Misconceptions about the use of strong opioids have shown to undermine optimal pain control among Asian cancer patients undergoing chemotherapy and radiotherapy, according to a study in the Saravak municipality in Malaysia.
In a study to be submitted to the ESMO Asia 2018 Congress, 133 patients with solid tumors at all stages treated with strong opioids were asked to assess their pain experience the week prior to transmission of the survey using a visual analogue VAS scale of 0 to 10, and to self-assess the impact of pain on daily activities by completing the short form of pain – short form (BPI-sf).
Researchers also investigated the types of strong opioid use and patient-related barriers to the effective management of cancer pain; the results were assessed by social determinants, including the ethnic group, religion and education.
Overall, 62% of study subjects (painkiller <4) treated with strong opioids reported good pain control. Although pain levels have improved by more than half in 83.5% of patients receiving strong opioids – this confirms the effectiveness of these drugs, there are still some patient-related barriers, "said study author Dr. Won Singing Jay from Saravak, "The fear that strong opioids can damage the immune system and develop addiction is seen as the most common misconceptions in about 40% of patients, followed by the belief that pain can hide the monitoring of cancer progression (23.3%), (18.05%) , complaints that pain can divert doctors from cancer treatment (16.5%) and fatalism (5.3%). "
Greater pain control barriers have been found in patients with higher education, which may reflect the overwhelming misconception of the use of opioids in social media. The fear of adverse effects of opiate use is more common in the Malay community, followed by Chinese and daily groups. "These differences may reflect some injustice in access to optimal cancer care in the state, but many socioeconomic factors can also play a critical role in opioid use, so further research is needed," said Dr. Von.
Although adequate pain relief is a major cause of supportive care, it is still hampered by lack of accessibility or opioid access in some countries, according to Professor Sumitra Thongprasert of Bangkok Chiang Mai, Thailand, co-chair of ESMO Asia 2018 Public Policy program. "Beliefs and other cultural issues can only partially explain the suboptimal use of opioid analgesics, and several other factors remain to be evaluated, including how information on the benefits of these medicines from healthcare providers is provided," she said. "More importantly, access to prescribing opioids and government constraints in terms of the total amount the patient can receive each time can significantly affect access and patterns of use in cancer patients."
Accessibility, cost and regulatory barriers that may limit the prescription and release of opioid analgesics in low and middle income countries were first outlined in 2013 by the Global Opioid Policy Initiative (GOPI) conducted by ESMO with other international partners. expanded the results of a similar study conducted in Europe in 2010. The availability of opioid report was low in all 20 Asian countries except South Korea and Japan and evidence of excessive regulation of prescription of opioids in the Asia Pacific , which may restrict or impair access to treatment for relief. The results of this initiative also highlighted the particular need to improve the knowledge of palliative care among clinicians in Asian countries.
"At present, although the availability of critical drugs such as opioids, targeted medicines and immunotherapies can be improved in Asia, accessibility problems will be hard to overcome in the near future due to the high cost of treating cancer," continues Thongprasert. "Some countries in the Asia / Pacific region are simply not able to provide expensive medicines for local communities In countries where patients have to pay for cancer treatment, high medication costs can be the main cause of poor quality of cancer care. "
Prof. Nathan Cherny of the Shaare Zedek Institute of Cancer Institute, Israel, as a coordinator of the Global Opioid Policy Initiative for ESMO, added: "According to the results of the report published in 2013, there is an agreement between the WHO, the International Board and ESMO and the 20 international and national palliative and oncology societies that cooperate on the project on the fact that opioid analgesic therapy is the cornerstone of pain management and that there is no economic barrier available for this indication of opioids and that it should be a priority for public health. "
Strategies to improve the availability and availability of anti-cancer drugs in the LMIC will be discussed in a debate that will trigger a debate to be held at ESMO Asia 2018 Congress in Singapore. "As cost savings for oncology drugs may take some time, other potential strategies, such as creating different pricing according to economic status, pharmaceutical companies providing a patient access program or technology transfer to LMIC , the production of own medicines, the availability of generic and biological medicines that are guaranteed in quality, and the compulsory licensing of anticancer medicines. and, in these countries are likely to remain significant barriers due to the rapid pace of development of new drugs, restricting access to research projects and lack of new technologies. "Thongprasert added.
The global commitment to providing access to cancer drugs has increased in recent years and according to ESMO chairman Josep Tabernero, stakeholder collaboration can help better target Asia-Pacific countries to improve access and availability of key medicines , vaccines, diagnostics and medical devices.
"In general, it is necessary to adequately prioritize limited resources for clinical benefits, and joint efforts have led to new tools and approaches that can play an important role in addressing policy issues in LMICs. One such platform is the ESMO Magnitude of Clinical Benefit Scale (ESMO-MCBS), which can help governments revise and correct their respective national drug lists to ensure that they prioritize the most cost-effective ones that provide the highest value to patients. "
"Also, by facilitating the education and updating of oncology specialists in the Asia-Pacific region, the ESMO's annual Asian Congress, launched in 2014, provides a knowledge-sharing arena as well as discussing and discussing the main challenges in the field of oncology, which led to real and necessary changes, "the ESMO chairman concluded.