title: Supportive and palliative care for metastatic breast cancer: resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement.
abstract: Many women diagnosed with breast cancer in low- and middle-income countries (LMICs) present with advanced-stage disease. While cure is not a realistic outcome, site-specific interventions, supportive care, and palliative care can achieve meaningful outcomes and improve quality of life. As part of the 5th Breast Health Global Initiative (BHGI) Global Summit, an expert international panel identified thirteen key resource recommendations for supportive and palliative care for metastatic breast cancer. The recommendations are presented in three resource-stratified tables: health system resource allocations, resource allocations for organ-based metastatic breast cancer, and resource allocations for palliative care. These tables illustrate how health systems can provide supportive and palliative care services for patients at a basic level of available resources, and incrementally add services as more resources become available. The health systems table includes health professional education, patient and family education, palliative care models, and diagnostic testing. The metastatic disease management table provides recommendations for supportive care for bone, brain, liver, lung, and skin metastases as well as bowel obstruction. The third table includes the palliative care recommendations: pain management, and psychosocial and spiritual aspects of care. The panel considered pain management a priority at a basic level of resource allocation and emphasized the need for morphine to be easily available in LMICs. Regular pain assessments and the proper use of pharmacologic and non-pharmacologic interventions are recommended. Basic-level resources for psychosocial and spiritual aspects of care include health professional and patient and family education, as well as patient support, including community-based peer support.
authors: University of Wisconsin Comprehensive Cancer Center, Madison, WI, USA.
authors: James
authors: J
authors: Cleary
authors: Henry
authors: H
authors: Ddungu
authors: Sandra R
authors: SR
authors: Distelhorst
authors: Carla
authors: C
authors: Ripamonti
authors: Gary M
authors: GM
authors: Rodin
authors: Mohammad A
authors: MA
authors: Bushnaq
authors: Joe N
authors: JN
authors: Clegg-Lamptey
authors: Stephen R
authors: SR
authors: Connor
authors: Msemo B
authors: MB
authors: Diwani
authors: Alexandru
authors: A
authors: Eniu
authors: Joe B
authors: JB
authors: Harford
authors: Suresh
authors: S
authors: Kumar
authors: M R
authors: MR
authors: Rajagopal
authors: Beti
authors: B
authors: Thompson
authors: Julie R
authors: JR
authors: Gralow
authors: Benjamin O
authors: BO
authors: Anderson
mesh_terms: D001859:Bone Neoplasms / Q000556:secondary / Q000628:therapy; D001932:Brain Neoplasms / Q000556:secondary / Q000628:therapy; D001943:Breast Neoplasms / Q000191:economics / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D003906:Developing Countries; D005260:Female; D006282:Health Personnel / Q000193:education; D006801:Humans; D007415:Intestinal Obstruction / Q000628:therapy; D008113:Liver Neoplasms / Q000556:secondary / Q000628:therapy; D008175:Lung Neoplasms / Q000556:secondary / Q000628:therapy; D009362:Neoplasm Metastasis; D059408:Pain Management; D010166:Palliative Care; D010353:Patient Education as Topic; D040841:Resource Allocation; D012878:Skin Neoplasms / Q000556:secondary / Q000628:therapy; D029181:Spirituality; D013727:Terminal Care / Q000523:psychology
keywords: Low- and middle-income countries; Metastatic breast cancer; Palliative care; Resource allocations; Site-specific metastasis; Supportive care
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