The misuse of the use of strong opioids has been shown to undermine optimal pain control in patients undergoing cancer chemotherapy and radiotherapy patients in the Sarawak General Hospital in Malaysia.
In a study to be presented at ESMO Asia 2018 Congress, 133 patients with solid tumors in all phases treated with strong opioids were asked to estimate their pain experience during the week before submitting the questionnaire via a visual analogue scale (VAS) of 0-10 and self-assessment of impact pain in daily activities by filling out short-term short-form pain (BPI-sf).
The researchers also investigated the types of potent opioids that are used and the patient-related barriers to effective cancer treatment; the results are assessed by social determinants, including the ethnic group, religion and level of education.
Overall, 62% of respondents received good pain control (pain score <4) treated with strong opioid use. "Although the level of pain is improved by more than half to 83.5% of patients taking strong opioids – confirming the effectiveness of these drugs, there are still barriers to patients," said Dr. Voon Pei Jye of Sarawak General Hospital, "Fear of strong opioids can damage the immune system and develop addiction as the most common misconceptions in about 40% of patients, followed by the belief that pain could mask the progression of cancer progression (23.3%), perceived difficulties in managing opioid side effects (18.05%) , complaints that pain can distance doctors from cancer treatment (16.5%) and fatalist attitude (5.3%). "
Bigger pain control barriers have been found in patients with a high level of education, which may reflect the overall misconception of the use of opioids in social media. It has been noted that the fear of the detrimental effects of opioid use is more common in the Malaysian community, followed by the Chinese and Dayak groups. "These differences may reflect some inequalities in access to optimal cancer protection in the state, but many socioeconomic factors can also play a key role in the use of opiates, so further research is needed," Dr. Voon commented.
Although adequate mitigation of pain is crucial for caretaker care, it is still hampered by the lack of opioid availability and accessibility in some countries, says prof. Sumitra Thongprasert from Bangkok Hospital, Chiang Mai, Thailand, co-chaired by ESMO Asia 2018 Public Policy Program. "Certainties and other cultural issues can only partially explain the suboptimal use of opiate analgesics and a number of factors remain to be evaluated, including how information on the benefits of these drugs is provided by healthcare providers," he comments. "More importantly, access to opiate recipe and state limitations in terms of the total amount that the patient could receive each time can significantly affect the patterns of access and use among cancer patients."
Problems of Accessibility, Costs, and Regulatory Obstacles that May Limit Prescribing and Issuance of Opioid Analgesics in Low and Medium-Sized Countries (LMICs) were first mapped in 2013 through the Global Opioid Policy Initiative (GOPI), which ESMO conducted with other international partners and which expanded results of similar research conducted in Europe in 2010. Opioid availability was poor in all 20 surveyed countries in Asia, except South Korea and Japan, and evidence of over-regulation of opioid recognition was found in the Asia-Pacific region that can restrict or reduce access to pain management . The results from this initiative also emphasized the specific need to improve palliative care knowledge among Asian clinicians.
"At present, although the availability of critical remedies such as opioids, targeted drugs and immunotherapy may potentially improve in Asia, it will be difficult to overcome accessibility problems in the coming future because of the high cost of cancer treatment," Thongprasert continued. "Some countries across Asia / Pacific are simply not able to provide expensive medicines to local communities, and in countries where patients have to pay for cancer treatment themselves, high drug costs can be the main cause of poor quality cancer care."
Prof. Nathan Cherny from the Institute of Oncology Institute Shaare Zedek, Israel, then coordinator of the Global Opiate Policy Initiative for ESMO, added: "According to the results published in the paper published in 2013, there is agreement between the WHO, the International Narcotics Control Board and ESMO , and 20 international and national palliative and oncological societies that co-operate on the project, the fact that opioid analgesic therapy is the foundation of cancer fire-fighting fireplaces and that there are no economic obstacles to opioid production available for this indication and must be a priority of public health. "
Strategies to improve access to and availability of anti-cancer drugs in LMICs will be discussed in a debate that triggers a mission mission to be held at the ESMO Asia 2018 congress in Singapore. "Since reducing the cost of anti-cancer drugs may take some time, other potential strategies, such as setting different prices to economic status, pharmaceutical companies that provide Patient Access or technology transfer to LMICs for making their own medication, should be evaluated; Availability quality generic and biosimile drugs, and compulsory licensing of cancer drugs. In addition to regulation, it is likely that these countries will remain the main obstacles to the rapid development of new medicines, access restrictions to research projects and the lack of new technologies, "added Thongprasert.
Global commitment to securing access to cancer drugs has increased over the last few years, and ESMO President Josep Taberner, co-operation among various stakeholders can contribute to better targeting the Asia and Pacific countries to improve access to and availability of essential drugs, vaccines, diagnostics and medical devices.
"Overall, there is a need for adequate priorities of limited resources on clinical benefits, and collaborative efforts have resulted in new tools and approaches that can play a critical step in solving policy issues in LMICs. One such platform is the ESMO Magnitude of Clinical Benefit Scale (ESMO- MCBS), which can help the government review and adapt its national drug lists to ensure that the highest priority is given to those who provide the highest value to patients. "
"Also, by facilitating the education and updating of oncology experts in the Asia Pacific region, the annual ESMO Asia Congress, launched in 2014, provides space for sharing knowledge, as well as discussing and discussing the main challenges of oncology in the direction of improving the area and bringing about real and necessary change "concluded ESMO President.