[Difficulties with using morphine in cancer pain management: Ivorian experience]. / Les difficultés de la prise en charge par la morphine de la douleur en cancérologie: expérience ivoirienne.

UNLABELLED: Pain is the most frequent functional aspect found with cancers. Pain leads to incapacity in 69% of cases. However, pain is insufficiently handled, especially in developing countries. Pain considerably affects the quality of life of patients, and it imposes adequate care including the use of morphine when it is necessary. OBJECTIVE: To determine the difficulties to handle pain in particular with the use of morphine in order to propose some solutions. METHODS: Prospective study over six months in the Cancerology Unit of Treichville Training Hospital. It includes 120 patients who had questioning and physical examination including pain evaluation by the VAS. RESULTS: Chronic pain occurred to 96 patients (80%), pain was nociceptive for 48 patients (50%) and 19 patients (20%) had mixed pain. Morphine was relevant in 54 cases but only 27 prescriptions were made. One of the reasons was the fear of some physicians. Only eight prescriptions were respected. Six patients did not respected prescription because of unavailability whereas the remaining mentioned financial reasons as the obstacle. None adverse reaction occurred. CONCLUSION: Morphine represents a major tool to handle pain for a patient suffering of cancer. In Ivory Coast, the development of palliative care enables through national workshop to start a campaign in favor of the availability and easy geographical and financial accessibility of morphine (mainly morphine powder) whenever the prescription is required.

[Implementation of palliative care in Ivory Coast]. / Mise en place de la politique nationale des soins palliatifs en Côte d'Ivoire.

Ivory Coast adhered to the strategy of the primary cares of health whose leading principles served basis to the definition of the National politics of sanitary development, exposed in the National plan of sanitary development 1996-2005. The improvement of the quality of the cares is the main objective of this plan. The attack of this objective cannot make itself without the hold in account of the palliative cares that are a component of the cares for the patients affected by chronic and incurable affections, since the diagnosis until the death and even after the death. Conscious of the necessity to develop the palliative cares to improve the quality of life of the patients and their families, the ministry in charge of health, in collaboration with the partners to the development, initiated a project of development of the palliative care in Ivory Coast. It is about an innovating gait in Ivory Coast concerning politics of health. This work has for goal to present the big lines and the setting in which this politics has been put in place.

[Hormonal status and overexpression of HER2 in breast cancer, Cancerology department of Treichville UHC. Preliminary results]. / Prévalence des récepteurs hormonaux et de HER2 dans le cancer du sein au service de cancérologie du CHU de Treichville. Résultats préliminaires.

MAIN OBJECTIVE: determine the profile of the hormonal receptors and HER2 in order to optimize the patient's treatment by hormonotherapy and to propose targeted therapeutic to the few patients can procure themselves, when the indication is put. SECONDARY OBJECTIVES: show the feasibility of these exams in sub-Saharan Africa and also the necessity to improve the technical tray permitting to do these exams in routine thus. PATIENTS AND METHODS: Preliminary results of a prospective, descriptive study, on 10 months, achieved to the Cancerology service of Treichville CHU in Abidjan (Ivory Coast). Our results were about 22 patients. RESULTS: The middle age of our patients was of 42.7 years. The stages to the diagnosis were advanced (86%) with nodes metastasis (77%), 8 patients out of 20 were RH+ of which only one postmenopausal patient, 8 patients out of 20 were HER2+ of which 2 to 2++ and 6 to 3+++. The FISH test has been achieved for the 2 positive patients to 2 ++ by IHC and came back positive. One of patients HER2+ could have adjuvant Herceptin. CONCLUSION: Breast cancer is bad prognosis affection in our developing countries because of the patient's young age, of the advanced stages to the diagnosis. The knowledge of the status of the hormonal receptors and the HER2 over expression is necessary, as well the importance to pursue this survey and to set up an immunohistochemy unit in Ivory Coast. It will permit the realization in routine of these exams and, then, the improvement of the breast cancer patient's treatment.