Pain management lacking in SA

The majority of patients with advanced cancer and HIV suffer pain.

In the case of cancer, the pain is mostly caused by inflammation or pain in the bones.

With HIV/Aids, a patient can suffer various versions of pain, with some of the more common being peripheral neuropathy, meningitis, thrush in the mouth, oesophageal thrush, and cramps from diarrhoea.

Most medical practitioners only treat patients with antiretrovirals, which take several months to relieve symptoms such as pain.

“How long does a person have to live with pain until the antiretrovirals kick in and reduce all those problems?” asks Dr Liz Gwyther, CEO of the Hospice Palliative Care Association of SA, who believes that many South African doctors lack education in pain management and assessment.

There is also an overlap between these two diseases, as the development of certain cancers is encouraged by the absence of a fully-functional immune system – as is the case in patients living with HIV.

Kaposi’s sarcoma, Hodgkins and non-Hodgkins lymphoma, cancer of the cervix, and anal, lung and liver cancer are particularly common in the HIV-positive population.

In South Africa, and in other countries on the continent, there is a tendency for cancer patients to seek medical attention for their condition only at a very late stage, at which time the cancers are well advanced and are often incurable.

The reasons why patients present so late with cancer include a lack of healthcare facilities, or the costs of having to travel vast distances to get to a clinic, as well as a culture of attending traditional healers, who might not be trained to recognise the disease for what it is.

“A person with a breast lump is encouraged (by a traditional healer) to wait, because they believe evil spirits are released when the cancer bursts through the skin. Now, for us that is Stage 4 cancer,” says Gwyther.

If a cancer is localised to a lump in the breast, that indicates Stage 1 or 2 cancer, which is often curable.

A cancer that bursts through the skin of the breast indicates Stage 4 or 5 cancer, which is advanced and mostly incurable.