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updated: 18 December 2009
The Access and Control Newsletter
The Access and Control Newsletter is sent by the World Health Organization, Department of Essential Medicines and Pharmaceutical Policies, Quality and Safety: Medicines Unit. The Newsletter provides the latest news from WHO on access to medicines controlled under the international drug treaties and evaluation of substances for their dependence producing properties. This edition considers the 35th Expert Committee on Drug Dependence, the definition of the scope for WHO chronic pain guidelines, availability of the opioid on-line course, VNGOC, and the World Cancer Declaration.
Access to Controlled Medications Programme, Biennial Report 2006-2007
Cancer control Knowledge into Action WHO Guide for Effective Programmes
Fight against cancer. Strategies that prevent, cure and care (2007)
Access to Controlled Medications Programme WHO Briefing note
Quality Assurance and Safety: Medicines, Department of Medicines Policy and Standards
Health Technology and Pharmaceuticals, World Health Organization
Contact: Dr Willem Scholten — Tel.: +41 22 791 5540. Email:
http://www.who.int/medicines/areas/quality_safety/sub_Int_control/en/index.html
The 58th World Health Assembly resolution on global cancer control – implications for Palliative Care
In May 2005, The 58th World Health Assembly adopted a resolution on cancer prevention and control which will clearly place cancer care on the health agenda for the future. The World Health Assembly, or body of international experts who propose key targets on which The World Health Organisation should focus its efforts, agreed this resolution on May 25th 2005 in Geneva, Switzerland. The resolution calls for action by the W.H.O and member states to address the increasing burden of disease due to cancer and emphasizes the reinforcement of national programmes which include early detection, prevention, improved treatment and palliative care. To meet this need, the Director General of the W.H.O has advocated a global cancer control strategy which translates cancer control knowledge into public health action, provides a sound evidence-base for best practice and the development of dedicated support groups to ensure the administration and implementation of the strategy. These expert groups will work in an advisory capacity at the national and international level to prepare reports and technical working papers relative to the overall strategy.
Palliative Care remains a visible force within the agenda and its inclusion as an integral part of the overall global programme indicates a growing international view of its importance in the delivery of health care. It is clear from this resolution and other W.H.O briefings that for the majority of cancer patients in the world, their first meeting with a medical professional is usually when their disease is already in the advanced stages. The broad multidisciplinary approach advocated in palliative care is seen by the W.H.O as a way of addressing not only the clinical but psychological and social burden of cancer care. It can be implemented in resource-poor situations, relatively simply and inexpensively and substantially improve quality of life for patients and families. In the global context, given limited access to treatment and late presentation to medical services as already suggested, palliative care may be the realistic option for many people and therefore is considered integral and not an adjunct to, cancer control practice.
Despite the evident benefits of this approach, the report also indicates the significant barriers which impact on implementation. In point 9 of the Cancer Control report
( EB114/3) which forms the base for this resolution, the problems facing palliative care development are outlined; lack of political will, insufficient education and information to the general public and health care providers. Despite the clear evidence that morphine remains the gold standard for pain relief and may be administered safely and with relatively little expense, excessive and unnecessary regulation of opioids still prevents its use where it is most needed. Notably, this does not only apply to resource-poor countries and challenges palliative care providers to strengthen the agenda for palliative care at the political level.
The resolution which has been adopted has clear resonance for those of us involved in the delivery of palliative care in all its varied disciplines and levels. The report calls on us to recognize the suffering of cancer patients and families and the burden, both personally and economically, it places on them. It states that palliative care is not simply an additional support service to cancer care, but “an urgent, humanitarian responsibility” (EB114/3 pg 4). It calls on its member states to develop systematic and equitable strategies which incorporate palliative care as a key element in the continuum of cancer care. The evaluation of such programmes is essential to ensure sustainability where resources are limited and need to be used to the benefit of an entire population and not just a limited group within. Finally, it urges compliance with W.H.O strategies for the provision of essential drugs, including opioids, to reach at least a minimum standard in each local situation.
The message of this resolution is clear. Partnership between active and palliative treatment programmes is an essential requirement for life quality and health policy in cancer care. The E.A.P.C. has always recognized this link and supported W.H.O initiatives through our work through the Council of Europe. The expert skills of Board members who link with W.H.O on palliative care matters, notably Professor Stein Kaasa from Norway have also contributed to this. Then fact that this resolution recognizes that the implementation of palliative care is an issue for highly-resourced countries as well as resource-poor ones calls for a political stratagem which supports the idea of “One Voice-One Vision” for all people who are in need of palliative care. The forthcoming International Hospice and Palliative Care day on October 8th affords one opportunity to address the political agenda and should be an ideal opportunity to make a stance in support of the 58th World Health Assembly resolution.
Further information about this resolution can be obtained from:
http://www.who.int/mediacentre/news/releases/2005/pr_wha05/en
http://www.who.int/nmh/a5816/en
Philip J Larkin
EAPC Vice-President.
WHO publication
"Comprehensive Cervical Cancer Control" a guide to essential practice
In 2004, the WHO Department of Reproductive Health and Research asked me to participate to the Technical Advisory Group (TAG) as EAPC palliative care expert in order to work on the realisation of the guide to essential practice.
The 46 TAG members were representing the following associations: WHO Department of Reproductive Health and Research, WHO Department of Chronic Diseases and Health Promotion, International Agency for Research on Cancer, Pan American Health Organization, Alliance for cervical cancer prevention, International Atomic Energy Agency, International Federation of Genecology and Obstetrics, International Gynecologic Cancer Society and EAPC.
The TAG group met 2 times 3 full days at the WHO, in Geneva and a complete process of reviewing several drafts went on. Many reviewers assisted in field-testing the guide in China, Egypt, India, Lithuania, Trinidad and Zimbabwe.
Françoise Porchet
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