China India RussianFederation
Nigeria Indonesia Pakistan Bangladesh Philippines Mozambique Egypt0
100k
200k
300k
400k
500k
600k
700k
canceratlas.cancer.org
0 1 - 1 , 5 9 8 1 , 5 9 9 - 5 , 2 7 05 , 2 7 1 - 1 3 , 6 0 41 3 , 6 0 5 o r m o r eN o d a t a
High Income
Middle Income
Low Income
High Income
Middle Income
Low Income
High Income
Middle Income
Low Income
canceratlas.cancer.org canceratlas.cancer.org
32 TAKING ACTION
FIGURE 32.3
Untreated deaths in pain by region, 2016
Essential medicine lists of the World Health Organization and many countries include opioid analgesics, such as morphine. The moderate or severe pain experienced by approximately 80% of people with advanced cancer cannot be relieved without them.
But access to opioid analgesics is limited in low- and middle-income countries, where 85% of the world’s population consumes just 7% of the medicinal opioids. FIGURE 32.2 Legal and regulatory restrictions, cultural misperceptions about pain, inadequate training of healthcare providers, poorly functioning markets, weak health systems, and concern about addiction and non-medical use all contribute to limited access, even though morphine, the most effective treatment for severe pain, is safe, effective, inexpensive, and easy to use.
Meanwhile, some high-income countries are dealing with a very different challenge related to pain relief, as rates of addiction continue to rise due to harmful and non-medical use of opioids.
Worldwide, the number of cancer patients in need of pain relief is projected to increase 48% from 2018 to 2035, but the increase is likely to be considerably higher in the regions with more rapidly increasing cancer rates and with the lowest access to pain relief, including South-Eastern Asia (projected 54% increase in cancer cases) and Africa (72% increase), where consumption of pain relief is sufficient to cover less than 25% of deaths in pain.FIGURE 32.3 A balanced approach to access to opioids with sufficient measures to prevent harmful and non-medical use has been achieved by many Western European countries and in some low- and low-middle income countries.
PAIN CONTROLMillions of cancer patients, almost entirely in low- and middle-income countries, lack access to essential pain medicines.
FIGURE 32.1
Untreated deaths in pain due to HIV and cancer, 2016
FIGURE 32.2
Total cancer and HIV deaths in pain and those treated for pain, by income level, 2016
Almost all untreated deaths in pain due to cancer and HIV are in
low- and middle-income countries.
Three quarters of untreated deaths in
pain occur in just ten countries
The greatest numbers of untreated deaths in pain are in East
Asia and the Pacific; South Asia; and sub-Saharan Africa.
East Asia & Pacific
South Asia
Sub-Saharan Africa
Europe & Central Asia
Latin America & Caribbean
Middle East & North Africa
North America*
Treated deaths in pain, based on opioid consumption
Total deaths in pain due to cancer or HIV, treated and untreated 651,867
*Zero untreated deaths in pain in North America, 2016.
2
41K 1
09K 95K 921K
578K
714K
The Pain-Free Hospital Initiative, a one-year hospital-based
health worker training initiative designed to improve the
quality of pain assessment and treatment, resulted in a tripling
of the use of essential pain medications and a
25% decrease in average pain scores in the oncology unit after
being implemented at Kenyatta National Hospital
in Nairobi, Kenya.
ACCESS CREATES PROGRESS
HIGH INCOME
99.9%
57%
17%
MIDDLE INCOME
LOW INCOME
2,094,499 Total deaths
5,306,664 Total deaths
3,022,701 Treated deaths
76,163 Treated deaths
2,091,578 Treated deaths
447,538 Total deaths
Improved access to oral morphine is mandatory for the treatment of moderate to
severe cancer pain, suffered by over 80% of cancer patients in terminal phase.
— World Health Organization
“86% of untreated deaths in pain are in middle-income
countries.
copyright © 2019 the american cancer society, inc.
13,605 or more No data5,271–13,6041,599–5,270Zero 1–1,598
MAP 32.1
Untreated deaths in pain, 2016
JordanMorocco
MauritaniaMali
Niger
Nigeria
Chad Sudan
South Sudan
Ethiopia
Eritrea
Somalia
Sri Lanka
Senegal
Guinea
Cameroon
Central African Rep.
Ghana
GabonCongo
Rwanda—
AngolaZambia
Malawi
Zimbabwe
Botswana
Namibia
S. Africa
UgandaKenya
Tanzania
—Burundi
Burkina Faso
Benin
|Togo
Côte d’Ivoire
Gambia—
Guinea-Bissau
Sierra Leone
Liberia
AlgeriaEgypt
Kazakhstan Mongolia
China
Australia
IndiaSaudi Arabia
Libya
Armenia—
Lebanon—
Maldives—
—IsraelKuwait—
Syria
GeorgiaAzerbaijan
Turkmenistan
Afghanistan
Pakistan
Uzbekistan
Tajikistan
Japan
Philippines
Kyrgyzstan
—Lesotho
—Comoros
— Mauritius
—Djibouti
—QatarBahrain—
UAE
Oman
Nepal
Bangladesh
Bhutan
DPR Korea
Rep. Korea
Myanmar
Thailand
Cambodia
Viet Nam
Lao PDR
Yemen
Iraq
Kuwait—
New Zealand
Indonesia
Singapore—Malaysia
—Eswatini
Turkey
Cabo Verde |
Equatorial Guinea—Sao Tome & Principe—
Madagascar
— Seychelles
Brunei Dar.—
—Timor-Leste
Fiji—
Samoa—Vanuatu—
Solomon Is.|
United Kingdom
Ireland
Iceland
Portugal
Tunisia
Spain
France
Belgium
Netherlands |
Denmark
Norway
Sweden
Finland
Germany
Croatia
Poland
Bulgaria
Romania
Ukraine
Belarus
Lithuania Latvia
Estonia
GreeceItaly
Slovenia—
Slovakia
—Malta
Swit.
Andorra— | Monaco
Lux.— Czechia
Serbia
MoldovaAustria Hungary
Albania
Montenegro—N. Macedonia
Bos. & Herz.
Russia—
Papua New Guinea
Tuvalu—
—Palau | Micronesia
|Marshall Is.
|Kiribati
Nauru|
Tonga— Cook Is.—Niue—
Russia
Palestine—
DR Congo
IranCyprus—
Canada
Mexico
—Belize
GuatemalaHonduras
| El Salvador Nicaragua
Costa Rica
Panama
Colombia
Ecuador
Peru
Bolivia
Brazil
Paraguay
Uruguay
Argentina
Chile
Venezuela
Haiti
Guyana
Suriname
United States of America
Jamaica—
—Barbados—St. Lucia
|
Dominica
—Antigua & Barbuda
| St. Kitts & Nevis
—Grenada—Trin. & Tob.
St. Vin. & Gren.—
| Dominican
Rep.
Cuba
—Bahamas
Mozambique
