RESUMO
Between March 27 and 29, 1994, a group of representatives of 32 palliative care programs from eight Latin American countries met under the auspices of the World Health Organization (WHO) Palliative Care Program for Latin America in Florianopolis, Brazil. The participants included physicians, nurses, psychologists, volunteers, drug regulators, hospital administrators, and representatives from the pharmaceutical industry. A comprehensive report by David Joranson (University of Wisconsin-Madison) was followed by a general discussion moderated by Jan Stjernsward, Chief of the Cancer Unit, World Health Organization, and by Eduardo Bruera, Coordinator of the WHO Cancer Pain and Palliative Care Program for Latin America. A number of issues related to opioid availability were identified and discussed. This declaration summarizes the main conclusions of the meeting. The attendants would like to encourage the widest possible distribution of this document.
Assuntos
Analgésicos Opioides/uso terapêutico , Cuidados Paliativos/métodos , Analgésicos Opioides/economia , Brasil , Custos de Medicamentos , Uso de Medicamentos , Organização Mundial da SaúdeRESUMO
Radiotherapy services are closely linked to the level of medical care which, in turn, is an important component of the overall health care program, with its development related to social, economic, and educational factors. As a basis for understanding the situation regarding adequate coverage of the population by radiotherapy services, general information about the world population (currently 5 billion), age distribution, frequency of cancer occurrence, and causes of death is presented. For an appreciation of the obstacles that must be overcome, the situation with regard to Gross National Product (GNP), transfer of economic resources, and per capita expenditures for health services is shown. For example, in the developing world, most countries spend less than 5% of their GNP for health, and on a macro scale at least 20 billion U.S. dollars per year are being transferred from the poor nations of the southern hemisphere to the northern hemisphere. Information about the wide range of population coverage with radiotherapy resources and the trend regarding high-energy radiotherapy machines is presented. For example, in North America (USA) there are six high-energy machines for each one million persons, and each machine is used to treat about 230 new patients per year. In other parts of the world, such as large areas of Africa and South-East Asia, there may only be one high-energy radiotherapy machine for 20 to 40 million people, and one machine may be used to treat more than 600 new patients per year. Many cancer patients have no access to radiotherapy services. When estimates of the need for radiotherapy services in the developing world as a consequence of cancer incidence are compared with the current health expenditures, it is concluded that a combined effort of national authorities, donor and financial institutions, professional and scientific societies, and international organizations is required. The knowledge, skills, and technology are available in many excellent radiotherapy centers throughout the world. The key issues are priority and the commitment of sufficient resources.
Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Agências Internacionais , Neoplasias/radioterapia , África/epidemiologia , Sudeste Asiático/epidemiologia , Países em Desenvolvimento/economia , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Neoplasias/epidemiologia , Radioterapia/instrumentação , América do Sul/epidemiologiaRESUMO
PIP: By examination of incidence, mortality, and relative frequency data, an estimate has been made of the number of cancer cases in 12 common sites and of all cancers that occurred in 1975 and in the 24 areas of the world for which the UN publishes population data. While several cancers are of importance in localized areas or regions; e.g., cancer of the larynx, these are infrequent on the world level and are not included here. While the relative importance of the selected sites varies from 1 area to another, on a global basis, the 1st 6 ranking cancer sites in males are lings, stomach, colon/rectum, mouth/pharynx, prostate, and esophagus; in females, they are breast, cervix uteri, stomach, colon/rectum, lung, and mouth/pharynx. Cancers of these sites, together with leukemias and cancers of the liver, bladder, and lymphatic tissues, account for 75% of the estimated 5.9 million cancers that occurred in 1975. When the 2 sexes are combined, stomach cancers are in 1st rank, followed closely by lung; it is suggested that, given current trends, their rank order will soon be reversed. There are clear opportunities for cancer prevention by controlling tobacco smoking, reducing infection by hepatitis B virus, and curbing the excessive intake of alcohol. The increasing adoption of high fat diets may lead to more cancers of the large bowel, breast, and prostate.^ieng