Transcript Situata onkologjike ne Shqiperi

Country Report for:
ALBANIA
DR. KRISTO HUTA
Demographic Data
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Albania: Population
» Year 1990: 3.380.000 inhabitants .
» Year 2010: 3.120.000 inhabitants
Area : 28748 km2
Average Age : 32 year-old.
Age group up to 45 years old : 43,8 % of population.
Age group 60 –79 year-old : 6,9 % of population.
45 % of population live in urban areas.
Mortality rate all causes, all ages 847/100.000
inhabitants
Level of fertility (per 1000) 13.8
Surce: INSTAT
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Epidemiology data on tumors
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Period 1986 – 1990
Average number of cases per year - 2.800
Population - 3.387.000 inhabitants
(ref. National Register of Tumors)
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2001:
-3.000 new cancer cases diagnosed
Population- 3.087.000
(ref. Inter Hospital Cancer Registry)
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2010:
- About 5000 new cancer cases diagnosed
Population- 3.127000
(Ref. GLOBOCAN)
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Mortality causes (2010)
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Cardio-vascular
50.2 %
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Oncology
16.6 %
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Traumas and accidents
6.8 %
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Other
11.3 %
Surce: Ministry of Health
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Epidemiological data on tumors in Albania
2008
Estimated incidence, mortality and 5-year
prevalence: woman
Estimated incidence, mortality and 5-year
prevalence: men
Women
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1.
Cancer pain and palliative care
2009 – 10 Member Steering Committee established
(Chairman: Vice Minister of Health)
December
May
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2011 - NCCP finished/submitted to Ministry of Health
June 2011 - NCCP finalized and endorsed by the Minister of Health
National Cancer Control Programme
Chairperson/Coordinator/Manager to be nominated
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Objectives for pain relive and Palliative Care included
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Availability of opioid analgesics specifically addressed
1.Cancer pain and palliative care
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Only 30% of terminal cancer patients have benefit palliative care
service.
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Currently, palliative care in Albania is provided mainly by non
profit sector.
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There is only one public service (Oncologic Home Service)
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There is a lack of inpatient and bed hospice unit.
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Very few non cancer patients receive palliative care .
1.Cancer pain and palliative care
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Pediatric palliative service is given in Pediatric Hospital in University
Hospital Center in Tirana
Very few pediatric patients are treated from NGOs
There are no specialist for pediatric palliative care
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Pediatric patients have access to opioid analgesics
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The government has not endorsed the WHO method for relief of
cancer pain and has not sponsored or endorsed training programs
in cancer pain relief, palliative care and medical use of
opioid analgesics.
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1.Cancer pain and palliative care (PC)
. For the first time PC was provided in 1993 only form non profit sector and
1997 from the state sector.
. In 2002 it is established the AAPC
. In 2003 it is founded the first inpatient hospice.
. Since 2010 there are optimistic developments
in PC in the country.
. Currently there are only 4 home care
providers of PC in Albania
- Sue Ryder Care (Tirane , Durres)
- Mary Potter
(Korce)
- Caritas
(Shkoder, Elbasan, Lezhe)
- SOB
(Tirane)
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2. HIV/AIDS pain and palliative care
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The National Strategy for the Prevention and Control of HIV/AIDS in
Albania (updated in 2010).
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There is National AIDS Program, as part of Institute of Public Health
structure.
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Pain relief and palliative care are not included in the above strategy.
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Neither opiod analgesics are addressed
2. HIV/AIDS pain and palliative care
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It is still a small number of patients with HIV/AIDS ,without a significant
weight for palliative care health structures
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Treatment and follow-up is done in Infectious Service in University Centre
Hospital in Tirana
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Only few terminal patients are followed up by NGOs
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government has not endorsed the WHO method for relief of
HIV/AIDS pain and has not sponsored or endorsed training programs
in HIV/AIDS pain relief, palliative care and medical use of
opioid analgesics.
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3. Opioid availability
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National Competent Authority for narcotics control for the country is
part of the Pharmaceutical Department at the Ministry of Health.
