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In collaboration with other organizations, the International Association for Hospice and Palliative Care (IAHPC) recently developed a list of medicines essential for palliative care in response to a request from the Cancer Control Program of the World Health Organization (WHO). The current WHO Model List of Essential Medicines has a section called "Palliative Care," which does not list any medications but contains the following statement:


Section 8.4-Medicines used in palliative care. The WHO Expert Committee on the Selection and Use of Essential Medicines recommended that all the drugs mentioned in the WHO publication Cancer Pain Relief: With a Guide to Opioid Availability, second edition, be considered essential. The drugs are included in the relevant sections of the Model List, according to their therapeutic use, e.g. analgesics.


The request from WHO was to prepare a list based on the recommendation from palliative care experts, taking into consideration two criteria: efficacy and safety. The WHO will be carrying out the cost-effectiveness analysis and evidence-based reviews of the recommended medications.


To work on this proposal, IAHPC formed a working committee that included board members of IAHPC and external advisors from the field. The group was chaired by Dr Neil MacDonald and co chaired by Dr Carla Ripamonti. Other members included Drs Kathy Foley, Eduardo Bruera, David Currow, and Liliana De Lima. Drs Peter Glassman and Karl Lorenz served as the expert advisors. The committee developed a plan of action that included a modified Delphi process, a general survey among palliative care experts from around the globe, and a face-to-face meeting in Salzburg, Austria, with representatives from 26 international palliative care and pain relief organizations.


Now that this task has been completed, the IAHPC has delivered its list to the WHO. The IAHPC list includes 34 medications, of which 14 are already included in the WHO list of essentials for the treatment of certain conditions. Some of these conditions are also common in palliative care.


The IAHPC hopes that this list will serve as a reference to palliative care providers and institutions around the world and that the WHO will include the recommended medications in the "Palliative Care" section of its Model List.


The IAHPC List of Essential Medicines in Palliative Care will be published in several pain and palliative care journals in the next few months. In addition, IAHPC is working on the completion of a manuscript to be published in an upcoming edition of the Oxford Textbook of Palliative Medicine.


More information about IAHPC and the programs and projects that it is currently engaged in to improve access to palliative care around the globe can be accessed from its Web site at http://www.hospicecare.com.