Over one million new cases of cancer are registered in India annually. More than a third of patients undergoing cancer treatment, and 60% to 90% of those in advanced stages of cancer report significant cancer pain . Today it is imperative to review an often-overlooked aspect of comprehensive cancer care that focuses on alleviating pain and improving quality of life: Palliative care.
What is Palliative Care?
The World Health Organisation (WHO) defines palliative care as “an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with a life-threatening illness. The relevance of palliative care is growing thanks to the rise in non-communicable diseases and chronic lifelong conditions. The list of those who need palliative care is keeping pace with the increase in the average human life span. Palliative care is needed for cancer , HIV/AIDS, dementia, stroke, progressive neuromuscular diseases, and terminal organ failures.
Why we need it ?
It prevents and relieves suffering…from pain and other problems, whether physical, psychosocial or spiritual. More than 80% of all adults and children dying from cancer require palliative care at end of life. This estimate does not take into consideration those needing palliative care early in the course of their illness. Early palliative care not only improves quality of life for patients but also reduces unnecessary hospitalisations and use of health-care services.
Three types of palliative care services are available in India: Home-based care, Outpatient services, and Hospice (in-patient) care services. An institution can provide any one of these services, any combination of these services, or all of these services at a time. Home-based care caters to people with cancer in advanced stages who choose to receive care in the comfort and privacy of their homes. It is also one of the few ways patients in rural areas can access palliative care when health care facilities are sparse. Out-patient services facilitate all aspects of palliative care for patients and their families, while hospice care is recommended for management of difficult symptoms requiring expert management, and terminal phase (end-of-life) management.
Challenges in implementing Palliative Care Programmes
Palliative care is not recognised as it should be, and access to it is restricted. This not only impacts a large population negatively but hurts the socially and economically disadvantaged the most.
The availability of morphine—a scheduled drug essential for pain management in serious cases, used to be a challenge in provision of palliative care services in India. Due to earlier stringent regulations, the supply of morphine was severely restricted across the country, subject to rules laid down by the Narcotics, Drugs, and Psychotropic Substances Act of 1985. Following an amendment to the Act in 2014, morphine and similar opioid pain medications are now made available for clinical use by licensed practitioners, providing suffering patients much needed relief.
“While low awareness of patients in seeking palliative care is a challenge, a bigger issue is that of referral of such patients to palliative care by oncologists and physicians. A common misconception among oncologists is that palliative care implies merely end-of-life care. The goal of palliative care is in fact to provide the best possible quality of life, at every stage of treatment, starting from diagnosis. The advantage of early palliative care has been demonstrated to influence patient-related outcomes too. Such a misconception, in addition to lack of awareness among the medical community of palliative care entirely, leads to a vast number of patients and their families with no avenue to seek relief during treatment.”
Making palliative care accessible to all those who need it is not an impossible dream. The obstacles that stand in its path can be easily overcome. They are a lack of awareness among policy makers, health professionals and the public about what palliative care is and the benefits it can offer if integrated into existing health systems, especially at the primary level.
We are also living in a cultural environment that would rather deny death, and view it as a medical failure, then accept it as a corollary of life. Another misconception is that improving access to opioids like oral morphine, so essential for meaningful pain control, will lead to increased substance abuse.
“We cannot change the outcome, but we can affect the journey”
We at cancer pain control.
To know more about Pain and palliative care from Dr. Anurag Aggarwal you can write at www.painxtotal@gmail.com or Whatsapp me at +919958830005. We are committed to providing the best Interventional Pain Management solutions and palliative Care to cancer patients in Delhi NCR.
For any further query or assistance write to us @ Painxtotal@gmail.com or call on +91 9958830005 or whattsapp@9811797894 to Dr Anurag Aggarwal
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