Mongolia: The Present Situation and Future of Palliative Care

Abstract

Cancer annually affects 10 million people and causes 6 million deaths worldwide. Mongolia has a very small population. In 2000, there were about 2.4 million inhabitants in Mongolia. The mortality rate is 598.3 per 100,000 (14,237 deaths in 2000). The main causes of death were cardiovascular diseases (31–38%); cancer (21–22%); injury, poisoning and other external causes (13–16%); diseases of the respiratory system (6–18%); and diseases of digestive system (8%). Forty-one percent of Mongolian patients who died from cancer had liver cancer, 16% had stomach cancer, 13% had pulmonary cancer, 11% had esophageal cancer, and 2% had cervical cancer. The epidemiology of cancer pain or other quality-of-life concerns has not been evaluated in Mongolia. Overall, 10,672 patients died in hospital in 2000, 4119 from cardiovascular diseases and 2649 (24.8%) from cancer. Most cancer patients (1668/2649 in 2000) died during the first year after the diagnosis of cancer. This means that 62% of cancer patients were diagnosed very late and required palliative care more than cancer treatment. Only 3976 patients died at home during 2000. Of this group, 1627 (41%) had cancer. Thus, 41% of the total home deaths were related to cancer. These patients were incurable and stayed at home without palliative treatment, suffering from pain, dyspnea, anorexia, cachexia, constipation, depression, and many other uncomfortable problems and symptoms because family doctors were not trained in palliative care.