GENEVA: On 31 January 2019, ahead of World Cancer Day (4 February), the World Health Organization (WHO) released new guidance on managing cancer pain, with a view to improving the health sector response and ending the needless suffering of cancer patients.
Around the world, pain is experienced by more than half (55%) of patients undergoing treatment for cancer and two thirds (66%) of people with advanced or terminal cancer.
Cancer is among the leading causes of death and illness, responsible for 18.1 million new cases and 9.6 million deaths in 2018. Globally, about 1 in 6 deaths is due to cancer, with roughly 70% of deaths from cancer occurring in low- or middle-income countries, where access to pain relief is not always available.
“Controlling pain should be an essential part of cancer treatment,” notes Dr Etienne Krug, Director of WHO’s Department for the Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention. “When pain is managed effectively, people can enjoy time with family and friends, rest better and continue many of their daily activities, like work, school and play. No one should live or die in pain.”
The WHO Guidelines for the pharmacologic and radiotherapeutic management of cancer pain in adults and adolescents provide evidence-based guidance to health-care providers on appropriate approaches to the medical and radiotherapeutic management of cancer pain. This includes guidance on the:
- choice of analgesic medicines (painkillers)
- use of adjuvant medicines (steroids)
- specific techniques for treating pain from bone metastases (bisphosphonates and radiotherapy).
The recommendations take into account the balance of benefit and harm of each intervention, the values and preferences of patients, and the costs and resource use and other practical issues, in particular for health care providers in low- and middle-income countries. These interventions are best implemented as part of an integrated care plan.
Opioids painkillers like oral morphine are an essential treatment for moderate to severe cancer pain. Even though oral morphine is on the WHO Model Lists of Essential Medicines, in 2018 only 6% of low-income countries reported it was generally available in primary care facilities, while 67% of high-income countries did so.
While cancer patients in most countries suffer from inadequate access to such medicines, opioid overuse is a concern in some parts of the world. As such appropriate stewardship of opioid analgesic medicines in the cancer treatment setting is essential to ensure the safety of patients and nonpatients and to reduce the risk of diversion of medicine into society.
Through the dissemination and use of the WHO Guidelines for the pharmacologic and radiotherapeutic management of cancer pain in adults and adolescents, it is hoped that access to effective and safe pain relief will increase and that millions of people suffering from cancer pain will receive the care to which they have a right.
WHO Guidelines for the pharmacologic and radiotherapeutic management of cancer pain in adults and adolescents
WHO management of cancer
WHO Model Lists of Essential Medicines
WHO palliative care