Palliative Care Experience In Breast And Uterine Cervical Cancer Patients In Ibadan, Nigeria

摘要

Introduction: World Health Organisation defined palliative care as an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care is a newly emerging field of health care with little or no documentation of its services in Nigeria. With the establishment of the first hospice and palliative care unit in University College Hospital (UCH), Ibadan, patients have had access to palliative care since the last three years .The purpose of this study is to evaluate the pain management and palliative care services accessed by patients with advanced cervical and breast cancer. Methodology: This is a retrospective study reviewing treatment notes of all patients with advanced uterine cervical and breast cancer that received palliative care at the newly established Hospice and Palliative Care Unit of University College Hospital(UCH), Ibadan, from June 2008 to December 2010. Informatiom retrieved included dermography, histological diagnosis, patients symptoms (Pain and other symptoms) on presentation, Palliative measures applied including medications, assessment of response to care, assessment of level of satisfaction to care provided. Results: In the period under review, 178 patients with advanced uterine cervical (80) and breast (98) cancers were seen. The age range for the two groups of patients was 17 to 96 years; mean age was 55 and 54 for cervical and breast cancer respectively. 93.82% of patients had pain as one of their symptoms at presentation to palliative care team with over 80% having pain scores indicating mild to severe pain. Most commonly used pain relief drug was liquid morphine (58.43%). 65.75% of those who accessed care were resident outside Ibadan and financial constraint was the most reported psychosocial issue (24.16%). At the time of this review, 65 (36.5%) have gone back to their respective home base from where they were referred, 102 (57.3%) were reported dead while 11 (6.2%) were still in the care of the palliative care team. Conclusion: Pain is a major symptom at presentation for the majority of those that accessed the palliative care services. Most of those who accessed these services were resident outside Ibadan indicating additional travel cost to receive treatment. There is a need to adopt a palliative care model suitable for resource poor environment that would be available to the patients near their homes to avoid long distance travel to access palliative care services and reduce the cost of treatment on the long run. Introduction The occurrence of cancers in Africans was once believed to be rare due to the high prevalence of communicable diseases. Parkin et al reported that in indegenous African population 650,000 people of the estimated 965million are diagnosed of cancer annually1. WHO reported that worldwide 12.5% of all deaths are attributable to cancer and if the trend continues, it is estimated that by 2020, 16million new cases will be diagnosed per annum out of which 70% will be in the developing countries2. The relative frequencies of breast cancer among other female cancers, from Cancer Registries in Nigeria were 35.3% in Ibadan,28.2% in Ife-Ijesha, 44.5% in Enugu,17% in Eruwa, 37.5% in Lagos, 20.5% in Zaria and 29.8% in Calabar3. Breast cancer is the commonest cancer among women in Nigeria and the incidence is increasing5. Cervical cancer on the other hand is the second most common cancer among women worldwide, with an estimated 529,409 new cases and 274,883 deaths in 2008 with about 86% of the cases occurring in developing countries 6. It is one of the few preventable cancers since it has a clear pre-cancer stage 7. Despite the preventable nature of this cancer, it is still a major public health problem found mostly among poor co