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05.02.2021 Feature Article

Palliative Care Is the Future for Advanced Cancer Management

Palliative Care Is the Future for Advanced Cancer Management
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Cancer, like other chronic diseases is an increasing public health concern. In 2018, about 9.8 million people died of cancer, with about 70 percent of these mortality being recorded in low-and-middle-income countries [LMICs]. It is worthy to note that about 60 percent of new cases of cancers are being recorded in Africa, Asia, Central and South America. This situation is alarming and calls for priority attention.

As stated earlier, cancers are chronic or a degenerative disease. In cancer, cells divide, grow uncontrollably, forming malignant tumors, and invade nearby body parts. Hence, cancers are categorized into stages (Stage 0 – Stage 4) based on the extent of their spread to other body parts beyond the point where it developed. At Stage 0 cancers are still located in the place they started and have not spread to nearby tissues. However, at Stage I, it is usually a small cancer or tumor that has not grown deeply into nearby tissues. Stage II and Stage III indicate larger cancers or tumors that have grown more deeply into nearby tissue while Stage IV means that the cancer has spread to other organs or parts of the body, and can therefore be considered as advanced or metastatic cancer.

In advanced cancer, very little can be done for the patient, as they have passed the stage where treatment is viable. Moreover, in the advanced stages of cancer, the patient experiences severe pain (physical, psychosocial and/or spiritual pain), thereby compromising their quality of life. As such, there was the need to develop a comprehensive care for persons living with advanced cancer. Thus, giving birth to palliative care.

The World Health Organization (WHO, 2012) defines palliative care as ‘an approach for early diagnosis, evaluation and treatment of physical, psychosocial and spiritual problems of patients and families, who face problems accompanied with the life-threatening diseases, for relieving or preventing their pain, with the aim of improving their quality of life". This encompasses 24-hour care, pain management, spiritual care, as well as speech, physical, and occupational therapies. Palliative care is fundamentally recognized as a catalyst for improving the quality of life of advanced cancer patients by means of keeping them at peace and developing a sense of positivity in the patient.

Despite the importance and relevance of palliative care in managing pain and improving the quality of life of advanced-stage cancer patients, very few patients are referred for this service. Each year, an estimated 40 million people are in need of palliative care, and 78 percent of these people live in low- and middle-income countries. Furtherance to this, the WHO (2018) shows that globally, about only 14% of people who need palliative care currently receive it. This implies that hundreds of thousands of advanced cancer patients in need of palliative care do not receive it, and this may subsequently translate into higher mortality rates among these cohort.

In a replete of empirical evidence, it has been identified that several factors contribute to the low prevalence of palliative care, particularly in LMICs like Ghana. Dominant among these contributing factors are: absence of a clear service delivery model, lack of clear guidelines and protocols, low knowledge about the availability of palliative care, cost of care, inadequate palliative care specialists, among others (Partridge et al., 2014; Sahan & Terzioglu, 2015; Sarfo et al., 2016).

Recognizing the relevance of palliative care in the care for persons living with advanced cancer, there is the need to resolve the identified barriers in order to facilitate effective palliative care. To this end, countries without explicit strategies and framework for the implementation and regulation of palliative care must develop one. Also, there will be the need for national health insurance policies of individual countries to cover palliative care services. Universities and higher educational institutions, particularly in LMICs must begin to train health care providers in general palliative care service provision in order to make up for the shortfall in the absence of specialist palliative care. When these strategies are put in place, then the world would be moving towards a brighter future for persons living with advanced cancer.

I end by emphasizing that cancer is preventable; it is also treatable if detected early. Therefore, early detection is key in this endeavor. Together, we shall overcome cancer.

Reference

Partridge, A. H., Seah, D. S., King, T., Leighl, N. B., Hauke, R., Wollins, D. S., & Von Roenn, J. H. (2014). Developing a service model that integrates palliative care throughout cancer care: the time is now. Journal of Clinical Oncology, 32(29), 3330-3336

Sahan, U. F., & Terzioglu F. (2015) Palliative Care Education and Organization in the World and Turkey. Cumhuriyet Nursing Journal 4(2),81-90.

Sarfo, L. A., Opare, M., Awuah-Peasah, D., & Asamoah, F. (2017). Knowledge and perception of nurses on palliative care. A case study at Agogo Presbyterian Hospital. Applied Research Journal, 2(1).

World Health Organization (2018). Palliative Care: Key facts. Accessed from: https://www.who.int/news-room/fact-sheets/detail/palliative-care.

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