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Supportive Care in Cancer
Published in: Supportive Care in Cancer 6/2019

Open Access 01-06-2019 | Original Article

Optimizing cancer pain management in resource-limited settings

Authors: Sam H. Ahmedzai, Mary Jocylyn Bautista, Kamel Bouzid, Rachel Gibson, Yuddi Gumara, Azza Adel Ibrahim Hassan, Seiji Hattori, Dorothy Keefe, Durval Campos Kraychete, Dae Ho Lee, Kazuo Tamura, Jie Jun Wang, CAncer Pain management in Resource-limited settings (CAPER) Working Group

Published in: Supportive Care in Cancer | Issue 6/2019

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Abstract

Purpose

Adequate cancer pain management (CPM) is challenging in resource-limited settings, where current international guideline recommendations are difficult to implement owing to constraints such as inadequate availability and accessibility of opioids, limited awareness of appropriate opioid use among patients and clinicians, and lack of guidance on how to translate the best evidence into clinical practice. The multinational and multidisciplinary CAncer Pain managEment in Resource-limited settings (CAPER) Working Group proposes a two-step initiative to bridge clinical practice gaps in CPM in resource-limited settings.

Methods

A thorough review of the literature, a steering committee meeting in February 2017, and post-meeting teleconference discussions contributed to the development of this initiative. As a first step, we developed practical evidence-based CPM algorithms to support healthcare providers (HCPs) in tailoring treatment according to availability of and access to resources. The second part of the initiative proposes a framework to support an effective implementation of the CPM algorithms that includes an educational program, a pilot implementation, and an advocacy plan.

Results

We developed CPM algorithms for first-line use, breakthrough cancer pain, opioid rotation, and refractory cancer pain based on the National Comprehensive Cancer Network guidelines and expert consensus. Our proposed educational program emphasizes the practical elements and illustrates how HCPs can provide optimal CPM according to evidence-based guidelines despite varied resource limitations. Pilot studies are proposed to demonstrate the effectiveness of the algorithms and the educational program, as well as for providing evidence to support a draft advocacy document, to lobby policymakers to improve availability and accessibility of analgesics in resource-limited settings.

Conclusions

These practical evidence-informed algorithms and the implementation framework represent the first multinational step towards achieving optimal CPM in resource-limited settings.
Appendix
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Metadata
Title
Optimizing cancer pain management in resource-limited settings
Authors
Sam H. Ahmedzai
Mary Jocylyn Bautista
Kamel Bouzid
Rachel Gibson
Yuddi Gumara
Azza Adel Ibrahim Hassan
Seiji Hattori
Dorothy Keefe
Durval Campos Kraychete
Dae Ho Lee
Kazuo Tamura
Jie Jun Wang
CAncer Pain management in Resource-limited settings (CAPER) Working Group
Publication date
01-06-2019
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 6/2019
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-018-4471-z

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