By Susan Miesfeldt, MD
Owing to insufficient public and private investment in chronic disease prevention and control, millions of sub-Saharan Africans present with late stage, life-threatening diseases -- including cancer. Because of poor health systems and symptom control infrastructure, and limited numbers of palliative care specialists, most Africans with late-stage cancers lack access to basic symptom control interventions, medicines, and resources.
The palliative care needs of cancer patients is a growing concern in Africa, with at least half a million dying of cancer annually and a projected doubling of cancer incidence and mortality by 2030, due to population growth and increasing life expectancy. Although data are scant, a two-country study revealed significant symptom burden among late-stage cancer patients; with pain (87.5%), lack of energy (77.7%), and sadness (75.9%) reported most often, and pain reported as the most severe symptom. Despite a recognized need for effective pain control, there are global logistical and regulatory barriers to opioid access among late-stage cancer patients, resulting in avoidable suffering at end of life.
Provision of effective palliative care in Africa, with a focus on both an adequate supply of and widespread access to pain control medications is a critical public health issue in need of global attention and intervention. The WHO public health palliative care strategy is based on four pillars including: i) government policy and national strategy to improve access, ii) education for health workers and the public, iii) drug availability, and iv) implementation throughout health-care systems. These pillars are not achievable without high quality research to ensure that public health solutions are: i) evidence-based, ii) culturally acceptable, iii) feasible, iv) responsive, v) effective, and vi) scalable. There is an immediate need for increased palliative care research in Africa, focused on the four WHO pillars, in order to ensure provision of equitable, achievable, and effective care. Research is particularly critical where the demand for palliative care is highest and available resources are scant.
Recognition by governments of the urgent symptom control needs of advanced cancer patients and patients with progressive non-cancer conditions is essential to advancing access to these services in Africa. Efforts focused on effective health policy that breaks through legislative barriers to medication access and investment in palliative care program development are essential throughout sub-Saharan Africa, with the greatest requirements at the community level.
In commemoration of World Cancer Day (WCD), this blog is part of a series of posts by ASCO International Affairs Committee members on four areas being highlighted as part of WCD awareness efforts. Additional posts include:
Oncology professionals worldwide can play a central role in improving access to effective end-of-life care for cancer patients. This includes advancing both research in this area as well as international advocacy aimed at access to essential medications and effective palliative care programs at the health system level throughout Africa and other low-income nations.
Susan Miesfeldt, MD, is a practicing medical oncologist, clinical investigator, and principal investigator for Maine Medical Center’s past National Cancer Institute Community Cancer Center Program (NCCCP). She currently serves as the Medical Director for the Cancer Risk and Prevention Program at Maine Medical Center.