Pattern of palliative care, pain management, and referral trends in developing countries: Still far from optimum

Abstract

e20694 Background: Although palliative care and pain management are essential components of oncology practice, studies show that these areas are often inadequately addressed, more so in the developing countries where palliative care and pain management units are still inadequate. Methods: We randomly selected 252 patients receiving palliative RT (radiotherapy) at our tertiary care centre for oncology, from October 2006 to august 2008. Patients with bone pain were excluded as it could add a bias. Patient's records were studied retrospectively. Results: A median follow-up of 21 weeks was available for 197 males and 55 females with a median age of 55 years. Maximum (60%) patients were of head and neck cancers followed by oesophagus (14%), lung (10%) and others. All cases belonged to stage III (27%) or IV (73%). Dysphagia (35%), growth/ulcer (34%), respiratory symptoms (12.5%) and pain (7%) were the chief indications for palliative treatment. Overall, pain was present in 154 (61%) cases, out of which 92 (60%) were referred to pain clinic. All except two consulted pain clinic with a median pain score of 8 (0–10 point scale). Eighty six (96%) patients received opioid based treatment with adequate pain relief in 33% cases and loss of follow-up in 40% cases. Only eight (3%) cases were referred to a hospice. Thirty six (14%) cases were considered for radical treatment following very good response to palliative RT. Conclusions: In this selective sample, the standard of analgesic treatment is satisfactory. However, there is a lot of scope for improvement regarding referral to pain clinic and later to the hospice. Patients’ follow-up needs to be improved along with further studies evaluating patients who are considered for further RT till radical dose. Programs to change the patients’ attitude towards palliative care, physicians’ (residents) training to improve communication skills, and institutional policies may be the promising strategies. No significant financial relationships to disclose.