L. A. Flores

Barriers to the Development of Palliative Care in the Countries of Central and Eastern Europe and the Commonwealth of Independent States

During the years of communist rule in the countries of Central and Eastern Europe (CEE) and the Commonwealth of Independent States (CIS), there were few significant palliative care developments. Since the political changes of the 1990s, however, there has been a steady development of palliative care services in this region. In 2005, the European Association for Palliative Care Task Force for the Development of Palliative Care in Europe undertook a qualitative survey among boards of national associations to identify barriers to the development of palliative care in CEE and CIS. By July 2006, 44 of 52 (85%) European countries had responded to the survey, but we report here on the specific results from 22 of 27 (81%) countries in CEE and CIS. Data were analyzed thematically by geographic region and by the degree of development of palliative care in each country. Four significant barriers to the development of palliative care were identified: 1) financial and material resources; 2) problems relating to opioid availability; 3) lack of public awareness and government recognition of palliative care as a field of specialization; and 4) lack of palliative care education and training programs. Despite huge variations in the levels of provision across the countries of CEE and the CIS, data collected in the qualitative survey reveal that the development of palliative care in many countries continues to remain uneven, uncoordinated, and poorly integrated across wider health care systems, mainly as a result of inadequate investment and limited palliative care service capacity.

The reality of palliative care in Spain

With the sponsorship of the Spanish Society of Palliative Care (SECPAL), two nation-wide studies from the University of Valladolid were carried out in 1996 and 1998 into the state of palliative care teams in Spain. This report is based on those studies and is the first overall analysis of the current situation of palliative care in Spain. A total of 143 programmes were identified and data were collected from 128 teams (89%): 53 were programmes with hospitalised patients, 75 for home-based patients and 15 were mixed programmes. From the activity data, provided by 75% of the teams, it may be estimated that each year 22 638 terminally ill patients receive palliative care attention. Of these, 18 021 (79.6%) are cancer sufferers. Of the patients who die from cancer each year in our country, 21.2% receive palliative care during the final weeks of life. More than 10 years have passed since the first teams in Spain started their work. The time has now come to recognize the reality of palliative care in our society and to adopt a national policy for terminally ill patients, in line with World Health Organization recommendations formulated in 1989.

Spain: Palliative Care Programs in Spain, 2000: A National Survey

Carlos Centeno, MD, Silvia Hernansanz, MD, Luis A. Flores, RN, Alvaro S. Rubiales, MD, and Francisco Lopez-Lara, MD Facultad de Medicina (C.C., S.H., L.A.F., A.S.R., F.L.L.), Universidad de Valladolid; Centro Regional de Cuidados Paliativos y Tratamiento del Dolor (C.C.), Salamanca; Equipo Domiciliario de Cuidados Paliativos (S.H.), Hospital Universitario de Valladolid; Centro de Salud de Medina del Campo (L.A.F.), Valladolid; and Servicio de Oncologia (A.S.R., F.L.L.), Hospital Universitario de Valladolid, Spain.

Reacción de llamarada en el cáncer de mama avanzado

• Propósito: La reacción de llamarada se manifiesta de inicio como un aumento aparente de la actividad tumoral inducido por el propio tratamiento. No es raro que se presente como un incremento del metabolismo de las lesiones tumorales, principalmente óseas, sin embargo es infrecuente que aparezca junto con otros problemas como dolor o alteración metabólica. • Material y métodos: Presentamos dos pacientes con cáncer de mama avanzado que desarrollaron esta reacción de llamarada inducida en un caso por el tratamiento hormonal (tamoxifeno) y en el otro por quimioterapia. • Resultados: Ambas pacientes presentaron de inicio un aumento del dolor que sugería progresión de la enfermedad asociado a una elevación de los marcadores. Más tarde se evidenció una clara respuesta del tumor. Destaca el manuscrito en que la propia paciente describe cómo vive los síntomas que se le presentan. • Conclusiones: La reacción de llamarada puede manifestarse como un aparente empeoramiento transitorio de la enfermedad al que sigue la respuesta tumoral.