INCTR’s Palliative Access (PAX) Program

INCTR’s PAX team; from left to right, Stuart Brown, Director (palliative care specialist), Virginia LeBaron, nurse consultant, Doug Ennals, social work consultant, Fraser Black, Associate Director (palliative care specialist).

INCTR’s mission is to reduce death and suffering from cancer in developing countries. Along with programs to improve prevention, early diagnosis and treatment, INCTR has also developed a palliative care program to provide an improved quality of life for all patients with cancer, especially those for whom cure is not possible. Although designed with cancer in mind, palliative care services are made available to all who have need, regardless of their underlying illness.

The INCTR Palliative Access (PAX) Program has three main strategies:

1. To help set up Regional Palliative Care Centers in collaboration with regional and international agencies and by using the existing INCTR network. These will provide specialist palliative care for adults and children with advanced cancer and other illnesses, such as AIDS, TB and malaria. The centers will offer a combination of inpatient, outpatient and home/community-based care. In addition, they will become teaching centers, promoting the development of palliative care in the region. They will also support activities advocating for improved opioid availability and relevant public policy initiatives. At present, the PAX Program is concentrating on developing services in Kathmandu, Nepal; Hyderabad, India, and Dar es Salaam, Tanzania. These centers are already involved in regional and national teaching programs educating health professionals, administrators and volunteers about palliative care. Initial planning is also underway for a similar project at Santa Marcelina Hospital, São Paulo, Brazil, and INCTR has agreed to be the primary partner, along with the World Health Organization, in helping to enhance palliative care in Nicaragua, one of the IAEA PACT model countries. Also on the horizon is the development of a palliative care program in Cameroon, where INCTR has recently established a branch, and pediatric palliative care in Pakistan. Finally, PAX members actively collaborate with the Middle East Cancer Consortium program of education in palliative care and have agreed to participate in the European School of Oncology’s Black Sea project.
   


2. To provide consulting services to national or regional governments in the assessment of palliative care needs and planning services to improve access to care. At present, we are collaborating in this way in Tanzania, Yemen and Nicaragua under the auspices of IAEA PACT. The main goals of these collaborations are the integration of palliative care services into national health programs, the addition of palliative care education to medical, nursing and paramedical curricula, and interaction with narcotic regulators to improve opioid availability.
   
   
3. To promote the provision of palliative care by oncologists and other health professionals not specialized in palliative care. We carry this out by means of lectures and seminars at oncology conferences and symposia. We are collaborating with a number of other groups to develop curricula to be used at the workshops at the regional centers. Telemedicine technology will allow the PAX team to carry out distance learning programs as well as follow-up mentorship to those who have attended the workshops. Practical clinical information is provided in the PAX Program Clinical Guidelines. These guidelines are available as a pocket-sized book or may be accessed online through the INCTR portal and are meant to act as an aide memoire to those who have attended some basic training in palliative care.