Inadequate information on translating guideline recommendations into clinical practice; resource limitations; lack of education of healthcare providers (HCPs)/policymakers/patients are factors contributing to the gap between best practices and actual clinical practice in cancer pain management (CPM). To address these gaps and optimize CPM in resource-limited settings (R-LS), we propose a two-step initiative – the development of practical resource-based CPM algorithms, and an education and advocacy framework to support effective implementation of the algorithms in R-LS.
The CAPER WG–a global, multidisciplinary consortium of oncologists, pain specialists, and palliative care experts–has developed an education and advocacy framework for improving CPM in R-LS, stemming from literature review and a workshop held in February 2017.
We developed CPM algorithms incorporating guideline recommendations and expert opinion, applying a hierarchy of resource-based constraints to provide HCPs a tailored approach to manage patient needs. To support the implementation of these CPM algorithms, we formulated a framework comprising an educational program, pilot implementation, and an advocacy plan. The educational framework provides HCPs with clinically-relevant information, emphasizing the practical element of translating knowledge into practice and illustrating how optimal CPM can be provided despite resource limitations. Pilot implementation studies are essential to demonstrate the effectiveness of the algorithms and the educational program; the results will allow algorithm refinement, optimization of implementation strategies and development of advocacy plans. A strategic advocacy plan is imperative to achieve our ultimate goal of optimizing CPM in R-LS; effective advocacy will drive collaborative and multifaceted efforts amongst key stakeholders to ensure improvement of resource access and availability.
The proposed framework for education and advocacy can guide the translation of our resource-based CPM algorithms into clinical practice in all settings, ultimately providing optimal CPM for all patients despite differential resources.
Clinical trial identification
Legal entity responsible for the study
CAPER Working Group
Mundipharma Pte Ltd
M.J. Bautista: IS a member of the Advisory Board and Expert Panel of Mundipharma Philippines and Mundipharma's Speakers' Bureau; has co-authored international research sponsored by Mundipharma; and has received remunerations for lectures given. S.H. Ahmedzai: has received payments for conducting research, giving educational lectures and taking part in advisory boards with Astra Zeneca, Grunenthal, Kyowa Kirin and Mundipharma. S. Hattori: has served in a advisory role for Terumo Inc, Shionogi Co., and Hisamitsu Co. D.C. Kraychete: serves on the Latin America Board of Grunenthal Group. D.H. Lee: has received honoraria from AstraZeneca, Boehringer-Ingelheim, Bristol-Myers Squibb, CJ Healthcare, Eli Lilly, Jansen, Merck, MSD, Mundipharma, Novartis, Ono, Pfizer, Roche, Samyang Biopharm and ST Cube for participating in advisory boards; consulting fees from Ministry of Food and Drug Safety (MFDS) Korea, Health Insurance Review and Assessment Service (HIRA) Korea, National Evidence-based Collaborating Agency (NECA) Korea, and National Cancer Control Planning Board Korea. K. Tamura: has received remunerations for lectures from Kyowa Hakko Kirin Co. Ltd., Ono Pharmaceutical Co. Ltd., Eli Lilly Japan K.K.
All other authors have declared no conflicts of interest.