Palliative care is an important part of the treatment plan

Renu Sud Sinha

GHar le jao aur seva karo — Doctors are the last resort when all treatments stop working. „But they don’t tell you how to do it,” says Dr Firuza Patel, founder of Chandigarh Hospice. A radiation oncologist who was inspired to start this palliative care program by seeing the plight of cancer patients at PGI, Chandigarh said, “This is the stage where specialist treatment is most needed as the pain is unbearable.

The Indian Association of Palliative Care (IAPC) defines palliative care (PC) as active total care, applicable from the time of diagnosis, aimed at improving the quality of life of patients and their families facing a serious life-limiting illness. Relief from pain and other physical symptoms and psychological, social and spiritual distress through socially acceptable and affordable interventions.

„Palliative care is applicable to almost all critical diseases, but its breakthrough is only in cancer treatment,” says Dr. Patel, who started this hospice in 2000 in collaboration with the UT Red Cross. This may be because 70-75 per cent of cancer patients approach doctors only at an advanced stage, says Dr Nagesh Simha, palliative care specialist and medical director at Karunashraya, a Bengaluru-based clinic.

„Cancer cannot be treated without a PC, starting from the first day the patient and his/her family are informed,” says Dr Ravinder Mohan, Director (Training and Research), CanSupport, one of the largest and oldest organizations in Delhi. NGOs providing free home PC services to cancer patients and families across North India.

PC is often misunderstood as end-of-life care, even by oncologists. But if PC is integrated early in cancer treatment, various symptoms and pain management will be under control, giving the patient a better quality of life, says Dr Sushma Bhatnagar, head of palliative medicine, AIIMS, New Delhi. .

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Many studies suggest that this leads to better survival rates because, rather than the disease, patients fear the associated pain. Additionally, PC can free up active ICU beds, says Dr. Bhatnagar.

These pioneers, especially Dr. Patel, Dr. Simha and Dr. Bhatnagar, who have been associated with PC management for over 25 years, have little awareness not only among the public but also among many doctors.

„Despite the large cancer burden, less than 5 percent of patients develop PC,” says Dr. Bhatnagar. This is because doctors are only trained to fight the disease till the end and treat (cure) but not (palliative) treatment, says Dr Simha. Attitudinal change, more advocacy and awareness campaigns are needed to overcome other challenges such as lack of trained professionals. Only eight medical colleges across India, including AIIMS-Delhi and Tata Memorial Hospital in Mumbai, offer a postgraduate degree in PC, and eight institutes offer a diploma. IAPC also offers short courses for professionals. It has so far trained 7,000 doctors and 5,000 nurses.

Oral medical morphine has limited use for pain management because many physicians are unaware or reluctant to prescribe it. „Also, procurement of medical morphine is very difficult in many states including Punjab, Haryana, UP and Bihar,” says Dr Mohan.

Although the Center has recognized the need for all states to integrate PC into the public health system, a huge push is required. Experts recommend making palliative care mandatory for doctors and nurses, in the junior curriculum, more funding, more decentralization, and training of doctors and other staff at primary health care levels to make it accessible in villages. Where it is most needed.

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