Impact of educational strategies in positioning Samarium-153 EDTMP as a treatment for metastatic bone pain

To educate is a difficult task but its results make efforts worthwhile. Many patients in Peru suffer from intractable bone pain due to metastases. Since 1993 radionuclides were used to palliate bone pain due to metastases in Peru. First, with the help of the IAEA, Peru participated in a clinical trial using Phosphorus 32 and Strontium 89. Then, efforts were performed to produce Samarium 153 EDMTP locally, which was achieved in 1995. Nevertheless, years passed and Samarium use did not increase proportionally to the needs of people with cancer and bone pain, mainly the poor. Educational strategies have been proven useful for delivering solutions to many health problems in other diseases and also in cancer. Health education makes patients and their relatives assume responsible care of their problems. The purpose of this work was to increase Samarium EDTMP use as palliative treatment in patients with bone pain due to metastases, using educational strategies as means to change attitudes towards this health problem. In September 2003, a task group conducted studies in order to apply several methods to achieve the goal of increasing Samarium EDTMP use. Educational strategies employed were performed to provide verbal and written information to patients, physicians, medical students, residents, pain specialists, oncologists and neurologists, as well as general public. Verbal information included radio interviews, television spots and a phone number (in charge of two secretaries, prepared for answering and if not possible, a physician was in charge of attending patient consultation), e-mail and a web page for consultation. Written material was delivered to several newspapers, including clinical use of Samarium, possibilities of being elected for treatment, benefits and risks and a photography of the product. Politics of the institution producing Samarium changed, in order to achieve minimum cost of the product and it was delivered to all publics at the lowest cost for a year, which has finished in December 2004. Three television spots were delivered to public: 'Hello, Doctor', which has a morning audience and in two interviews in news programs, with high rating performance. Five interviews were given in radio programs, one of them was for a feminine audience, three for general public and the other two with national impact. In every program a web page, an e-mail and a telephone number were given for consultation. In Nuclear Medicine Centers in Lima telephone calls have been received since the beginning of the campaign every day, up to date. In a year, a monthly conference was delivered to physicians. Samarium EDTMP treatment increased substantially after the campaign. The more significant means in mass media for changing management were patient education, continuous meetings with specialists and one of the television spots used ('Hello, doctor'), which continues to be delivered in the closed circuit TV network of the social security system. We conclude that repetitive educational strategies have a positive impact in delivering radiopharmaceuticals for bone pain palliation to patients with bone metastases