PALLIATIVE CARE- 2015, ORLANDO
SUPPORTING ADULT CANCER PATIENTS IN
IBADAN, NIGERIA.
PROF. OLAITAN A SOYANNWO , DR. OLADAYO
AIKOMO & OLOLADE MABOREJE RN, BSc
HOSPICE & PALLIATIVE CARE UNIT, UNIVERSITY COLLEGE
HOSPITAL, IBADAN & CENTRE FOR PALLIATIVE CARE, NIGERIA
Greetings from---Nigeria, University College
Hospital, Ibadan & Centre
for Palliative Care, Nigeria
team
2
Nigeria
•
•
•
•
•
Largest country in Africa
Population 170 million
250 cultural tribes
36 States + FCT
Religion : Islam(50.5%).
Christianity(48.2%),
Others(1.4%).
• Low MDGs despite oil
wealth!
• Health agenda at Federal and
State levels
• Emphasis on communicable
disease prevention/treatment
• NCDs and Pain issues emerging
area of interest
• Bulk of health funding is borne by
households (out of pocket
payment)
SOYANNWO O A 2015
3
Cancer
• One of the leading causes of adult death.
• Recent new cases of cancer diagnosed in
Africa in 2008 and Nigeria in 2010 is 715,000
and 500,000 respectively. [1]
[1] Jemal A, Bray F, Forman D, O’Brien M. Ferlay J, Center M, Parkin
M. Cancer burden in Africa and opportunities for prevention.
Cancer. 2012; 118(18):4372-4384
SOYANNWO O A 2015
4
Palliative care in Nigeria
• Advocacy commenced in 1991
• Few trained health professionals (mainly at Hospice
Africa Uganda)
• 8 functional palliative care centres in tertiary
hospitals
• No stand alone Hospice
• Hospice and Palliative care association ( HPCAN)
inaugurated in 2007
• Opioid availability and accessibility problematic
SOYANNWO O A 2015
5
Day care Hospice and Palliative care
centre, UCH, Ibadan
• Established in collaboration
with Centre for Palliative
Care, Nigeria (CPCN), an
NGO in 2007.
• Structured services
commenced in 2008.
• Team of trained palliative
care staff - doctors, nurses,
social worker, admin staff
and volunteers
SOYANNWO O A 2015
6
STUDY OBJECTIVES
• To review palliative care services offered to
caner patients by the Hospice and Palliative
care Unit of the University College Hospital
(UCH), Ibadan
• To identify challenges
• Review outcome of service
• Proffer way forward
SOYANNWO O A 2015
7
Methodology
• Retrospective study of patients seen over a
period of one year (January – December
2013)
• Information retrieved from case files include
bio-data, stage of cancer, presenting
complaints, palliative care issues identified,
services rendered, days on programme,
outcome and challenges encountered.
• Data shown in a simple descriptive format.
SOYANNWO O A 2015
8
Results
• Total number of patients seen at the hospice
during study period 189.
• Adult cancer patients = 121 ( 64%)
• Stage of disease – Advanced (96.7% stage IV)
• Male : Female = 1:1.8
• Religion = Muslim 67(55%) Christian 54(45%)
• Age range = 21-91years( Mean age= 59 (SD+/-15)
• Days on programme ranged from 5-224 days.
SOYANNWO O A 2015
9
Results
• AGE DISTRIBUTION
Age( Years)
N
%
18-35
11
9.1
36-53
24
19.8
54-71
78
64.5
72-89
5
4.1
>90
3
2.5
121
100.0
Total
SOYANNWO O A 2015
10
Diagnosis
Diagnosis
N
%
Breast carcinoma
29
23.9
Gastrointestinal cancers
24
19.8
Prostatic carcinoma
17
14.0
Cervical carcinoma
14
11.6
Other gynae-oncological
carcinoma
12
9.9
Head/neck cancers
12
9.9
Blood cancers
4
3.3
Lung cancers
4
3.3
Other urological cancers
3
2.5
Osteosarcoma
2
1.7
Peripheral nerve sheath tumor
1
0.8
121
100.0
Total
11
Palliative care issues identified
Palliative care
issues
Number of
patients
% (n =121)
Psychosocial +
Pain
79
65.3
Psychosocial +
spiritual + Pain
53
43.8
Spiritual + Pain
37
30.6
Unconscious
12
9.9
SOYANNWO O A 2015
12
PAIN : 89/121(73.6%).
Number of pain site (s)
Pain score (NRS)
Number of
pain site(s)
Pain score
N
%
N
%
1
70
79
1-3
0
0
2
12
13
4-7
62
70
>3
7
8
8-10
27
30
Total
89
100
Total
89
100
SOYANNWO O A 2015
13
Other symptoms
Symptoms
Number
of patients
% (n= 121)
Weight loss and
anorexia
86
71.07
Nausea ,vomiting
and dry mouth
65
53.7
Weight loss and
cough
38
31.4
Nausea and
anorexia
24
19.8
SOYANNWO O A 2015
14
Pain and other symptoms control
80 (90%) had their pain controlled.
MEDICATIONS
Medications
OTHER MODES OF TREATMENT
N
%
Strong opioid+
NSAIDs + adjuvant
54
61
Weak opioids +
adjuvant
19
21
NSAID + non-opioid
10
11
6
7
89
100
Weak opioids +
NSAID
Total
Modes of treatment
N
%
Chemo -radiotherapy
42
35
Radiotherapy
27
22
Chemotherapy +
surgery
27
22
Chemotherapy
12
10
Surgery + chemoradiotherapy
10
8
3
3
121
100
Hormonal
Total
SOYANNWO O A 2015
15
Other interventions
• Financial Support (through the NGO, CPCN)
• Comfort packs, subsidy of the cost of
medications(morphine).
• Psychotherapy sessions
• Involvement of occupational therapist,
physiotherapist and social workers.
• Spiritual care (hospital chaplaincy committee)
• Family conferences
SOYANNWO O A 2015
16
Spiritual care, herbal and traditional
remedies also favored by patients
SOYANNWO O A 2015
17
Outcome
Outcome
N
%
Dead
82
68
Alive
24
20
Lost to
contact
15
12
Total
121
100
SOYANNWO O A 2015
18
Discussion
• Late presentation/referral
• Most presented with moderate to severe
pain.
• Morphine- the only strong opioid available
• Less spiritual issues due to role of religious
beliefs.
• Financial support – Centre for Palliative Care,
Nigeria (NGO) collaboration
SOYANNWO O A 2015
19
Challenges
• Late referrals
• Poverty and severe financial constraint
• Interrupted supply of strong opioid/restricted
opioid switch.
• Myth concerning use of oral morphine
• Limitation of service to 20km radius
• Poor knowledge about palliative care –
public, policy makers, health professionals
SOYANNWO O A 2015
20
Conclusion
• Palliative care service was found to be beneficial
to the patients enrolled on the programme and
their families
• Pain is a major problem and availability of
opioid analgesics is essential for better
management.
• Such care can be improved with adequate
collaboration and partnerships.
• Improved education and policy will enhance
extension to community level.
SOYANNWO O A 2015
21
From our team - Thank you for
listening.
SOYANNWO O A 2015
22