Cancer pain management in low-resource settings

Cancer pain remains a significant issue impacting the lives of many cancer patients. "Freedom from cancer pain" has remained at the top of the World Health Organization ladder. Many advances have been made in this treatment, allowing our patients to get closer to this goal. These include non-pharmacologic, pharmacologic, and interventional modalities. However, there remains a high level of variability worldwide in the availability and application of these treatment modalities. There exist many low-resource settings in which differences in facilities, training, and availability of supplies lead to limitations in the treatment of cancer pain. This can occur in certain populations such as minorities, as well as countries with low and middle incomes. Numerous challenges exist in these low-resource settings, ranging from lack of infrastructure in regard to healthcare facilities and availability of equipment, to insufficient training of healthcare personnel to properly assess and treat cancer pain, to systematic barriers preventing adequate access to certain medications used in the treatment of cancer pain. Opportunities also exist in these low-resource settings to improve access to care and thereby improve the treatment and quality of life of many cancer patients. These range from systematic improvements in the construction and maintenance of appropriate facilities, improved training of healthcare personnel, local and national advocacy for the treatment of cancer pain, and improved access to medications and supplies. In this chapter, we highlight the etiologies and treatments of cancer pain as well as the challenges and opportunities that exist in low-resource settings.