Mohammed VI Center for the Treatment of Cancers, UHC Ibn Rochd, MoroccoMorocco
Mohammed VI Center for the Treatment of Cancers, UHC Ibn Rochd, Morocco; Hassan II University of Casablanca, Casablanca, MoroccoMorocco
Middle East Cancer Consortium, P. O. Box 7495, Haifa, IsraelIsrael
Also available as PDF (figures and tables appear in the PDF).
Since the implementation of the first National Cancer Prevention and Control Plan (PNPCC1) in 2010, palliative care in Mo-rocco has been a strategic approach in its own right, alongside the prevention, early detection and cancer management approaches.
OpenJournal PUBLISHERS Editorial Setting Higher Standards in Cancer Care: Experiences at the First Palliative Moroccan Care Congress Casablanca, Morocco, March 2022 1 1,2 1,2 3* Asmaa El Azhari, MD ; Abdellatif Benider, MD ; Souha Sahraoui, MD ; Michael Silbermann, PhD 1Mohammed VI Center for the Treatment of Cancers, UHC Ibn Rochd, Morocco 2Hassan II University of Casablanca, Casablanca, Morocco 3Middle East Cancer Consortium, P. O. Box 7495, Haifa, Israel * *Corresponding author Michael Silbermann, PhD Executive Director, Middle East Cancer Consortium, P. O. Box 7495, Haifa, Israel; E-mail: cancer@mecc-research.com Article information th th th th Received: April 5 , 2022; Revised: April 11 , 2022; Accepted: April 11 , 2022; Published: April 13 , 2022 Cite this article El Azhari A, Benider A, Sahraoui S, Silbermann M. Setting higher standards in cancer care: Experiences at the first palliative moroccan care congress Casablanca, Morocco, March 2022. Palliat Med Hosp Care Open J. 2022; 8(1): e1-e2. doi: 10.17140/PMHCOJ-8-e011 ince the implementation of the first National Cancer Preven- one of the obstacles to access to palliative care, in general, and its 3,4 tion and Control Plan (PNPCC1) in 2010, palliative care in Mo- decentralisation towards primary care.3,4 S rocco has been a strategic approach in its own right, alongside the prevention, early detection and cancer management approaches. “I don’t know how to prescribe morphine” or “how are we going Since then, several measures have been put in place to facilitate the to manage a stockpile of opioids? This must really be a source of trouble!” or deployment of the actions representing this axis, i.e. the develop- “what if the patient goes into respiratory distress while taking morphine?”. ment of the palliative care network, pain management, palliative care research, as well as social and family support for palliative These are the main fears of healthcare professionals re- cancer patients.1 garding cancer patients in advanced palliative care due to lack of training.5 This indirectly raises a second question about the situa- Palliative care units have been established in seven re- tion of palliative care in Morocco, which is the inaccessibility to gional oncology centers, four of which have mobile home teams, opioids. Their supply is limited to regional oncology centres and in addition to outpatient and inpatient activities.
they are only sold in pharmacies in the cities where these special- ised centres are located, despite the fact that Moroccan law allows Palliative care activity is, therefore, centralised at the ter- their prescription by all doctors, regardless of their status as spe- tiary level of care, ensuring care for advanced palliative cancer cialists or not.
patients only in urban areas, through home visits, outpatient or inpatient care. However, they are inaccessible to patients living in There is no sense of responsibility, obligation or ethi- peri-urban or rural areas, unless they can physically travel to the cal duty in the caregiving community to “not abandon” a patient regional oncology centre where specialised palliative care teams at the end-of-life (EoL). On one hand, this is due to a lack of operate. Unfortunately, this is not the case for most patients in training; on the other hand, this is due to the lack of an “integrated advanced or terminal palliative situations.
palliative care process (IPC-PC)”. Organisational models are arbitrary, It is in this context of inaccessibility to palliative care that “everyone does what they can”, scenarios are unclear and the patient is the palliative care strategic axis of the second National Cancer Pre- lost in an unfocused and complicated system. This biased com- vention and Control Plan (PNPCC2 2020-2029) was designed, em- munity approach can be represented as a chain of disconnected phasising the community approach to palliative care, the proposal rings, though, in reality, it has only two rings at the end of the two of regulatory texts in line with the principles of bioethics, as well extremes: the tertiary level and the community represented only as the reinforcement of the training of health professionals in pal- by the patient’s family. It does not incorporate all the intermediate liative care to achieve full coverage of patients in need of palliative rings which should contribute to a coordinated system of palliative care and its good integration in the community: liaison nurses, sup- care.
port teams at the primary care level, volunteer teams, social work- In fact, the lack of awareness and training in basic pallia- ers, respite hospitalisations at the provincial hospital level, etc.,3 tive care among oncologists, specialists and general practitioners is especially when the patient lives in the periphery or in a rural area. cc Copyright 2022 by Silbermann M. This is an open-access article distributed under Creative Commons Attribution 4.0 International License (CC BY 4.0), Palliat Med Hosp Care Open J. 2022; 8(1): e1-e2. doi: 10.17140/PMHCOJ-8-e011 PUBLISHERS The development of the IPC-PC model such as the IPC- spoken aspects of medicine, such as the spiritual pain often associ- PC could guarantee good coordination aimed at the continuity of ated with physical and psychosocial distress9 and the awakening of care for cancer patients in palliative care by assigning each health- the community of caregivers to compassion is the ultimate key to care professional, each level of care and all the components of our active and authentic intervention in patients at end-of-life. healthcare system “a well-defined role” in the care of cancer patients from the moment the patient is identified as being in a palliative CONFLICTS OF INTEREST situation until death. In other words, to define in an institution- alised way the what, who, when, how and where of interventions The authors declare that they have no conflicts of interest. aimed at the care of these patients.6