In 2007, 13% of all deaths worldwide were due to cancer, and of these 72% occurred in low- and middle-income countries. Opioids are essential for the successful delivery of palliative care and pain control. This paper reports data from a cross-sectional survey that aimed to investigate the use of morphine in advanced cancer in palliative care setting in Bangladesh, in order to inform clinical practice and fledgling service development. The study was a single semi-structured qualitative interview study. Cancer patients, family members and palliative care specialists (20 in total) were interviewed in two medical settings. Transcripts were transcribed verbatim, translated and cross-checked with two local interpreters. Data were imported into NVIVO 8 for coding. A coding frame was generated following line by line coding. Relational codes were established following peer review of coding units and the resulting frame. Despite having been under the pain and palliative care clinics only six out of 10 patients had received morphine. Lack of morphine availability resulted in physical suffering of patients and emotional distress of their families. Lack of availability of morphine was identified as the main barrier to pain control. International attention and collaboration with local policy makers is needed to simplify narcotic regulations and increase the availability of morphine.

Background Breast cancer is one of the leading cancers among the Bangladeshi women. Coping helps these patients to adjust with this life-changing disease. Each individual has unique and different coping mechanism. But we know a little regarding their coping strategies. This study aims to explore the different coping strategies adopted by the women with metastatic (stage IV) breast cancer attending the palliative care unit and their relationship with the common mental health issues like anxiety and depression. Methods This cross-sectional study was conducted among 95 patients with metastatic (stage IV) breast cancer attending the Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University, Bangladesh from April 2021 to September 2021. Data was collected by face-to-face interview using a structured questionnaire adapted from Hospital Depression and Anxiety Scale (HADS), Brief COPE inventory and Eastern Cooperative Oncology Group (ECOG) performance scale. Pearson correlation test was used to find the relationships between various domains of coping strategies and psychological variables. Correlation matrix was done to observe the internal correlation among different coping strategies. Kruskal-Wallis H test was done to find the relationship between different coping strategies and ECOG performance status. Result The mean age of the respondents was 48.9 ± 9.9 years. Most of them were married (94.7%), Muslim (92.6%) and homemakers (82.1%). Commonly used coping strategies by the patients were: acceptance (median 10; IQR 10), religion (median 9; IQR 8–10) and instrumental support (median 9; IQR 6–10). Significantly strong positive correlation was found between emotional and instrumental support (R = 0.7; p = 0.01), planning, acceptance and active coping (R = 0.7; p = 0.01); behavioral disengagement, self distraction and denial (R = 0.5; p = 0.01). Significantly fair negative correlation was observed between active coping and depression (R = -0.4, p <0.001). Patients with better performance status on ECOG scale (Grade 0–2) leaned more on the positive coping strategies like instrumental support, emotional support, positive reframing and venting. Conclusion Different coping strategies, especially positive coping helps the patients to adapt with their disease over time. All women suffering from breast cancer should be routinely screened and assessed for psychological distress and ensure early intervention and management to promote a better quality of life.

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