Abstract 973: Silent suffering: the urgent need for improved palliative care and opioid access for breast cancer patients in the Caribbean
Authors: Alexandria E. Curry, Advith Suresh, Robin Williams, Samrawit Zinabu, Miriam Michael
Journal: Cancer Research (2025)

Abstract This study aims to investigate the availability and accessibility of palliative care and opioid-based pain management for patients with advanced breast cancer in the Caribbean, highlighting regional disparities and barriers to effective end-of-life care. We analyzed the availability of palliative care services and opioid medications in Caribbean countries, focusing on gaps in healthcare infrastructure, regulatory challenges, and cultural or legal barriers to opioid use. We collected data from national reports, healthcare registries, and published literature. Our study found that access to palliative care in the Caribbean is severely limited, with some nations, like Haiti, having no palliative care physicians. The Bahamas, which has the highest breast cancer mortality in the region, only has one. Countries with established programs, like Barbados and the Cayman Islands, struggled to expand services beyond limited geographic and population reach due to funding constraints and a lack of trained professionals. Despite the inclusion of at least two forms of opioid medications in most national formularies, their actual use remains significantly lower than global standards—20 times less than the per capita usage in the United Kingdom and 60 times less than the usage in the United States. Barriers included restrictive laws, negative perceptions of opioids, and logistical inadequacies in medication access. In many countries, opioids could only be obtained from hospital pharmacies, further restricting access and stigma and fear of addiction contributed to underprescription and underuse, even when medications were available. These issues were compounded by a lack of provider education in safe opioid prescribing, resulting in unnecessary suffering for patients with advanced disease. These gaps in palliative care result in inadequate care, leaving many patients without the necessary support to manage their symptoms and maintain quality of life. Access to palliative care and effective pain management for advanced breast cancer patients in the Caribbean is critically inadequate. There is an urgent need for enhanced palliative care services, including professional training, and the development of formal guidelines to address regulatory barriers to opioid access. To address these challenges, we recommend the creation of a resource-specific guide for low- and middle-income countries that focuses on integrating pain medication into palliative care protocols as a central component of treatment. Additionally, we propose a basic level of supportive care for patients with organ-based metastatic disease, which provides site-specific recommendations for managing symptoms and complications in resource-limited settings. These measures are essential to improving the quality of life and ensuring equitable care for patients in the region. Citation Format: Alexandria E. Curry, Advith Suresh, Robin Williams, Samrawit Zinabu, Miriam Michael. Silent suffering: the urgent need for improved palliative care and opioid access for breast cancer patients in the Caribbean [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 973.