Assessment of the state of palliative care in Kazakhstan

Relevance of the topic. The mortality rate from malignant neoplasms remains one of the main causes. Such an important indicator as an indicator of morbidity (the prevalence of malignant neoplasms) is growing from year to year. [1]

Almost 1/5 of patients with oncological diseases are patients with stage IV malignant neoplasms who need appropriate professional medical and psychological assistance. But, if they try to help patients with oncopathology more or less on the basis of a systematic approach, then such diseases as tuberculosis, AIDS, non-oncological chronic progressive diseases in the terminal stage of development are outside the palliative care services, and to a greater extent on the shoulders of the general medical network. [2 ]

This year, according to experts, doctors diagnose more than 18 million new cases of cancer in the world. [3] Purpose of the study. Assess the situation of palliative care in the Republic of Kazakhstan.

Materials and methods of research. The most urgent care is palliative care. It improves the quality of life for patients and their families who face problems associated with life-threatening illnesses, whether physical, psychosocial or spiritual. The quality of life of carers is also improving. The main goal is to ensure the highest possible quality of life for the patient, to help him accept his condition. Palliative care also extends to the patient's relatives: specialists try to support them, explain how to communicate with the patient, take care of him. [4]

The problem is serious, but, nevertheless, gradually, step by step, Kazakhstani scientists and doctors are directing efforts to solve this problem and note positive results. If we talk about how things are with cancer in the country, I can cite the following figures that clearly reflect the situation: at the end of 2018, the incidence of malignant neoplasms in the republic was 35,753 cases per 100 thousand population, in 2017 this figure was 35,695 cases.

The five leaders in morbidity are the regions: Pavlodar (316.9 per 100 thousand population), North Kazakhstan (311.7 per 100 thousand population), East Kazakhstan (306.3 per 100 thousand population), Kostanay (290 , 7 per 100 thousand population), Akmola region.

In the structure of morbidity, breast cancer is in 1st place (12.6%), in 2nd place is lung cancer (9.9%), in 3rd place is stomach cancer (7.4%), in 4th place is cervical cancer and colon cancer with the same proportion of 4.7%. There is a decrease in mortality from cancer, so according to the electronic register of cancer patients, the mortality rate from 314 was 78.3 per 100 thousand population (2017 - 93.3).

The proportion of cancer patients living 5 years or more with breast cancer increased to 54.4% (indicator indicator - 51.4%, 2017 - 53.2%), with cervical cancer - to 55.5% (indicator indicator - 53.9%, 2017 - 54.2%), with colorectal cancer up to 45.4% (indicator indicator - 43.1%, 2017 - 43.7%). [5]

The most common cancers in both sexes are breast, lung and bronchial cancer, colorectal cancer, malignant neoplasms of the stomach, cervix, esophagus, prostate, kidney, ovary, pancreas, endometrium, and liver.

Today, the palliative service of Kazakhstan has a scattered structure and represents the functioning of specialized institutions mainly in the Northern and Eastern regions of the republic: hospices operate in six cities of the republic - in Almaty, Pavlodar, Karaganda, Ust-Kamenogorsk, Semipalatinsk and Kostanay. Such institutions contain not only cancer patients, but also elderly and senile patients with therapeutic pathology who need supportive therapy and several nursing care centers and practically no palliative care for children is provided, there is no single hospice service for patients with cancer, AIDS and tuberculosis. [6]

Hospices in Kazakhstan differ in many respects from similar institutions in developed countries. First of all, they are funded by the state, while in many countries up to 80% of the hospice budget is made up of charitable contributions, donations from individuals and companies, contributions of state and non-governmental organizations and religious foundations.

Many Kazakhstanis cannot take advantage of high-tech diagnostic methods and innovative treatment, including radiation therapy. Currently, in Kazakhstan, no more than 30% of patients are provided with radiation therapy. In Kazakhstan, medical information systems are poorly integrated to monitor treatment and follow-up of cancer patients, and there are no systems for archiving and transmitting radiological images. A big problem is the shortage of oncologists, currently this figure is more than 40%. Due to these problems in Kazakhstan, the five-year survival rate of patients with malignant neoplasms has not been achieved. This indicator is the main indicator of the effectiveness of the provision of cancer care. [7]

Conclusion. Thus, the provision of palliative care in Kazakhstan is in its infancy. It is characterized by a shortage of medical personnel and specialized beds, despite high morbidity rates. Palliative care, as an integral part of the oncological service, does not have its own unified, standardized legal basis for its activity. In this regard, a number of recommendations are proposed for improving the service for the provision of palliative care and the development of this area in the country as a whole.

Recommended solutions to the named problems:

  1. Approval of state standards for the provision of palliative care.
  2. Development of a system of statistical registration of patients in need of palliative care and calculation of the need for narcotic drugs.
  3. Reducing administrative barriers to access to pain medications.
  4. Increase in funds allocated for the purchase of narcotic drugs, including within the guaranteed volume of free medical care to the population.
  5. Development and implementation of guidelines for medical practitioners on pain relief and palliative care.

List of used literature.

  1. Novikov G.A., Osipova N.A., Starinskiy V.V. and other Organization of palliative care for cancer patients and the prospects for its improvement. Oncology Issues 1995; 2: 27-28.
  2. Pharmaceutical Review of Kazakhstan: Palliative care in Kazakhstan - problems and solutions. URL: https://pharm.reviews/stati/sobytiya/item/60-palliativnaya-pomoshch-v-kazakhstaneproblemy-i-reshenie (date accessed: 01.04.2018)
  3. Pharmacotherapy of chronic pain syndrome in adult patients in the provision of palliative care in inpatient and outpatient settings, guidelines, “Federal Medical Research Center named after P.A. Herzen "of the Ministry of Health of the Russian Federation, Moscow
  4. Pharmaceutical Bulletin: Kazakhstan occupies one of the last places in the world for the consumption of opioids for medical purposes. URL: https://pharmvestnik.ru/publs/lenta/v-mire/kazaxstan-zanimaet-odno-iz- poslednixmest-v-mire-po-potrebleniju-opioidov-v-medtseljax.html#.WxETv1Uza70
  5. Kazakhstan Association for Palliative Care: Palliative Care in Kazakhstan. URL: http://palliative.kz/pp_v_kazahstane
  6. Methods of calculating the need for drugs containing drugs in the provision of palliative care in a medical organization strategic research under the Presidents of the Republic of Kazakhstan) / №3 (55), September / 2017, 6-20 p.
  7. Order of the Minister of Health and Social Development of the Republic of Kazakhstan from January 26, 2015 № 32
Year: 2021
City: Shymkent
Category: Medicine