Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report

Poor people in all parts of the world live and die with little or no palliative care or pain relief. Staring into this access abyss, one sees the depth of extreme suffering in the cruel face of poverty and inequity. A milestone for palliative care and pain reliefUniversal health coverage (UHC) has assumed an iconic place in work to achieve the Sustainable Development Goals (SDGs). Its central importance for achieving SDG 3—ensuring healthy lives for all—is proven by the increasingly sophisticated efforts to measure UHC and to estimate to what extent UHC can be achieved by 2030. An example is the Global Burden of Disease (GBD).1 The GBD team constructed a UHC Index by beginning with the idea of access to quality essential health-care services and access to safe, effective, quality, and affordable essential medicines and vaccines. Full-Text PDF Felicia Marie Knaul: advocate for better pain relief and palliative careThe time before her father died of stomach cancer in 1984 had a lasting impact on Felicia Knaul. “Each day brought new and ever-more challenging horrors—bone metastases popping up throughout his body…lungs filling with fluid and agonising, rattling breathing for which for several days I could do little other than keep his head elevated to stop him from drowning”, recalls Knaul, who was just 18 years old at the time. Eventually, he was given sufficient opioids to make him more comfortable. Since then, Knaul, a health economist, has devoted herself to tackling neglected aspects of health care and social justice worldwide. Full-Text PDF Palliative care for drug-resistant tuberculosis: when new drugs are not enoughThe availability of new and repurposed drugs for the treatment of drug-resistant tuberculosis (DR-TB) provides hope in a field in which treatment options are severely limited and treatment success rates rarely exceed 50%. Despite the ongoing search for shorter, more tolerable, and more efficacious treatment regimens, DR-TB remains a death sentence for a considerable proportion of people affected. Additionally, these patients must bear debilitating side-effects of centuries-old medication, along with social isolation, stigma, loss of income, and psychological distress. Full-Text PDF Early integration of palliative care—new evidence and old questionsHow to integrate patient-centredness with a tumour-directed treatment approach when treatment options are becoming increasingly complex is a continuous challenge in contemporary oncology. Influential organisations worldwide recommend early integration of oncology and palliative care as a means to achieve this goal.1–3 Full-Text PDF Department of ErrorKnaul FM, Farmer PE, Krakauer EL, et al. Alleviating the access abyss in palliative care and pain relief—an imperative of universal health coverage: the Lancet Commission report. Lancet 2018; 391: 1391–454—In this Commission (published online first on Oct 12, 2017), Camilla Zimmermann's surname has been corrected, and Odontuya Davaasuren (Mongolian National University of Medical Science) has been included in the Acknowledgments section. Minor typographical and citation errors have also been corrected. Full-Text PDF Portugal needs to revolutionise end-of-life careEnd-of-life care is one of the most neglected areas in Portugal's health system.1 In adults and children, deaths caused by conditions requiring palliative care are rising,2,3 and this aligns with global projections.4 Portugal has the fourth highest aged population in the world, and is predicted to have the third by 2050.5 There is a continuing trend towards dying in hospital,2,3 which is often against people's preferences.6 Falling investment in end-of-life care will diminish the chances of reversing this trend and affect the conditions in which people die in hospitals. Full-Text PDF Rethinking chronic painTo live with chronic pain is to live with daily challenges around simple tasks that others take for granted. It often means being disbelieved, stigmatised for not getting better, or judged as not coping. It might mean living with poor mental health and self-esteem, absenteeism from school or work, the breakdown of relationships, and socioeconomic disadvantage. For society, the costs are staggering: low back pain is the leading cause of years lost to disability and chronic pain costs billions of dollars through health system expenditures, productivity losses, reduced quality of life, and informal care. Full-Text PDF Palliative care in liver disease: a matter of life and deathModern medicine has provided us with ever-increasing power to rally against the destructive forces of disease and injury and to extend lifespans. But this doesn't seem to be the case for liver disease, which is now the third most common cause of death in people of working age, with mortality increasing by 400% in the UK between 1970 and 2013. Despite the risk of death and substantial discomfort, pain, and suffering experienced by patients with advanced liver disease, referral to palliative or supportive care remains low, and more than two-thirds of patients with liver disease die in hospital, with the final year of life often marred by multiple inpatient hospital stays. Full-Text PDF