Professor Julia Downing, IAHPC Board Member, was in Melbourne, Australia, for the UICC (Union for International Cancer Control) congress on 3-6 December. Here, she reflects on some of the key palliative care issues discussed.
Prof Julia Downing
As December began, I was excited to be in Melbourne for the Clinical Oncology Society of Australia’s (COSA) Annual Scientific Meeting and the UICC World Cancer Congress, as I had been invited to speak and it was a privilege to be able to attend and speak about palliative care.
Two thousand seven hundred participants from 115 countries attended the World Cancer Congress, with 350 speakers presenting over three days at 120 sessions. Thus the challenge was how to make the most of the conference, fit in all the different sessions that I wanted to attend, and meet all the people that I needed to meet! Palliative care was on the agenda throughout, with a separate track looking at cancer survivorship and palliative care and an opening plenary, given by Prof. Irene Higginson, addressed the issue of ‘Sustainable models of palliative care in cancer: Is integration the answer?’
Before the conference, the World Cancer Leaders’ Summit focused on the case for investment in different aspects of cancer control. Within palliative care the importance was stressed of framing our approach to palliative care to take account of human rights, equity and health systems strengthening. Global disparities in access to palliative care were highlighted, in particular the lack of access to medicine for moderate to severe pain. This theme continued throughout the main cancer congress, initially through a session looking at ‘Cancer pain across the world: Global efforts to define and meet the challenges’. The session explored the issue, and presented some of the findings from different studies and ongoing work in this field. Dr. James Cleary set the scene by discussing the global crisis of unrelieved pain. He discussed the history of pain relief; in particular the use of opioids and the legal framework that has developed around their use, and the importance of balance so that drug control measures do not interfere with medical access to opioids.
Dr. Nathan Cherny then shared some of the findings of an international collaborative project to evaluate the availability and accessibility of opioids for the management of cancer pain in Africa, Asia, Latin America and the Middle East. He addressed issues such as formulations and cost, actual availability of seven essential opioids, eligibility restrictions, who can prescribe and for how long, and restrictions in dispensing the medications and within the pharmacy. Finally, I discussed different global initiatives addressing the problem of inadequate cancer pain relief, including the work of IAHPC through the Opioid Price Watch project, which aims to improve access to strong opioids for legitimate medical use through the dissemination of information on their prices, availability and affordability.
This theme was continued in a panel discussion held the following day addressing ‘Global and local steps to shaping a health systems approach to palliative care and pain relief as a core component of NCCP (National Cancer Control Programme)’. The session focused on attempts to improve access to pain management and continued the discussions from the previous day. Similarly, a sub-plenary run by the International Children’s Palliative Care Network (ICPCN) addressed the issue of accessibility to palliative care medications for children, exploring the evidence for pain management in children.
Thus, as I reflect on the World Cancer Congress, and the different aspects of cancer control discussed, it is important that we continue to strive for increasing accessibility to palliative care throughout the world, in order to improve the quality of life of those who need it.
Prof Julia Downing, Email: [email protected]
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