FROM WORLD HOSPICE AND PALLIATIVE CARE DAY, HOSPICE HOUSE, 34-44 BRITANNIA ST, LONDON WC1X 9JG, UK

7% of World Population Suffering Unnecessary Cancer Pain

A new report published today [28th September] shows that 80% of the world’s cancer sufferers have no access to pain relief and 7% of all people in the world suffer cancer pain that could be relieved but isn’t due to lack of access to low cost and effective pain relieving drugs. Access to Pain Relief – an Essential Human Right, which also looks at pain relief with reference to other advanced and terminal diseases including AIDS(1), heart disease, chronic obstructive pulmonary disease and renal disease, has been produced by the UK’s national hospice charity, Help the Hospices, and includes an introduction from the World Health Organization (WHO).

The report is being published to mark World Hospice and Palliative Care Day (6th October, www.worldday.org) and provides a global snapshot of the availability of vital pain relieving drugs. It looks in detail at why so many people do not have access to basic drugs named on WHO’s ‘Essential Medicines List’. It contains findings of a specially commissioned survey of medical staff in 69 hospice and palliative care services across Africa, Asia and Latin America and reveals that the main barriers to access are not cost, but rather lack of education and training, bureaucracy, excessively strict legislation, misplaced fear of addiction, abuse, tolerance and/or side effects and poorly developed health systems. In fact, medicines used to relieve pain are well established with known, predictable and preventable side effects.

Survey findings

NB this survey only looks at availability of pain relieving drugs within the hospice and palliative care services surveyed. The vast majority of people living in the survey countries do not have access to these services or to palliative care of any kind(2), therefore the actual level of access is far lower than the survey indicates.

Key survey findings include:

• In one main hospital in Malawi, aspirin is the only pain killer which is ‘always available’. Aspirin is not recommended in children therefore there are no suitable pain killers available for children.
• Professional training for 82% of the palliative care workers in Latin America and 71% in Asia did not include either pain relief or opioid use(3).
• 25% of palliative care providers in Asia, 35% in Latin America, and 39% in Africa cannot always access a strong opioid.
• For 41% of palliative care providers in Africa and 39% in Latin America oral morphine is not always available and for 18% and 21% respectively oral morphine is never available.
• Over 20% of palliative care providers in Africa never have access to strong opioids.
• Only 55% of health care workers providing palliative care in Asia, Africa and Latin America have a weak opioid ‘always available’. 22% have access only ‘occasionally’ or ‘never’.

The report’s author, pharmacist Vanessa Adams, said, “For most palliative patients, particularly in developing countries, the cause of pain cannot be removed, therefore it is vital that a reliable supply of pain relieving drugs is available for each patient. Pain is extremely distressing for patients and their friends and families. It decreases people’s ability to sleep, carry out everyday activities, work, communicate, concentrate, resolve conflict and address issues which, if thought through, allow peace of mind as the end of life approaches.”

Comments from health care workers responding to the survey included:

• “It is simply irrational that oral morphine is not available in the country…Lack of doctors’ training, awareness and cure-oriented approach of the society as well as of the medical community makes palliative medicine an unknown field.”
• “[There is] fear at all levels of using opioids even when they are available, including among specialist doctors.”
• “In my ten years’ experience I have never seen a doctor suggest or prescribe opioids other than for cancer patients, and they dismiss out of hand suggestions to consider it for end term AIDS patients, or end stage patients with severe respiratory distress.”

Recommendations

In order to prevent millions suffering pain needlessly the report recommends coordinated international and national programmes to increase awareness, education, supply and access. Palliative care and access to essential pain relieving medicines should be an integral part of all national policies relating to cancer, HIV/AIDS and other chronic diseases. The report outlines essential steps that need to be taken to improve access including improved education and accountability, reviewing laws and policies and strengthening health facilities.

The report will be available to download in full, free of charge, from 28th September 2007 at http://www.worldday.org/documents/access_to_pain_relief.pdf. For more information about the report in advance of its publication on September 28th, please contact Claire Morris, Help the Hospices on +44 207 520 8250 or

For media enquiries, to obtain a copy of the report (under embargo until 28th September) or images, please contact: Jo Pratt, Help the Hospices on +44 208 699 6566 or

(1) It should be noted that the availability of anti-retroviral therapy for HIV patients does not decrease their need for pain relief.

(2) In Africa 21 out of 47 countries have no identified hospice or palliative care services at all and only four have a reasonable number of palliative care services. In India, less than 1% of people who need palliative care have access to it. In Pakistan there is only one palliative care service to serve a population of 158 million (compared to more than 240 services in the UK).

(3) The WHO analgesic (pain relieving drug) ladder forms a sound basis for relieving most types of pain. The main ‘steps’ in the ladder are:

1. paracetamol and NSAIDs (non-steroidal anti-inflammatory drugs) eg ibuprofen
2. weak opioids e.g. codeine
3. strong opioids e.g. oral morphine.

Notes to editors

• Palliative care, which is the kind of care given in hospices as well as some other settings, improves the quality of life of patients and their families. It aims to provide the best possible care for people living with and dying from a terminal illness and helps prevent and relieve suffering through expert pain and symptom relief as well through practical help, emotional and spiritual support.
• Half of the world’s 234 countries have no palliative care services available to their populations and one third have yet to take the first steps in planning to build service capacity.
• In those countries where hospice and palliative care services are present, provision is mostly localised, with only 15% of countries having achieved a measure of integration with mainstream healthcare service providers.
• There are currently six million cancer deaths and over 10 million new cases of cancer every year, rising to 15 million by 2020.
• It is estimated that 100 million people could benefit from basic palliative care every year. This number is made up of 33 million people dying (60% of the total number dying in the world each year) and their 66 million family members, companions or carers (based on a conservative estimate of two people giving care and support for every person that dies). The actual number of people that receive palliative care is far lower. Although Sub-Saharan Africa has twice as many deaths per 1000 head of population annually as North America, it has only 1.5% of global palliative care resources compared to 55% in North America.
• World Hospice and Palliative Care Day is co-sponsored by the World Health Organization and has been developed by the Worldwide Palliative Care Alliance (a network of national hospice and palliative care organizations) and other global partners. Details of members of the World Day organising group can be found at www.worldday.org/partners.asp.
• The secretariat for World Hospice and Palliative Care Day is provided by Help the Hospices, the UK charity for the hospice movement, which supports over 220 local hospices in their vital work on the front line of caring for people who face the end of life. Hospices provide a wide range of care, from in-patient beds to day care or care for people in their own homes. The UK government contributes an average of 32% of running costs for adult hospices in England and 22% for children’s (note: based on latest figures available) – the rest has to be obtained through charitable fundraising. For more information on Help the Hospices visit www.helpthehospices.org.uk