Access to Cancer Pain Management in Ecuador from Health Workers’ Perspective: a Qualitative Study

Abstract

Background: Ecuador is facing increasing health-related suffering due to cancer; however, the distributed opioid analgesic in the country is below the global average. Aim: This study explores the access to cancer pain management (CPM) from the healthcare professionals’ perspective in a middle-income country. Methods: Thirty problem-centered interviews with healthcare providers were conducted in six cancer facilities and were analyzed thematically. Results: Limited and unequal access to opioid analgesics was reported. Structural weaknesses of the healthcare system restrain access for the poorest, at the primary care level, and for people living in remote areas. The lack of education among the healthcare personnel, patients, and society was identified as the main barrier. Conclusion: Access barriers were interrelated; therefore multisectoral strategies must be considered to improve access to CPM.

Plain language summary

The number of patients with cancer in Ecuador is growing. It is known that people with a cancer diagnosis often experience severe pain, which requires opioid analgesics. In this study, we explore the opinion of healthcare providers regarding access to opioid analgesics to alleviate cancer pain in Ecuador. We interviewed 30 healthcare professionals working at six cancer centers in different cities, who deal daily with patients with a cancer diagnosis. We found that it is difficult for cancer patients in the country to access adequate pain therapy and this generates avoidable severe health-related suffering. The structure of the healthcare system makes it difficult to be supplied with the medication they need. That is worst for the country’s poor and people in rural areas. The main problem is the lack of knowledge on the subject among health workers, patients and society.

We conclude that the obstacles in providing patients access to cancer pain relief lie in different areas, including the healthcare system, the healthcare professionals and the patients and society, all of which are interrelated. All areas must work together to improve the situation.

Keywords::

• analgesia
• cancer pain management
• Ecuador
• opioids

Supplementary data

To view the supplementary data that accompany this paper please visit the journal website at: www.tandfonline.com/doi/suppl/10.2217/pmt-2023-0023

Acknowledgments

This paper is part of the dissertation by J Fleckner, which was developed in cooperation with the Global Palliative Care Research Group at RWTH Aachen, Germany and Maria Cervantes, SOLCA, Quito (Ecuador). Support to contact interviewees include: J Vela (SOLCA Santo Domingo), L Jerves (SOLCA Cuenca, FASEC Cuenca), C Acurio (SOLCA Loja), P Gonzales (SOLCA Loja) and P Bonilla (UTPL Loja).

Financial & competing interest disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval from all involved institutions [University Hospital Aachen (EK 186/19), and all the different SOLCA and FASEC institutions in Ecuador (CEISH Quito código de aprobación: CEISHSOLCAQ.OBS.19.119, 10.10.2019; SOLCA Loja Oficio N°2020.029.SNL.P, 20.01.2020; SOLCA St. Domingo as part of CEISH Quito, SOLCA & FASEC Cuenca through Lourdes Jerves)]. A written informed consent was obtained from all interviewees involved.