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 20153

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): SOYANNWO O A 20154

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 20155

Day care Hospice and Palliative care centre, UCH, Ibadan Established in collaboration with Centre for Palliative Care, Nigeria (CPCN), an NGO in Structured services commenced in Team of trained palliative care staff - doctors, nurses, social worker, admin staff and volunteers SOYANNWO O A 20156

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 20157

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 20158

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 days. SOYANNWO O A 20159

Results AGE DISTRIBUTION Age( Years)N% > Total SOYANNWO O A

Diagnosis N% Breast carcinoma Gastrointestinal cancers Prostatic carcinoma Cervical carcinoma Other gynae-oncological carcinoma Head/neck cancers Blood cancers Lung cancers Other urological cancers Osteosarcoma Peripheral nerve sheath tumor Total

Palliative care issues identified Palliative care issues Number of patients % (n =121) Psychosocial + Pain Psychosocial + spiritual + Pain Spiritual + Pain Unconscious SOYANNWO O A

PAIN : 89/121(73.6%). Number of pain site (s) N % >3 7 8 Total Pain score (NRS) Pain score N % Total SOYANNWO O A

Other symptoms Symptoms Number of patients % (n= 121) Weight loss and anorexia Nausea,vomiting and dry mouth Weight loss and cough Nausea and anorexia SOYANNWO O A

Pain and other symptoms control 80 (90%) had their pain controlled. MEDICATIONS Medications N % Strong opioid+ NSAIDs + adjuvant Weak opioids + adjuvant NSAID + non-opioid Weak opioids + NSAID 6 7 Total OTHER MODES OF TREATMENT Modes of treatment N % Chemo -radiotherapy Radiotherapy Chemotherapy + surgery Chemotherapy Surgery + chemo- radiotherapy 10 8 Hormonal 3 3 Total SOYANNWO O A

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

Spiritual care, herbal and traditional remedies also favored by patients SOYANNWO O A

Outcome N% Dead Alive Lost to contact Total SOYANNWO O A

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

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

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. Conclusion SOYANNWO O A

From our team - Thank you for listening. SOYANNWO O A