International Pain Policy Fellowship, Cohort III Country Report : Sri Lanka

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  • International Pain Policy Fellowship, Cohort III Country Report : Sri Lanka
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  • Dr. N. Jeyakumaran MD Consultant Clinical Oncologist. Teaching Hospital, Jaffna Sri Lanka Country Report For SRI LANKA Part I Cancer Pain and Palliative Care
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  • Sri Lanka Total Land area : 65,610 Sq km Population : 20.2 Million SriLanka
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  • Sri Lanka Nine Provinces. Nine Cancer Units
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  • Cancer Pain and Palliative Care Management mainly at Cancer Hospitals. One Cancer Unit in each province. Varying pattern of pain management policies. Pain Management. Mainly By Oncologists. Anaethetists. WHO Pain Management. Radiation treatment. IV preparations.
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  • No / 100,000 Cancer Incidence in Sri Lanka
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  • YearSexNumber%CRASR 1985Male2 56451.231.734.9 Female2 44848.831.539.4 Total5 012 31.637.6 1990Male2 97949.134.438.6 Female3 08450.937.046.9 Total6 063 35.743.1 1995Male3 45047.137.343.6 Female3 87552.943.658.6 Total7 325 40.451.2 2000Male5 13047.052.063.7 Female5 79553.061.184.9 Total10 925 56.474.6 2005Male6 05845.362.368.1 Female7 31454.773.473.3 Total 13 372 67.970.6 Cancer Pattern (1985 2005)
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  • All SiteNoCRASR Breast19089.7 Lip Oral Cavity & Pharynx16178.28.7 Esophagus10225.25.6 Cervix Uteri8814.54.6 Trachea Bronchus & Lungs8324.24.5 Thyroid7523.83.6 Colon & Rectum7413.83.6 Lymphoma6043.13.3 Ovary5963.0 Leukaemia5702.93.0 All Sites 13372 67.9 70.6 Leading Cancer sites overall (2005)
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  • Rank Male SiteNoCRASR 1Lip Oral Cavity & Pharynx124012.714.1 2Trachea Bronchus & Lung6666.97.7 3Esophagus4985.15.8 4Colon & Rectum3884.04.4 5Lymphoma3603.73.9 6Larynx3243.33.7 7Leukaemia3133.23.3 8Prostate3033.13.5 9Unknown Primary Site2572.72.9 10Brain1711.8 All Sites 6058 62.3 68.1 Leading Cancer sites in Male (2005)
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  • Rank Female SiteNoCRASR 1Breast185918.718.3 2Uterine Cervix8818.9 3Ovary4965.9 4Thyroid35925.6 5Oesophagus5245.5 6 Lip Oral Cavity & Pharynx 3773.8 7Colon & Rectum3533.6 8Leukaemia2572.82,8 9Lymphoma2432.5 10Uterus23712.42.4 All Sites 73.4 73.3 Leading Cancer sites in Female (2005)
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  • Source : GLOBOCAN 2008 Estimates
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  • Source : GLOBOCAN 2008 Estimates
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  • YearNo. of Cancer Deaths Crude Death Rate Proportionate mortality rate 1985441627.94.5 1990447926.44.6 1995571031.55.5 2000 7,84241.16.7 2001806342.97.1 2002798642.07.1 2003 8,39643.87.3 2004 9,12747.07.9 2005 9,40347.97.1 2006 10,38652.38.8 Cancer Mortality Data (1985 2003)
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  • Cancer Prevention & Control Strategies Primary Prevention Early Detection & Screening Diagnosis and Treatment Rehabilitation & Palliative Care Cancer Surveillance (Cancer Registry) Cancer Research National Cancer Control Programme. (NCCP) Director - NCCP. Policy - Is being drawn.
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  • Role of Govt. in Pain Relief Education: Specialist Training. Palliative Care included. Analgesics including Opioids. Given Free of charge in all Hospitals Policy towards improved Health Care
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  • Pain Management at Cancer Hospitals Most Cancer Patients present at Late Stages. Govt. of Sri Lanka provides free Health Care. Pain Management. WHO method. WHO Ladder is followed. Opioid available in Cancer Hospitals. Few hospices. Training Programmes. Need to be organized.
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  • Availability of Pain Relief and Palliative Care Services Places of Treatment. At all Cancer Units. At the Hospices. Drugs: Mild Analgesics. Moderate Analgesics. Strong Analgesics. Adjuvant drugs. For Children. Oral solutions Not available.
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  • Hospices
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  • Sathya Sai Suva Sevana
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  • Play Therapy
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  • Art Therapy
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  • Partners in Palliative Care Training institutions. Postgraduate Institute of Medicine. Professional Organizations. Sri Lanka Medical Association. Sri Lanka College of Oncologists. NGO Sri Lanka Cancer Society. Cancer Aid for North and East. International Partners WHO Palliative Care Centre. Kerala Palliative Care Centre. PPSG. Pallium India & Trivendram Centres.
