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Palliative care from diagnosis for every advanced cancer, including opioid access, worldwide

Palliative care given early alongside cancer treatment improves quality of life and sometimes survival, and most of the world has no access to it or to morphine. Make both universal.

Early integrated palliative care improved quality of life, mood and in some trials survival in metastatic cancer (Temel 2010), and is guideline-recommended, yet is delivered late or not at all in most settings; the Lancet Commission on palliative care documented that most of the world's population lacks access to opioids for pain. The proposal is a global standard: automatic palliative care referral at diagnosis of advanced cancer, trained generalist palliative capacity in every cancer unit, and a financed programme guaranteeing affordable oral morphine and essential palliative medicines in every country.

Hypothesis
Universal early palliative care and opioid access reduce severe uncontrolled pain at end of life by over half and improve quality of life scores in advanced cancer across participating countries.
Rationale
The evidence is settled and the interventions are inexpensive; the barriers are regulation of opioids, workforce and the misconception that palliative care means giving up.
What would test it
National implementation in three countries with a WHO-style essential package; measure opioid availability, referral timing and patient- and family-reported outcomes against matched countries.
Maturity
being tested at scale
Who has to act
policy
Cost to try
Large (over $50M)
Years to first evidence
5
Bottlenecks it attacks

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