The dearth of cancer-related palliative care in Sri Lanka
View(s):Palliative care is an approach that improves the quality of life for patients and their families who face issues associated with life-threatening illness through the prevention and relief of suffering through early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial, and spiritual. According to the International Association for Hospice and Palliative Care, palliative care is active holistic care that focuses on individuals across all ages with serious health-related suffering due to severe illnesses, especially those near the end of life. Further, it aims to improve not only the quality of life of patients but also their families and caregivers.
Dr. B. Sunil S. De Silva, Dean / Senior Lecturer in Nursing, Faculty of Health Sciences, The Open University of Sri Lanka, Nawala, Nugegoda, Sri Lanka.
Palliative care has developed rapidly since the late 1960s based on the groundbreaking work of Cicely Saunders, who was working as a nurse in the 1940s and was the founder of St Christopher’s Hospice in London. She is generally recognised as the founder of the palliative care movement. Her pioneering work was especially focused on drawing attention to the end-of-life care needs of patients with advanced cancer. Further, palliative care began to be demarcated as a subject of activity in the 1970s and came to be associated with care provided by a multidisciplinary team for the physical, social, psychological, and spiritual needs of patients with a life-threatening illness. Even though palliative care services have developed in many settings and have often been closely related to oncology at its initial stage, it gradually has spread to different patient groups with life-limiting illnesses and is no longer limited to cancer.
Currently, palliative care is considered one of the crucial elements of each country’s healthcare system. In most developed countries, up to 80% of individuals who die due to life-threatening illnesses could benefit from palliative care much earlier in their illness. Although palliative care in community care settings may be related to lower costs than palliative care in hospitals, studies in developed and developing countries highlighted that most individuals wish to die at home. However, it was further noticed that a growing number of patients with chronic diseases in developed countries are dying in the hospital. According to recent studies, nearly half of all cancer deaths were reported in hospitals. Hence, palliative care was known to be the main cause of hospitalisation and more than half of all patients with cancer died in acute care settings. Those explanations further emphasized the significant role that hospitals play in the care of patients with advanced cancer and the delivery of palliative care. However, the great variances between countries in the place of death are only partially explained by differences in the cause of death, sociodemographic factors, and health care supply, which proposes that country-specific palliative and end-of-life care policies may be among the factors that play a vital role in where people die.
When considering the Asia Pacific and Oceania regions, Sri Lanka was identified as a developing country with limited provision of palliative care services to its population. It was identified that only one palliative care clinic was available in Sri Lanka compared to Japan, which had 686. The researchers mapped the world situation regarding palliative care in 2008 and 2013 and identified Sri Lanka as having localized provision and isolated provision, respectively. Thus, palliative care in Sri Lanka is very limited. Accordingly, there were no significant achievements in the field of palliative care in Sri Lanka from 2008 to 2013. Hence, patients with life-threatening illnesses and patients with cancer who need palliative care do not have access to it.
According to the Palliative Care Association of Sri Lanka (2016), physical symptoms in cancer patients, as well as non-cancer palliative care patients, are usually addressed by the treating oncologist and the respective physician as long as the patient is under his/her direct care. However, anaesthetists are sometimes called to manage severe pain if the patient is admitted to a cancer hospital or any other relevant acute care setting. Furthermore, the Palliative Care Association of Sri Lanka (2016) highlighted that formal palliative care services are not yet available in Sri Lanka except for the few hospices that function as non-governmental organisations (NGOs) and offer incomplete services to patients with advanced cancer. The prominent NGOs are the Sri Lanka Cancer Society, Maharagama Shantha Sevana Home, Sri Lanka Palliative Care Organization, Northern Province Palliative Care Service, and Shanthi Foundation.
Palliative care information and services can also be obtained from some public hospitals and units, such as the National Cancer Hospital, Maharagama (Apeksha Hospital), National Cancer Control Programme, Palliative Care Unit and Maxillo-Facial Surgical Unit of the Kuliyapitiya Base Hospital, and Palliative Care Unit of the Vavuniya General Hospital. Hence, the Sri Lankan health system does not support palliative care as a speciality, and it is practised by only a few people in Sri Lanka and just a few oncology units in public hospitals. There is only one Cancer Hospital in Maharagama, Sri Lanka, that must serve the entire population. However, the Ministry of Health, Nutrition, and Indigenous Medicine recently recognised that palliative care services in Sri Lanka need significant development and drafted the National Strategic Framework for Palliative Care Development in Sri Lanka from 2018 to 2022. The overall goal of this framework is to promote quality of life, respect dignity and lifestyle, and ensure a holistic support system for patients with life-threatening illnesses and their families through evidence-based, multi-disciplinary, and cost-effective approaches. Further, eleven strategies were identified to achieve this goal. Among them, the seventh strategy is to “empower family members, and caregivers for the provision of palliative care”. Therefore, the proposed National Strategic Framework for Palliative Care Development in Sri Lanka has already identified the need for informal caregivers for the provision of palliative care that may lead to addressing the dearth of cancer-related Palliative Care in Sri Lanka at least to some extent.
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