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  • Part II HIV/AIDS & Palliative Care Dr. Suraj Perera MBBS, MSc, MD Consultant Community Physician National Cancer Control Programme, Ministry of Health, Sri Lanka
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  • Number of HIV cases reported up to end of 2011 Sri Lanka PeriodMaleFemaleTotal% 1987 - 1989 13 3 16 1.1 1990 - 1994 76 31 107 7.3 1995 - 1999 101 80 181 12.4 2000 - 2004 173 137 310 21.2 2005 - 2009 344 238 582 39.8 2010 - 2011 159 108 267 18.2 Total 866 597 1463 100.00 Source : National STD/AIDS Control Programme, Ministry of Health, Sri Lanka
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  • Trend of reported deaths due to AIDS in Sri Lanka 1987-2009 Source: National STD/AIDS Control Programme, Sri Lanka. (2010).
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  • Estimated number of adults and children living with HIV, new infections and AIDS deaths, 1990-2009 Source: Prepared by www.aidsdatahub.org based on UNAIDS (2010). Global Report: UNAIDS Report on the Global AIDS Epidemic.www.aidsdatahub.orgUNAIDS (2010). Global Report: UNAIDS Report on the Global AIDS Epidemic.
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  • National STD/AIDS Control Programme Ministry of Health Anti Venereal Disease Campaign - established in 1952. With the advent of HIV/AIDS the Anti VD Campaign was restructured as the National STD/AIDS Control Programme (NSACP) in 1985, even before the first case of HIV infection was reported in Sri Lanka. Dr. Nimal Edirisinghe, Director National STD/AIDS Control Programme Ministry of Health No. 29, De Saram place, Colombo 10, Sri Lanka (94) 011 26 67163, (94) 011 533 6873 / (94) 011 2682859
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  • Objectives for pain relief and palliative care in National STD/AIDS Control Programme To maintain the provision of HIV treatment, care and support services for people living with and affected by HIV/AIDS and occupational post exposure prophylaxis (oPEP) for health care workers (HCWs) through the service delivery points of the National STD/AIDS control Programme or other relevant government health facilities in quality assured manner. To coordinate with and support institutions within and outside the Ministry of Health in the expansion of appropriate, high quality HIV treatment, care and support services for people living with and affected by HIV/AIDS and for oPEP in Sri Lanka.
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  • Availability of pain relief and palliative care services in the country for HIV/AIDS patients Pain relief medications are available for HIV/AIDS patients. But patients are not experiencing any significant pain during their HIV/AIDS journey from diagnosis to death according to the verbal communication of staff of inward facility for AIDS Patients in Sri Lanka.
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  • Part III : Opioid Availability
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  • Opioid Availability - National Competent Authority (NCA) Medical Supplies Division (MSD), Ministry of Health Director / Medical Supplies Division, Ministry of Health submits annual estimates of medical requirements of narcotic drugs including Morphine
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  • Calculating Annual estimates for Opoids Medical Supplies Division (MSD) of Ministry of Health calculates annual estimates based on estimates send by the Directors of Hospitals in the line Ministry and Provincial Ministries of Health Additional 10% is added, based on previous year consumption MSD provides annual statistics to INCB
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  • Palliative Care Pain Relief Drugs in Essential Medicines List Morphine & Tramadol is included (National Essential Medicine List Sri Lanka, 2009)
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  • Opoid Analgesics available in Sri Lanka Opioid analgesic Dosage FormGeneric / Trade Name Manufacturer Morphine10mg tablet DURAMOR 10Biological E Ltd, India 30 mg tabletMorphine SulphateBelco Pharma Ltd, India 30 mg tabletANAMORPHSigma Pharmacetical Pty Ltd, Australia 30 mg tablet CRDURAMOR 30Biological E Ltd, India 30 mg tabletRELIMAL CR 30Pharmachemie BV Netherlands 15mg/ml injectionMorphine SulphateBelco Pharma ltd, India 15mg/ml injectionMorphine SulphateS GmbH/Germany Hospira Australia pty Ltd Hameln Pharmaceutical, Australia
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  • Opoid Analgesics available in Sri Lanka Opioid analgesic Dosage FormGeneric / Trade Name Manufacturer Fentanyl100mcg/2 ml injectionFentanyl citrateS GmbH/Germany Hospira Australia pty Ltd Hameln Pharmaceutical, Germany 0.05mg/ml injectionFENTANYL JANSSENJanssen Pharmaceutica,, Belgium 0.1mg/2 ml injectionTALGESILDuo Pharma (M) Sdn, B hd, Malaysia Pethidine50mg /ml injectionPethidineBelco Pharma Ltd, India 50mg /ml injectionPethidineNEON Laboratories, India 50mg /ml injectionPethidineS GmbH/Germany Hospira Australia pty Ltd Ham