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The person in charge of this office is the Director of Pharmaceutical
Department.
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The Pharmaceutical Directorate and Drug issues Department are in
charge of submitting the annual estimate of medical requirements for
narcotic drugs, including morphine, to the International Narcotics
Control Board.
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A representative of this office is present at this meeting .
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3. Opioid availability
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National Competent Authority has not a method for calculating
estimates of annual need for opioids that they submit to INCB
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Therefore does not address unmet actual needs for opioids analgesics
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Estimation of annual need for opioids relies mainly in consumption of
previous year .
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Our NCA reports annual statistics on the consumption of opioid
analgesics to the INCB.
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3. Opioid availability
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WHO recommends an essential list with 33 drugs for palliative care, from
which 26 of them or 79% are available.
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In reimbursed drug list of Insurance Institute of Health Care, 15 drugs
are included or 45%.
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20% of this group of drugs ( Reimbursed for Palliative care) have limited
in usage dosage and quantity.
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Availability of drugs to the WHO essential list is satisfactory, but
nevertheless should be improved.
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Terminal patient don’t access these drugs due to lack of knowledge of
physicians
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3. Opioid availability
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Morphine is only available in 10 mg injection and in 10 mg long
acting tablets
Fentanyl is available, but too expensive to afford .
Methadone is only available for injecting drug users as part of
the HIV program .
Petidin very rarely used
No immediate release morphine preparations
The current company that provides slow release morphine is
Albtrade Pharma
The injection morphine is produced in Albania by a local
company(Propharma)
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3. Opioid availability
Opioid
Available
Not available
Reimbursed
Not
reimbursed
Codeine
X
X
Tramadol, injectable
X
X
Propoxyphene
X
X
Hyrdocodone
X
Morphine immediate release
X
Morphine sustained release
X
X
Morphine injectable
X
X
Oxycodone immediate release
X
Oxycodone sustained release
X
Methadone
X
Methadone injectable
X
Fentanyl transdermal
X
Fentanyl transmucosal
Fentanyl Injectable
X
X
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Hyrdomorphone immediate release
X
Hyrdomorphone sustained release
X
Hyrdomorphine injectable
X
Buprenorohine
X
Buprenorphine transdermal
X
Pethedine injectable
X
X
3. Opioid availability
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The opioids are not sufficiently available .
There are shortages .
No special training required for opioid prescribing ,but NGO offer
trainings
Prescribing is limited to doctors of NGO, authorized doctors in districts
where there is no palliative care service and GP’s with recommendation
from specialist
To prescribe opioids is required a license and signed a contract with
Insurance Institute of Health Care.
Nurses are not authorized to prescribe
Prescription forms required are special and approved from Insurance
Institute of Health Care .
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3. Opioid availability
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The physicians working in Palliative Care can prescribe opioid without dosage
limitations
 General practitioners can prescribe opioid no more than 100 mg /per day
 Prescriptions are limited up to seven days
 There is no a maximum length of time that a patients can receive opioids
 The validity of a prescription for an opioid such as morphine is 3 days
 Only cancer patients benefit opioids ,so prescribing regulations exclude
patients populations and diagnoses
There are no different legal requirements for prescribing ,dispensing or
purchasing different dosage forms of the same opioid, i.e., oral, transdermal ,
injectable.
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3. Opioid availability
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The national law or regulation does not require reporting names of
patients who receive opioid prescriptions to the government.
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The new law is under the process
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Health insurance coverage is a barrier to patients accessibility to opioid
analgesics because of limited value of reimbursement
The minimum penalty for physician or pharmacist who violates the
prescribing laws or regulations is 10$ -200$
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The maximum penalty is removal of license
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DRUG DISTRIBUTING SYSTEM
Level 1:International Narcotics Control Board
Level 2: National Competent Authority
Level 3 :Importer/Manufactures/Distributors
Level 4: Hospitals/Pharmacies/Pc Programs
Level 5: Physicians/Pharmacists/Other
Level 6 :PATIENTS
Medication
Information
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The symbol… against
pain and suffering is an
Albanian.
THANK YOU !