1. 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

2. Greetings from---- Nigeria, University College Hospital, Ibadan & Centre for Palliative Care, Nigeria team 2

3. 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

4. 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 20154

5. 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

6. 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 20156

7. 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

8. 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

9. 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 20159

10. 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 Total121100.0 SOYANNWO O A 201510

11. 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 Total121100.0 11

12. Palliative care issues identified Palliative care issues Number of patients % (n =121) Psychosocial + Pain 7965.3 Psychosocial + spiritual + Pain 5343.8 Spiritual + Pain 3730.6 Unconscious 12 9.9 SOYANNWO O A 201512

13. PAIN : 89/121(73.6%). Number of pain site (s) N % 1 70 79 2 12 13 >3 7 8 Total 89100 Pain score (NRS) Pain score N % 1-3 0 0 4-7 62 70 8-10 27 30 Total 89 100 SOYANNWO O A 201513

14. 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 201514

15. Pain and other symptoms control 80 (90%) had their pain controlled. MEDICATIONS Medications N % Strong opioid+ NSAIDs + adjuvant 54 61 Weak opioids + adjuvant 19 21 NSAID + non-opioid 10 11 Weak opioids + NSAID 6 7 Total 89 100 OTHER MODES OF TREATMENT Modes of treatment N % Chemo -radiotherapy 42 35 Radiotherapy 27 22 Chemotherapy + surgery 27 22 Chemotherapy 12 10 Surgery + chemo- radiotherapy 10 8 Hormonal 3 3 Total121 100 SOYANNWO O A 201515

16. 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 201516

17. Spiritual care, herbal and traditional remedies also favored by patients SOYANNWO O A 201517

18. Outcome N% Dead 82 68 Alive 24 20 Lost to contact 15 12 Total 121 100 SOYANNWO O A 201518

19. 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 201519

20. 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 201520

21. 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 201521

22. From our team - Thank you for listening. SOYANNWO O A 201522