Background & Aims

Pain is one of the most pervasive and distressing symptoms among cancer patients, but Vietnamese cancer patients suffer unnecessarily from lack of access to adequate pain control. Although the World Health Organization designates opioids as an essential medication and recommends them as the cornerstone for managing moderate to severe cancer pain, their accessibility is severely restricted, particularly in low- and middle-income countries. Despite Vietnam’s early endeavours in the advancement of palliative care, including a revised opioid prescription policy in 2008, opioid use for cancer pain remains suboptimal, with oral morphine available only in a few major hospitals. Recognizing the complexity and multifactorial nature of barriers to opioid access, this study aims to explore the views of different stakeholders, including healthcare providers, regulators, cancer patients, and their caregivers, on the barriers to safely accessing opioids for cancer pain management in Vietnam.

Methods

We conducted a qualitative, descriptive study and recruited six healthcare providers, four cancer patients and caregivers, and five regulators (i.e., policymakers in the Ministry of Health, directors of pharmacy departments, or executives in managerial positions of the hospitals) across Vietnam via purposeful sampling technique. Data were collected using semi-structured interviews, and the audio recordings were transcribed verbatim and subjected to inductive content analysis using a Framework Approach.

Results

Six categories of barriers were identified: 1) Patient-related barriers (fear of addiction and other side effects, morphine’s association with impending death, negative administration experiences, and religious beliefs); 2) Professional-related barriers (knowledge and experience deficit, fear of addiction and other side effects, concerns about opioid diversion and associated liabilities); 3) Medicine-related barriers (limited oral morphine availability, limited domestic pharmaceutical manufacturers and suppliers, supply interruptions, poor variety of opioid types and formulations, and difficulty accessing parenteral opioids); 4) Health information barriers (lack of guidelines, education and training, lack of information on opioid distribution channels); 5) Services delivery barriers (scarce palliative and home care services); 6) Regulatory barriers (difficulties in obtaining confirmation letters for patients’ opioid usage needs and overly strict regulation enforcement).

Conclusions

Barriers to safe opioid access for cancer pain control in Vietnam are multifactorial, interrelated, and mutually reinforcing, necessitating interdisciplinary solutions for overcoming them. This approach should involve enhancing education about the appropriate use and management of opioids, along with current opioid policies for patients, communities, healthcare providers, and regulators; empowering doctors to determine prescription durations; enacting and implementing policies mandating oral morphine availability at local health facilities; expanding palliative care services; utilizing telemedicine; and establishing an electronic opioid prescription monitoring system.

References

1.Cleary, J. F., & Maurer, M. A. (2018). Pain and Policy Studies Group: Two Decades of Working to Address Regulatory Barriers to Improve Opioid Availability and Accessibility Around the World. J Pain Symptom Manage, 55(2s), 121-134. https://doi.org/10.1016/j.jpainsymman.2017.03.029

2.Gale, N. K., Heath, G., Cameron, E., Rashid, S., & Redwood, S. (2013). Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol, 13, 117. https://doi.org/10.1186/1471-2288-13-117

3.Krakauer, E. L., Nguyen, T. P., Husain, S. A., Nguyen, T. H., Joranson, D. E., Luong, N. K., & Maurer, M. A. (2015). Toward safe accessibility of opioid pain medicines in Vietnam and other developing countries: a balanced policy method. J Pain Symptom Manage, 49(5), 916-922. https://doi.org/10.1016/j.jpainsymman.2014.10.012

4.Morriss, W. W., & Roques, C. J. (2018). Pain management in low- and middle-income countries. BJA Educ, 18(9), 265-270. https://doi.org/10.1016/j.bjae.2018.05.006

5.Reyes-Gibby, C. C., Ba Duc, N., Phi Yen, N., Hoai Nga, N., Van Tran, T., Guo, H., Bhat, S., & Cleeland, C. (2006). Status of cancer pain in Hanoi, Vietnam: A hospital-wide survey in a tertiary cancer treatment center. J Pain Symptom Manage, 31(5), 431-439. https://doi.org/10.1016/j.jpainsymman.2005.10.005

6.van der Plas, W. Y., Benjamens, S., & Kruijff, S. (2020). The increased need for palliative cancer care in Sub-Saharan Africa. Eur J Surg Oncol, 46(7), 1373-1376. https://doi.org/10.1016/j.ejso.2020.03.212

7.World Health Organization. (2018). WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents. https://www.ncbi.nlm.nih.gov/books/NBK537492/pdf/Bookshelf_NBK537492.pdf

Presenting Author

Trang Nguyen

Poster Authors

Trang Nguyen

BPharm, Master student

University Medical Center Ho Chi Minh City, Vietnam

Lead Author

Caroline Phelan (BN

RN

Flinders University

Lead Author

Eric Krakauer (MD

PhD)

Harvard Medical School, Massachusetts General Hospital

Lead Author

Tung Pham (MD

MPH)

Harvard T.H. Chan School of Public Health, Hanoi Medical University, VinUniversity

Lead Author

Linh Bui (MD

MPH)

Harvard T.H. Chan School of Public Health

Lead Author

Anh Dam (BPharm)

National Geriatric Hospital

Lead Author

Topics

  • Access to Care