Abstract
A Universal Health Coverage goal is to provide access to affordable palliative care to reduce disparities in end-of-life (EOL) outcomes. To assess progress toward this goal in Sri Lanka, our primary aim was to systematically assess differences in patients' physical, psychological, social and spiritual outcomes, and their perceived quality of care by their socioeconomic status (SES). As part of the multi-country APPROACH (Asian Patient Perspectives Regarding Oncology Awareness, Care and Health) study, we surveyed 199 patients with a stage IV solid malignant tumor and aged >21 years from the largest government cancer hospital in Sri Lanka. We assessed their physical (physical and functional well-being, symptom burden), psychological (anxiety, depression, emotional well-being), social (social well-being), and spiritual outcomes and perceived quality of care (physician communication, nursing care, and coordination/responsiveness). Low SES patients reported significantly lower physical and functional well-being, emotional well-being, spiritual well-being including meaning/peace and faith; and significantly higher symptom burden, anxiety and depressive symptoms compared with patients from high SES (p < 0.05 for all outcomes). Results have implications regarding reducing barriers in access to appropriate palliative care and EOL care services to stage IV cancer patients from low SES in Sri Lanka.
Highlights
For patients with a terminal cancer, palliative care is a basic human right
Many patients with advanced cancer in low- and middle-income countries, especially those from low socioeconomic status (SES), experience poor outcomes at the end of life (EOL) and perceive their care to be of poor quality (Mandelblatt et al, 1999; Vart et al, 2015; Halpern and Brawley, 2016; Allen et al, 2017; Yabroff et al, 2019)
We examine data from Sri Lanka, a middle-income country in Asia where palliative care services have not yet been formally established
Summary
For patients with a terminal cancer, palliative care is a basic human right. Recent Lancet Commission reports and World Health Assembly resolutions called for palliative care as an essential component of Universal Health Coverage (Knaul et al, 2018). Central to universal health coverage is a focus on equity, in that all patients with advanced cancer, irrespective of their socioeconomic status (SES), are able to access palliative care services at the end of life (EOL). Many patients with advanced cancer in low- and middle-income countries, especially those from low SES, experience poor outcomes at the EOL and perceive their care to be of poor quality (Mandelblatt et al, 1999; Vart et al, 2015; Halpern and Brawley, 2016; Allen et al, 2017; Yabroff et al, 2019). We examine data from Sri Lanka, a middle-income country in Asia where palliative care services have not yet been formally established. According to the 2015 national cancer registry, the overall age-standardized cancer incidence rate in Sri Lanka is 122.0/ 100,000. Oro-pharyngeal, lung, colorectal, and oesophageal cancers are the most common cancers among males, whereas breast, thyroid, colorectal, and cervical are the most common among females (National Cancer Control Programme, 2015)
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