Cancer Care in Countries and Societies in Transition by Michael Silbermann

Author:Michael Silbermann
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Insights on Palliative Care: Preferred Formats for Cancer Palliative Care

Given the large cancer burden, advanced stage at presentation and low cure rate the need of palliative care in Pakistan cannot be overemphasized. Development of palliative care services with prioritization of pain control were main objectives of WHO National Cancer Control Plan initiated in Pakistan in 2002 [18]. Unfortunately, implementation of the plan has been poor, particularly with regard to the development of services for early detection, palliative care, and morphine availability. As a result, most patients still present with advanced disease in need of palliation from the start, face abandonment when terminally ill and usually die of poorly controlled pain [19].

Palliative care in Pakistan is still at its developmental stage. With the exception of foreign qualified one palliative care physicians, there are no formally trained palliative care doctors in a country with an enormous cancer burden. Palliative care remains unrecognized at all level of medical education in Pakistan. There is no module of palliative care in any undergraduate and postgraduate medical curriculum except in oncology. There is no formal training, course or diploma offered by any medical and nursing institutions. In most places, palliative care is led by oncologist working in the organizations.

Palliative care nursing is also in the undeveloped phase. Very few institutions have trained nurses in their palliative care team with no formal qualification. Most of them are trained on job by physicians or have attended short courses or workshops. Pakistan Nursing Council the licensure body of nursing in Pakistan does not offer any certification or diploma in palliative care nursing [20].

The “registered” narcotics theoretically available for use are oral and parenteral formulations of morphine sulfate, parenteral pethidine and fentanyl, oral codeine phosphate, oral and parenteral buprenorphine, and fentanyl patches. The newly formed Drug Regulatory Authority of Pakistan (DRAP) has formulated new rules wherein any narcotics not already registered in Pakistan cannot be imported. The rules state that only companies approved by the DRAP can import narcotics [11]. Opioid availability is a major problem. Procurement of morphine in any institution is a complex, complicated, and cumbersome task. It has to go through four authorities: Federal and provincial health ministries, narcotic board and excise department. The whole process takes long team and often by the time it is procured the expiry is limited to 1.5 years. Morphine supply was sporadic but now with an increase in usage it is available most of the time [19].

Palliative care services are offered only in few hospitals and hospices in Pakistan. There are no community-primary health center services for palliation. Home-based service is only offered at a private hospital in Karachi.

There are fewer than five hospices limited to three major cities with no systemic approach to palliative care. These centers are mainly used for terminal care. At some of these centers, chemotherapy is also provided and they function more like a cancer hospital. They are looked after by oncologists and nurses. Psychosocial support is nonexistent or minimal. Most of them are run by NGOs with philanthropic support.

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