Posted on Jun 13, 2014 by Ruth Loftus
With medical news headlines often focusing on finding cures for diseases like HIV and different types of cancer, and the endless amount of money going into complicated research for drug development, it might seem somewhat surprising that the latest report from the World Health Organisation has prioritised a much more basic area of health care known as palliative care. Unlike many aggressive forms of modern medical treatment, palliative care is much more traditional in the holistic sense and focuses on relieving and limiting patients’ suffering.
According the WHO report, The Global Atlas of Palliative Care at the End of Life, Palliative care treatment is too often neglected and patients’ physical, psychosocial and spiritual pain is disregarded by healthcare systems. The WHO research indicates that this is a global trend, but highlights the fact that palliative care is especially lacking in low and middle income countries where 78% of adults in need of palliative care at the end of their lives.
One area where there is certainly a great need for palliative care is that of treating tuberculosis patients. In recent years, this has become an increasingly complicated task due to multi-drug resistant forms of the disease (MDR-TB). In 2011, WHO estimated that there were half a million new MDR-TB cases globally and their statistics indicate that 62% of the total of MDR-TB cases are located in developing countries such as Brazil, China, India and the Russian Federation. The drug resistant version of TB exists as a result of inadequate or badly administered treatment for simpler forms of TB.
Therefore, there is a drastic need for better palliative treatment for patients who have the MDR-TB form of the disease. Ideally, patients with MDR-TB would undergo at least two years of a dedicated multidrug regimen, but due to financial restrictions in the countries where TB is most prevalent, many patients go without treatment altogether. Death from TB is painful and can include symptoms such as coughing up blood, night sweats and weight loss as well as other complications with the bones, kidneys and lymph nodes.For these people, palliative care is essential even if finding a cure is not immediately available.
In the countries most affected by MDR-TB cases, policies need to be updated so that palliative and end-of-life care can address and soothe ongoing symptoms like dyspnoea, cachexia, and haemoptysis.
In developing countries, patients with HIV and AIDS are more likely to contract TB. These patients also have a much higher chance of dying of MDR TB. Co-infection is common as HIV patients already suffer from weakened immune systems and this makes them susceptible to further infection. Statistics indicate that TB is the largest single cause of death among AIDS patients and represents over one quarter of all AIDS-related deaths. More shocking is the fact that 99% of these deaths occur in developing countries. When it comes to palliative care for these patients, there is often limited support.
Pain relief is an essential part of end of life treatment for HIV, TB and Cancer patients, which the WHO’s pain treatment guideline highlights as those most likely to experience severe pain requiring opioid analgesics based treatment. Unfortunately, many patients with these diseases who are located in low and middle income countries are unlikely to receive the pain relief they require because medication is often in very short supply or deliberately restricted. The most common drug is morphine but since morphine is historically associated with addiction, many medical practitioners limit its use. This is particularly true in African countries. This attitude towards morphine has a huge impact on the level of palliative care available to the extent that many regional hospitals and medical centres now do not stock morphine at all. As a result, patients who are diagnosed with a terminal condition do not receive the pain relief that they need and therefore rarely receive the palliative care they require.
Communicable diseases like tuberculosis and HIV are traditionally, and statistically, much bigger killers in poorer countries. However, due to factors such as improved hygiene awareness and availability of certain vaccines, life expectancy is increasing. This brings new challenges for medical professionals in these countries as they need to learn to treat relatively ‘new’ diseases such as cancer and heart disease. According to the WHO, these causes of ill health are set to dramatically increase in developing regions over the course of the decade to the extent that they are predicted to represent approximately seventy per cent of deaths by 2020.
In the past, medical professionals in India and parts of Africa have had limited experience treating people suffering from cancer which has meant that patients have received little support to help them cope with the disease. In some cases, people suffering from cancer do not even understand their condition and they die without receiving a diagnosis. This expected change by 2020 will bring an enormous shift in the need for palliative care as the new illnesses for these regions will require painkilling treatment as well as more alternative treatments from specialists. Palliative care will become integral to improving health policies in these regions as efficient palliative care can improve the quality of life of cancer patients, by increasing awareness and peoples lack of understanding about the disease in wider society.
Clearly there is a long way to go in terms of integrating palliative care into the different healthcare systems that already exist in developing countries. However, the hope is that the recent WHO report will draw attention to what needs to be done to improve the level of palliative care available. The aim is that palliative care will get the attention it deserves and considered to be an integral part of any health care policy.