緩和ケアと医学

抽象的な

Analysis of Socio-Economic Disparities on the Outcome of Pain Management in Cancer Patients in Middle Eastern Countries

Mazin Al-Jadiry, MD, Hasanein Ghali, MD, Samaher Razaq Fadhil, MD, Glynis J. Katz, RN, MA, Loai Abu-Sharour, PhD, Suha Omran, PhD, Mohammad Al-Qadire, PhD, Hani Ayyash, MD, PhD, Ibtisam Ghrayeb, RN, Memeh Manasrah, RN, MSN, Azza Hassan, MD, Khaled Khader, PhD, Nahla Gafer, MD, Nesreen Alalfi, MsC, MsC, Gamila Ahmed, PsyD, Gulbeyaz Can, PhD, RN, Rejin Kebudi, Rejin Kebudi, MD, Ayfer Aydin, RN, PhD, Gonca Tuncel, MD, Gulcin Ozalp-Senel, MD, Fusun Terzioglu, RN, MSc, PhD, Elon Eisenberg, MD, Michael Silbermann, DMD, PhD, Michael Thomas MD, Boris Futerman, Haris Charalambous, MD, Sophia Nestoros, MD, M. Pall, Rasha Fahmi, MD, Mohamed Hablas, MD, Maryam Rassouli, PhD, Layth Mula-Hussain, MB, ChB, CCI, MSc, JB, EF, Safa Faraj, MD, Salma Al-Hadad, MD

Background: Cancer incidence in the Middle East is predicted to increase significantly in the near future. In recent years, some progress has been achieved in providing palliative care to cancer patients; throughout this part of the world, pain management is a more complex issue, ascribable to local traditions and beliefs which put a greater emphasis on the psychological, emotional and spiritual aspects of suffering. Socio-economic factors further contribute to the complexity of the problem in lower-middle income countries in the region.

Objective: To further analyze the barriers related to pain management, while comparing high- income, highermiddle income and lower-middle income countries (according to the World Bank categories) in the Middle East.

Design: Statistical analysis of a regional survey.

Setting/Subjects: Thirteen countries in the Middle East; the sample of 604 individuals was comprised of physicians, and pharmacists; employed in various health care settings.

Results: 64.19% of respondents in high-income countries achieved satisfactory outcomes, whereas only 52% achieved satisfactory outcomes in lower-middle income countries. This disparity can be associated with various economical factors, such as lack of resources; however, while analgesics cannot fully control pain in its entirety,patients would certainly benefit from them, and the usage of these analgesics is diminished by the cardinal role that religion and culture play in pain management in these countries.

Conclusion: Cancer pain management should focus much more on the emotional and spiritual aspects of patients’ suffering as patients lend great importance to their religious beliefs and traditions. The poorer they are, the more connected and devoted they are to a religious lifestyle.