Palliative Medicine in Pakistan: A Developing Country's Perspective

TO THE EDITOR

We read the paper “Oncology and Palliative Medicine: Providing Comprehensive Care for Patients with Cancer” by Finn et al with great interest. The authors are right in their assessment that palliative medicine encompasses patient care from diagnosis through potential survivorship.¹ We would like to carry forward the discussion by providing a perspective on a developing nation where economic crisis and lack of awareness have taken their toll on healthcare, especially palliative medicine.

In Pakistan, palliative medicine is not recognized as a discipline, so centers have not been established and physicians are not trained in palliative care. According to the survey published by the International Observatory on End of Life Care, Pakistan has the “least favorable ratio” for palliative care facilities, with only one service existing for a population of 157,935,000.² The medical curriculum taught in Pakistan has neither a dedicated course for palliative medicine nor a clinical rotation related to it. Palliative medicine fellowship programs in Pakistan are lacking as well.

The world dreads the future shortage of oncologists, but the situation could be even worse for Pakistan because of the absence of palliative medicine facilities and specialists.³ Physicians in Pakistan have expressed interest in being trained in this discipline,⁴ leaving Pakistan in a peculiar place where despite the interest by doctors, no initiative is being taken. According to a study by Smith et al, immediately starting palliative care for patients with metastatic cancer not only causes improvement in their quality of life and a high level of satisfaction but also decreases the entire outlay of treatment with no known drawbacks.⁵

Studies should be undertaken to assess the feasibility of initiating a palliative medicine training program in Pakistan and of incorporating it in undergraduate medical and nursing degree programs as well. International funding and training collaborations that could play a role in establishing and creating awareness regarding palliative healthcare are the need of the hour. Creating awareness could be a lifesaving step as many misunderstand palliative care to be only end-of-life treatment.