Le Groupe franco-africain d’oncologie pédiatrique (GFAOP) a contribué à une amélioration notable de la prise en charge des cancers pédiatriques permettant aujourd’hui de se pencher sur les soins de support.

Faire un état des lieux de la prise en charge de la douleur de l’enfant atteint de cancer en Afrique subsaharienne.

Un questionnaire a été adressé au médecin et à l’infirmier responsables de chacune des 8unités pilotes (UP).

Tous les médecins et 2 infirmiers ont répondu. Les moyens humains (3 médecins et 4 infirmiers par UP) étaient modestes face à un nombre moyen de 102 cas par an. Cinq UP seulement disposaient de morphine ; outre sa disponibilité aléatoire (62,5 %), la crainte des effets secondaires et les contraintes administratives étaient les principaux freins à son utilisation. En phase curative, plus de la moitié des parents devaient acheter les antalgiques à la sortie. L’évaluation de la douleur était essentiellement clinique (8 UP), mais généralement concordante avec celle des parents. La majorité des malades faisaient l’expérience de la douleur au moment du diagnostic et à un degré supérieur à la rechute, le cancer en étant la cause principale. La prise en charge des douleurs liées aux actes, aux mucites et les douleurs neuropathiques restait largement insuffisante. Ces insuffisances s’expliquent par les moyens modestes, humains et économiques, mais également par des facteurs culturels.

La prévention et le soulagement de la douleur sont devenus une obligation pour tous les soignants. L’Afrique en pleine mutation socioculturelle n’échappe pas à cette évolution. Les équipes des UP reconnaissent la situation et la nécessité de ressources et d’une formation accrues pour une amélioration indispensable de la prise en charge.

The French-African Pediatric Oncology group (GFAOP) has contributed to a significant improvement in the prognosis of pediatric cancers in Africa through the development of therapeutic protocols adapted to local conditions. In parallel, the development of supportive care such as pain management, is now a major priority of our group.

The main objective of this study was to evaluate the management of pain in children with cancer in sub-Saharan Africa.

A questionnaire was sent to both the doctor and nurse responsible for each of the 8 pilot units (PUs).

All physicians and 2 nurses answered the questionnaire. Human resources (3 doctors and 4 nurses per PU) were modest compared to the size of the pediatric population (71 million) and the mean number of 102 cases of cancer/year per PU. Only six physicians had received specific training in pediatric oncology. Morphine was available in only 5 of the 8 PUs; major limitations for its prescription were mainly inconsistent availability (62.5%), fear of side effects (50%), and regulations (37.5%). During the curative phase, more than half of the parents had to buy analgesics when leaving the PU. Pain assessment relied mainly on clinical evaluation (8/8), but was generally concordant with parents’ assessment. The majority of patients experienced pain at diagnosis and at a higher degree at relapse, cancer being the predominant etiology. Pain related to other causes such as medical procedures, mucositis, and neuropathic pain was detected; however, its management remained inadequate. Only 2 of 8 PUs had a written protocol for pain management. These deficiencies can be explained by limited resources, both human and financial, but also by cultural factors such as endurance against pain still advocated by many African traditions.

In recent years, pain prevention and relief, whatever its origin, have become a priority for all medical teams, especially for children with cancer. With its profound sociocultural changes, Africa is no exception. All teams in our group are aware of the situation and hope for major improvement in pain management in the near future through increased resources and training.