Annals Of Oncology

Annals Of Oncology

Annals Of Oncology

For patients with cancer, and especially those with advanced and incurable cancer, adequate relief of pain is the central goal of care. Indeed, adequate relief of pain is now recognized as a patient right . This right implies duties; the duties of clinicians to assess pain and to treat it in accordance with the best of contemporaneous practices (that prevailing resources will enable) and duties of governments and health care regulatory systems to ensure that patients can access the medications needed to relieve pain.

Opioid analgesics are critical to the effective relief of cancer pain. Effective treatment is predicated on sound assessments, individually tailored analgesic therapy and the availability and accessibility of the required medications. In some countries, pain relief is hampered by lack of availability or barriers to accessibility of opioid analgesics. In many countries, excessively zealous or poorly considered laws and regulations to restrict the diversion of medicinal opioids into illicit markets profoundly interfere with the medical availability of opioids for the relief of pain. Often, the logistics of the treatment of pain with opioids is so burdensome or complex for physicians, nurses and pharmacists as to be a major disincentive to involvement.

These burdens are compounded for patients and their families who, in many situations, must cajole doctors, chase after permits, wait excessively in inconveniently located pharmacies and return for frequent refills of prescriptions or any correction on a prescription that may not have been written with adequate attention to required details. In some countries, the degree of legal intimidation is such that fear of criminal prosecution contributes to deliberate undertreatment by clinicians to avoid risk of persecution or prosecution.

The consequences for health care professionals, patients and their families are manifold and profound. Excessive regulatory restrictions make it near impossible for many Europeans to achieve relief of cancer pain that undermines their quality of life. These issues are reflected in substantial differences in opioid consumption between European countries and in profound differences in morphine consumption between Western and Eastern European countries. It is a public health travesty that many patients in Europe do not receive adequate relief of pain because of poorly considered regulations and deficiencies in public policy. These issues have been highlighted in a review of the barriers to the development of palliative care in Eastern Europe

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