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Rosa WE, Knaul FM, Pettus KI, Bruera E, Rajagopal MR. The US Cancer Pain Crisis and the Global Pain Divide: Can Two Wrongs Make It Right? J Clin Oncol 2022; 40:310-311. [PMID: 34878827 PMCID: PMC8769097 DOI: 10.1200/jco.21.02049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- William E. Rosa
- William E. Rosa, PhD, MBE, NP, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY; Felicia Marie Knaul, PhD, MA, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, Department of Public Health Services, Leonard M. Miller School of Medicine, Miami, FL, Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL; Katherine I. Pettus, PhD, International Association for Hospice & Palliative Care, Houston, TX; Eduardo Bruera, MD, Department of Palliative, Rehabilitation, & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX; and M. R. Rajagopal, MD, Pallium India, Trivandrum Institute of Palliative Sciences (TIPS), World Health Organization Collaborating Center for Training and Policy on Access to Pain Relief, Thiruvananthapuram, Kerala, India,Corresponding author: William E. Rosa, PhD, MBE, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022; e-mail:
| | - Felicia Marie Knaul
- William E. Rosa, PhD, MBE, NP, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY; Felicia Marie Knaul, PhD, MA, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, Department of Public Health Services, Leonard M. Miller School of Medicine, Miami, FL, Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL; Katherine I. Pettus, PhD, International Association for Hospice & Palliative Care, Houston, TX; Eduardo Bruera, MD, Department of Palliative, Rehabilitation, & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX; and M. R. Rajagopal, MD, Pallium India, Trivandrum Institute of Palliative Sciences (TIPS), World Health Organization Collaborating Center for Training and Policy on Access to Pain Relief, Thiruvananthapuram, Kerala, India
| | - Katherine I. Pettus
- William E. Rosa, PhD, MBE, NP, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY; Felicia Marie Knaul, PhD, MA, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, Department of Public Health Services, Leonard M. Miller School of Medicine, Miami, FL, Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL; Katherine I. Pettus, PhD, International Association for Hospice & Palliative Care, Houston, TX; Eduardo Bruera, MD, Department of Palliative, Rehabilitation, & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX; and M. R. Rajagopal, MD, Pallium India, Trivandrum Institute of Palliative Sciences (TIPS), World Health Organization Collaborating Center for Training and Policy on Access to Pain Relief, Thiruvananthapuram, Kerala, India
| | - Eduardo Bruera
- William E. Rosa, PhD, MBE, NP, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY; Felicia Marie Knaul, PhD, MA, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, Department of Public Health Services, Leonard M. Miller School of Medicine, Miami, FL, Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL; Katherine I. Pettus, PhD, International Association for Hospice & Palliative Care, Houston, TX; Eduardo Bruera, MD, Department of Palliative, Rehabilitation, & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX; and M. R. Rajagopal, MD, Pallium India, Trivandrum Institute of Palliative Sciences (TIPS), World Health Organization Collaborating Center for Training and Policy on Access to Pain Relief, Thiruvananthapuram, Kerala, India
| | - M. R. Rajagopal
- William E. Rosa, PhD, MBE, NP, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY; Felicia Marie Knaul, PhD, MA, Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, Department of Public Health Services, Leonard M. Miller School of Medicine, Miami, FL, Institute for Advanced Study of the Americas, University of Miami, Coral Gables, FL; Katherine I. Pettus, PhD, International Association for Hospice & Palliative Care, Houston, TX; Eduardo Bruera, MD, Department of Palliative, Rehabilitation, & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX; and M. R. Rajagopal, MD, Pallium India, Trivandrum Institute of Palliative Sciences (TIPS), World Health Organization Collaborating Center for Training and Policy on Access to Pain Relief, Thiruvananthapuram, Kerala, India
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Pettus K, Cleary JF, de Lima L, Ahmed E, Radbruch L. Availability of Internationally Controlled Essential Medicines in the COVID-19 Pandemic. J Pain Symptom Manage 2020; 60:e48-e51. [PMID: 32387575 PMCID: PMC7204700 DOI: 10.1016/j.jpainsymman.2020.04.153] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 11/25/2022]
Abstract
Section 2 of the 2019 World Health Organization Model List of Essential Medicines includes opioid analgesics formulations commonly used for the control of pain and respiratory distress, as well as sedative and anxiolytic substances such as midazolam and diazepam. These medicines, essential to palliative care, are regulated under the international drug control conventions overseen by United Nations specialized agencies and treaty bodies and under national drug control laws. Those national laws and regulations directly affect bedside availability of Internationally Controlled Essential Medicines (ICEMs). The complex interaction between national regulatory systems and global supply chains (now impacted by COVID-19 pandemic) directly affects bedside availability of ICEMs and patient care. Despite decades of global civil society advocacy in the United Nations system, ICEMs have remained chronically unavailable, inaccessible, and unaffordable in low- and-middle-income countries, and there are recent reports of shortages in high-income countries as well. The most prevalent symptoms in COVID-19 are breathlessness, cough, drowsiness, anxiety, agitation, and delirium. Frequently used medicines include opioids such as morphine or fentanyl and midazolam, all of them listed as ICEMs. This paper describes the issues related to the lack of availability and limited access to ICEMs during the COVID-19 pandemic in both intensive and palliative care patients in countries of all income levels and makes recommendations for improving access.
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Affiliation(s)
- Katherine Pettus
- International Association for Hospice and Palliative Care, Houston, Texas, USA.
| | - James F Cleary
- Walther Center for Global Palliative Care, Indiana University, Indianapolis, Indiana, USA
| | - Liliana de Lima
- International Association for Hospice and Palliative Care, Houston, Texas, USA
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Bakitas M, Allen Watts K, Malone E, Dionne-Odom JN, McCammon S, Taylor R, Tucker R, Elk R. Forging a New Frontier: Providing Palliative Care to People With Cancer in Rural and Remote Areas. J Clin Oncol 2020; 38:963-973. [PMID: 32023156 DOI: 10.1200/jco.18.02432] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Mounting evidence supports oncology organizations' recommendations of early palliative care as a cancer care best practice for patients with advanced cancer and/or high symptom burden. However, few trials on which these best practices are based have included rural and remote community-based oncology care. Therefore, little is known about whether early palliative care models are applicable in these low-resource areas. This literature synthesis identifies some of the challenges of integrating palliative care in rural and remote cancer care. Prominent themes include being mindful of rural culture; adapting traditional geographically based specialty care delivery models to under-resourced rural practices; and using novel palliative care education delivery methods to increase community-based health professional, layperson, and family palliative expertise to account for limited local specialty palliative care resources. Although there are many limitations, many rural and remote communities also have strengths in their capacity to provide high-quality care by capitalizing on close-knit, committed community practitioners, especially if there are receptive local palliative and hospice care champions. Hence, adapting palliative care models, using culturally appropriate novel delivery methods, and providing remote education and support to existing community providers are promising advances to aid rural people to manage serious illness and to die in place. Reformulating health policy and nurturing academic-community partnerships that support best practices are critical components of providing early palliative care for everyone everywhere.
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Affiliation(s)
| | | | - Emily Malone
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | - Ronit Elk
- University of Alabama at Birmingham, Birmingham, AL
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