Abstract
Cancer care with curative intent remains difficult to manage in many resource-limited settings such as Cambodia. Cambodia has a small workforce with limited financial and health-care resources resulting in delayed diagnoses and availability of limited therapeutic tools. Thus, palliative care becomes the primary form of care in most cases. Although palliative care is becoming an integral part of medical care in developed countries, this concept remains poorly understood and utilized in developing countries. Angkor Hospital for Children serves a relatively large pediatric population in northern Cambodia. According to the modern definition of palliative care, approximately two-thirds of the patients admitted to the hospital were deemed candidates to receive palliative care. In an effort to develop a pediatric palliative care team utilizing existing resources and intensive training, our focus group recruited already existing teams with different health-care expertise and other motivated members of the hospital. During this process, we have also formed a palliative care training team of local experts to maintain ongoing palliative care education. Feedback from patients and health-care providers confirmed the effectiveness of these efforts. In conclusion, palliative and sustainable care was offered effectively in a resource-limited setting with adequately trained and motivated local providers. In this article, the steps and systems used to overcome challenges in Cambodia are summarized in the hope that our experience urges governmental and non-governmental agencies to support similar initiatives.
Highlights
Curative cancer care remains an enormous challenge for developing countries [1, 2]
Pediatric Palliative Care in Cambodia living with HIV due to a global effort to control the disease did not extend successfully to other life-threatening illnesses; it may provide a model for palliative care for children living with cancer [7, 9,10,11]
An estimated 60% of the children admitted to the Angkor Hospital for Children (AHC) suffer from life-threatening illnesses and could benefit from palliative care in addition to care targeting the disease
Summary
Curative cancer care remains an enormous challenge for developing countries [1, 2]. Eighty percent of children with cancer live in countries with limited resources, where more than 90% of childhood cancer deaths occur [3]. World Health Organization (WHO) made prevention and control of non-communicable diseases such as cancer priority with the launch of Global Action Plan in 2013 [2, 4]. The WHO Global Action Plan includes efforts to improve palliative care aimed at achieving relief of suffering in over 90% of cancer patients. Palliative care programs have been successfully implemented in a handful of resource-limited countries the concept of palliative care is still in its early stages in many others [5,6,7,8]. Pediatric Palliative Care in Cambodia living with HIV due to a global effort to control the disease did not extend successfully to other life-threatening illnesses; it may provide a model for palliative care for children living with cancer [7, 9,10,11]
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