 |
updated:
17 March 2007
WHO
publication
"Comprehensive
Cervical Cancer Control" a guide to essential practice
In
2004, the WHO Department of Reproductive Health and Research
asked me to participate to the Technical Advisory Group (TAG)
as EAPC palliative care expert in order to work on the realisation
of the guide to essential practice.
The 46 TAG members were representing the following associations:
WHO Department of Reproductive Health and Research, WHO Department
of Chronic Diseases and Health Promotion, International Agency
for Research on Cancer, Pan American Health Organization,
Alliance for cervical cancer prevention, International Atomic
Energy Agency, International Federation of Genecology and
Obstetrics, International Gynecologic Cancer Society and EAPC.
The TAG group met 2 times 3 full days at the WHO, in Geneva
and a complete process of reviewing several drafts went on.
Many reviewers assisted in field-testing the guide in China,
Egypt, India, Lithuania, Trinidad and Zimbabwe.
Françoise Porchet
Francoise.Porchet@chuv.ch
The
58th World Health Assembly resolution on global cancer control
– implications for Palliative Care
In
May 2005, The 58th World Health Assembly adopted a resolution
on cancer prevention and control which will clearly place
cancer care on the health agenda for the future. The World
Health Assembly, or body of international experts who propose
key targets on which The World Health Organisation should
focus its efforts, agreed this resolution on May 25th 2005
in Geneva, Switzerland. The resolution calls for action by
the W.H.O and member states to address the increasing burden
of disease due to cancer and emphasizes the reinforcement
of national programmes which include early detection, prevention,
improved treatment and palliative care. To meet this need,
the Director General of the W.H.O has advocated a global cancer
control strategy which translates cancer control knowledge
into public health action, provides a sound evidence-base
for best practice and the development of dedicated support
groups to ensure the administration and implementation of
the strategy. These expert groups will work in an advisory
capacity at the national and international level to prepare
reports and technical working papers relative to the overall
strategy.
Palliative
Care remains a visible force within the agenda and its inclusion
as an integral part of the overall global programme indicates
a growing international view of its importance in the delivery
of health care. It is clear from this resolution and other
W.H.O briefings that for the majority of cancer patients in
the world, their first meeting with a medical professional
is usually when their disease is already in the advanced stages.
The broad multidisciplinary approach advocated in palliative
care is seen by the W.H.O as a way of addressing not only
the clinical but psychological and social burden of cancer
care. It can be implemented in resource-poor situations, relatively
simply and inexpensively and substantially improve quality
of life for patients and families. In the global context,
given limited access to treatment and late presentation to
medical services as already suggested, palliative care may
be the realistic option for many people and therefore is considered
integral and not an adjunct to, cancer control practice.
Despite
the evident benefits of this approach, the report also indicates
the significant barriers which impact on implementation. In
point 9 of the Cancer Control report
( EB114/3) which forms the base for this resolution, the problems
facing palliative care development are outlined; lack of political
will, insufficient education and information to the general
public and health care providers. Despite the clear evidence
that morphine remains the gold standard for pain relief and
may be administered safely and with relatively little expense,
excessive and unnecessary regulation of opioids still prevents
its use where it is most needed. Notably, this does not only
apply to resource-poor countries and challenges palliative
care providers to strengthen the agenda for palliative care
at the political level.
The
resolution which has been adopted has clear resonance for
those of us involved in the delivery of palliative care in
all its varied disciplines and levels. The report calls on
us to recognize the suffering of cancer patients and families
and the burden, both personally and economically, it places
on them. It states that palliative care is not simply an additional
support service to cancer care, but “an urgent, humanitarian
responsibility” (EB114/3 pg 4). It calls on its member
states to develop systematic and equitable strategies which
incorporate palliative care as a key element in the continuum
of cancer care. The evaluation of such programmes is essential
to ensure sustainability where resources are limited and need
to be used to the benefit of an entire population and not
just a limited group within. Finally, it urges compliance
with W.H.O strategies for the provision of essential drugs,
including opioids, to reach at least a minimum standard in
each local situation.
The
message of this resolution is clear. Partnership between active
and palliative treatment programmes is an essential requirement
for life quality and health policy in cancer care. The E.A.P.C.
has always recognized this link and supported W.H.O initiatives
through our work through the Council of Europe. The expert
skills of Board members who link with W.H.O on palliative
care matters, notably Professor Stein Kaasa from Norway have
also contributed to this. Then fact that this resolution recognizes
that the implementation of palliative care is an issue for
highly-resourced countries as well as resource-poor ones calls
for a political stratagem which supports the idea of “One
Voice-One Vision” for all people who are in need of
palliative care. The forthcoming International Hospice and
Palliative Care day on October 8th affords one opportunity
to address the political agenda and should be an ideal opportunity
to make a stance in support of the 58th World Health Assembly
resolution.
Further
information about this resolution can be obtained from:
http://www.who.int/mediacentre/news/releases/2005/pr_wha05/en
http://www.who.int/nmh/a5816/en
Philip J Larkin
EAPC Vice-President.
Access
to Controlled Medications Programme WHO
Briefing note
Quality
Assurance and Safety: Medicines, Department of Medicines Policy
and Standards
Health Technology and Pharmaceuticals, World Health Organization
Contact: Dr Willem Scholten — Tel.: +41 22 791 5540. Email:
scholtenw@who.int
http://www.who.int/medicines/areas/quality_safety/sub_Int_control/en/index.html
|
