Patient eligibility for opioids is seriously restricted in some countries, with the highest rate of limited access to palliative care found in the Middle East, followed by Latin America and the Caribbean and Asia. Data are revealed by the ESMO Global Opioid Policy Initiative (GOPI) which identifies barriers to the availability and accessibility of essential pain relieving medication worldwide.1
But positive signals of polices ‘tailored’ to the needs of patients with advanced cancers are emerging worldwide, supported by 18 new oncology centres in Europe, Asia, Middle East and Latin America and the Caribbean that achieve the prestigious title of ‘ESMO Designated Centre of Integrated Oncology and Palliative Care’2. The accolade is presented today at the European Cancer Congress (ECC) 2015 in Vienna3, Austria, by Prof Nathan Cherny, former chair of the ESMO Palliative Care Working Group and initiator of the Designated Centres programme.
This year the group of Designated Centres has been joined by five new countries, such as Lebanon, Kuwait, Mexico, Kingdom of Saudi Arabia, Vietnam and Taiwan. As a commitment to the improvement of the quality of palliative care for cancer patients, national designated centres are especially important in those countries where there are barriers and restrictions on access to essential pain relieving medications. Data from ESMO GOPI show that discrepancies exist in the access to opioids in those countries and patients with advanced tumours are not equally eligible to drugs that potentially relieve cancer pain although approximately 70-90% of those who die from cancer will suffer from severe pain. In Western Europe more than 80% of outpatients, inpatients and hospice patients are eligible to opioids, in Middle East the rate is more than halved for the three groups (outpatients 19%, inpatients 38%, hospice patients 13%). Prescriber restrictions and limited availability of opioids further limit the palliative care programmes in those countries.
Many patients worldwide do not receive adequate relief of pain because of excessive regulatory restrictions on the availability and accessibility of opioids. ESMO National Representatives are lobbying their ministries of health for increased access to opioids for the relief of cancer pain. Ministries are being called upon to reduce the barriers to opioids at the national level to fulfil their obligation under the 2014 World Health Assembly on Palliative Care. They are also being asked to support the ‘UN Action Plan on Controlled Medicines’ during the April 2016 UN General Assembly Special Session (UNGASS) on Drugs.
The ESMO Designated Centres project4 began in 2003 and, in more than a decade, it has raised a lot of interest and the list of international centres that adhere to this programme is progressively growing. It is the top initiative across the globe for providing incentives and a structured model to enable centres with few resources to develop integrated programmes in oncology and palliative care. Promoting a multidisciplinary approach and high standards of care, ESMO’s initiative has encouraged the national cancer care programmes to open to patients needs. Until now this globally sought after distinction has been earned by 189 centres worldwide.
ESMO is leading the way in promoting best practice in palliative care, and was the first major oncology organisation to develop a dedicated working group. ESMO Designated Centres have been recognised in countries with barriers and restrictions in access to opioid drugs, which shows that progress is being made. The designation is valid for three years and indicates that these institutions are committed to meeting the physical and psychological challenges of patients and families with advanced cancers. The centres honoured today will ensure that fewer cancer patients suffer from undertreated pain and more receive the best care.