Misconceptions about the use of strong opioids have shown that they undermine optimal pain control among Asian cancer patients undergoing chemotherapy and radiation therapy according to a survey conducted at Sarawak General Hospital in Malaysia.
The study, which will be presented at the ESMO Asia 2018 Congress, 133 patients with solid tumors at all stages of treatment with strong opioids were asked to evaluate their pain experience during the week before taking the survey using the visual analogue scale (VAS) from 0 to 10 and for self-assessments of the effects of pain on daily activities, completing the short form of Short Pain (BPI-sf).
Researchers also investigated the types of strong opioids used and patient-related barriers to effectively treat cancer pain; results were evaluated by social determinants, including ethnic group, religion and level of education.
Overall, 62% of survey participants reported good pain control (pain score
Large barriers to pain control have been found in patients with higher education, which may reflect a common misconception about the use of opioids in social networks. It has been observed that fear of the harmful effects of taking opioids is more common in the Malay community, followed by Chinese and Dahak groups. “These differences may reflect some inequalities in access to optimal cancer treatment in the state, but numerous socio-economic factors can also play a critical role in the use of opioids, so further research is needed,” commented Dr. Vuon.
Although adequate pain relief is the basis for maintenance therapy, the lack of availability or accessibility of opioids in some countries is still hampered, according to Professor Sumitra Tongprasert from Bangkok Hospital Chiang Mai, Thailand, co-chairman of the ESMO Asia 2018 public policy program. “Beliefs and other cultural problems can only partially explain the non-optimal use of opioid analgesics, and several factors still need to be assessed, including information about how the benefits of these drugs are provided by health care providers,” she commented. "More importantly, access to the opioid prescription and government restrictions on the total amount a patient could receive each time can significantly affect access and use patterns among cancer patients."
Accessibility issues, costs, and regulatory barriers that may limit the prescription and release of opioid analgesics in low- and middle-income countries (LMIC) were first selected in 2013 by the Global Opioid Policy Initiative (GOPI) conducted by ESMO with other international partners, and which expanded the results of a similar survey conducted in Europe in 2010. Opioid availability was low in all 20 Asian countries surveyed, with the exception of South Korea and Japan, and evidence of over-regulation of opioid prescription was found in the Asia-Pacific region, which may limit or reduce access to pain relief procedures. The results of this initiative also highlighted the specific need for improved knowledge of palliative care among clinicians in Asian countries.
“Currently, although the availability of critical drugs such as opioids, targeted drugs and immunotherapy can potentially be improved in Asia, accessibility problems will be difficult to overcome in the future due to the high cost of cancer treatment,” Tongprasert continued. “Some countries in the Asia / Asia-Pacific region simply cannot provide expensive medicines for local communities. In addition, in countries where patients have to pay for cancer treatment themselves, the high cost of drugs may be the main cause of poor quality in cancer treatment. "
Professor Nathan Cherny from the Institute of Oncology at the Medical Center. Israel’s Shaar Zedek, at that time coordinating the Global Opioid Initiative for ESMO, added: “According to the results published in a document published in 2013, there is an agreement between WHO, the International Narcotics Control Board and ESMO, as well as 20 international and the national palliative care and oncology societies collaborating with the project, that opioid analgesic therapy is the cornerstone of pain management with cancer and that there is no economic obstacle for opioids, access for this indication, and that this should be a public health priority. ”
Strategies to improve the availability and accessibility of anticancer drugs at LMIK will be discussed in the debates of concern to be held at the ESMO Asia 2018 Congress in Singapore. “Since reducing the cost of cancer drugs may take some time, other potential strategies need to be evaluated, such as setting different pricing according to economic status, pharmaceutical companies providing patient access programs or transferring technology to LMIC to manufacture their own drugs; availability of high-quality and biosimilar drugs, as well as compulsory licensing of anticancer drugs. In addition to the rules, these countries are likely to remain major barriers due to the rapid pace of new drug development, limited access to research projects, and the lack of new technologies. ” added Tongprasser.
Global commitment to providing access to anticancer drugs has increased in recent years, and, according to President ESMO Josep Tabernero, collaboration among various stakeholders can contribute to better leadership of countries in the Asia-Pacific region to improve access to essential drugs, vaccines, diagnostics and accessibility. medical devices.
“In general, it is necessary to adequately give priority to limited resources for clinical benefits, and joint efforts have led to the emergence of new tools and approaches that can play a crucial role in addressing policy issues in the LMIC. One such platform is the ESMO Magnitude of Clinical Benefit Scale (ESMO-MCBS) (6,7), which can help governments revise and adjust their respective national drug lists to ensure that they are the most cost-effective, which provide the greatest value to patients. ”
“In addition, by promoting the education and updating of oncology specialists in the Asia-Pacific region, the annual ESMO Congress in Asia, launched back in 2014, provides an arena for knowledge sharing, as well as for discussing and discussing the main problems in oncology in the direction of development led to real and necessary changes, ”concluded the president of ESMO.
Quality care for cancer is not just a matter of anticancer drugs
Abstract 439P – “Pain control among cancer patients receiving strong opioids and their prospects for opioids in developing coituri with a diverse multicultural background” will be presented by Daniel Lee during a poster show on Saturday, November 24, from 18:00 to 19: 00 (SGT) in the exhibition area. Annals of Oncology, Volume 29, 2018 Addition 9, DOI: 10.1093 / annonc / mdy426