Congress is the beginning of an organized effort to tackle the challenge, says Dr. Cherny.