INSIDE

TECHNICAL

COOPERATION

Vol. 3, No. 3

TC FLASH

Pain Relief for Cancer Patients at Lower Cost

A three-year comparative study has yielded results that will lead to widespread pain relief for cancer sufferers while cutting costs of patient treatment dramatically. The study was organized through an IAEA coordinated research project (CRP).

Cancer patients with metastases commonly experience bone pain. Radiopharmaceutical treatment is widely accepted as the most effective and least toxic, especially when the pain sites are numerous and widespread. Cost remains the major constraint in the therapeutic use of radioisotopes in developing countries. Of the radiopharmaceuticals suitable for clinical use, strontium-89 is expensive but widely marketed by a single company and phosphorus-32 is relatively cheap, available in developing countries but less used.

The CRP, started in 1993, compared the efficacy and toxicity of intravenously administered strontium-89 and orally administered phosphorus-32 in the palliative treatment of painful cancer bone metastases. This was the first therapeutic clinical study undertaken by the IAEA and is so far the only one of its kind worldwide. Five countries - Austria, India, Indonesia, Slovenia and Peru - participated and 85 patients were investigated. The results of the study were presented at the final research coordination meeting in Llubljana, Slovenia, in April 1997. They confirmed that phosphorus-32 is as effective as strontium-89. On the basis of sound scientific evidence, the IAEA can now encourage developing countries to use phosphorus-32, which will benefit a large number of patients now denied the opportunity to improve their quality of life.

Potential Increase in Organ Donors

A new religious policy could pave the way for more TC involvement in nuclear medicine in some developing countries. Religious tradition can severely restrict the availability of organs for transplants. Shortages are particularly severe in Islamic countries, where religious authorities generally prohibit the surrender or replacement of any part of the body. Since government policies rarely attempt to challenge religious edicts in these countries, many patients needing transplants are forced to seek them abroad.

But break with tradition occurred this year in Egypt, where the top religious authority, Mohammed Sayed Tantawi, the Grand Sheik of Al Azhar, declared in May that transplants were indeed permissible and that he would donate his organs to needy patients when he died. Lists of dozens of prominent Egyptians who followed suit were published in Egypt's official newspapers. Tantawi, who presides over more than 6000 religious institutions in Egypt alone, exercises enormous influence throughout the Islamic world. His declaration reinforces the Egyptian Government's request to Parliament - in response of the concern of doctors troubled by the lack of available organs - to draft a law spelling out the circumstances under which organ transplants would be permitted.

The implication for the IAEA points toward increasing technical cooperation with developing countries in using isotopic techniques and industrial radiation processes in efforts to improve human health. The introduction of organ donation and the growth of centres for transplants in Islamic countries would foster collaboration between institutions to share their experience with medical grafts using human tissues.