Palliative care as a part of national cancer control plan in Uzbekistan – first steps towards the solution

Abstract

Background: Palliative care is an integrated part of cancer patient care. However, the situation in palliative care in Uzbekistan is very critical. Morphine consumption of 0.08 mg per capita is a direct indication of painful deaths in this country. Method(s): We have created a questionnaire which evaluates the general health condition and health status of the patients. Simultaneously, we have created questionnaire for doctors to evaluate the status of their knowledge in palliative care. 500 patients from cancer centers, at different stages of disease, and 82 oncologists were surveyed. The survey for patients included physical pain status, psychological condition of the patient and self-evaluation of quality of life. Survey of doctors included evaluation of patient's pain status, patient's mood and knowledge of pain control. Result(s): Patients were in pain throughout the whole course of disease. Patients in late stages had suffered from pain more than patients in early stages. Physical pain after surgery noted in all patients the mean pain status was 5.7. Mostly, NSAIDs in combination with H1 blockers were used to cope with pain, paracetamol was used only in one patient. Narcotic analgetics (nalbuphine, tramadol, promedole morphine) were used mostly during surgery, rarely in patients with stage IV disease and in postoperative period. Most of the patients noted emotional fatigue and depression. However, the predominant number of patients did not know their diagnosis and possible prognosis. More than half of the doctors (47-57.3%) knew the principles of step by step analgesia. But only a few (2-2.43%) used it in their day-to-day practice. The reasons for opiophobia were unwillingness of filling in different forms as well as utilization of empty ampulas, fear of dependency and incorrect evaluation of patient's pain status. Conclusion(s): Creating 15 departments of palliative care and 4 hospices throughout the country are implemented in NCCP. All above mentioned institutions will have mobile palliative care units. Protocols of palliative care and adequate pain control, simplifying the drug administration as well as development of education are being developed according to international standards.