52. Pain Control for People with Cancer and AIDS

Palliative care has developed in Romania since the early 1990s, largely through the Romanian Association for Palliative Care. Support has come predominantly from U.K. charities and from the Open Society Institute. Services are provided throughout the country by paid staff and volunteers in 10 hospital-based inpatient services, 9 hospice home care teams, 2 day care services, and 1 palliative care training center that provides services. Coverage is still low: only 15 percent of cancer patients are treated with opioid analgesics. Morphine is available (paid for by the government) only for terminally ill cancer patients. Prescription restrictions and extra authorization needed for releasing morphine to each patient are still so burdensome that patients may die before the paperwork is completed. The situation is improving gradually, however.

Palliative care has developed in Chile over the past 15 years, largely through nongovernmental organizations. The Ministry of Health's cancer program has also played a role by including palliative care in its National Cancer Control Program initiative and by moving to reform drug laws. As a result, morphine consumption increased from less than 5 kg in 1990 to 55 kg in 2000. Despite these efforts, only a minority of patients have access to oral morphine for chronic pain related to cancer or AIDS. The remaining barriers include inadequately trained clinicians, a lack of national standards and guidelines, cure-oriented cancer treatment policies, fear of addiction on the part of both professionals and the public, and a lack of resources to improve the health care infrastructure.

Sources: International Observatory on End of Life Care 2005.