Palliative Care in Low and Middle-Income Countries to Reduce Cancer Suffering: A Systematic Review

In low- and middle-income countries, the incidence of cancer is rising, with diagnoses frequently made at advanced stages, limited access to treatments, and high mortality rates. Palliative care may alleviate suffering, enhance quality of life, and reduce costs. In this review, we aimed to explore the development of palliative care in low- and middle-income settings and assess if and how this contributes to mitigating or alleviating the human suffering of people with cancer.

A best-fit framework synthesis approach was employed, and seven databases were systematically searched in 2025. Data from eligible studies were extracted and qualitatively synthesized into themes and subthemes, initially using a framework constructed from indicators from the WHO Conceptual Model for Palliative Care Development and the Integrated Palliative Care Oncology Practice Model. The review is registered with PROSPERO (CRD42024511158) FINDINGS: Studies (n = 81) were reviewed. Interventions by multidisciplinary teams, combined with a bio-psycho-socio-spiritual approach, led to improved patient outcomes. Palliative care reduced hospital stays, decreased unnecessary end-of-life treatments, and facilitated home deaths. Community-based palliative care empowered patients and families to manage care at home, cope with uncertainties, and lower healthcare costs. Successful implementation relied on a participatory public health system and support from nongovernmental organizations, which provided access to palliative care, telehealth, and training for primary care providers. However, when compared to the indicators from the two models, only a few aligned with core elements.

Although progress has been made in integrating palliative care in low- and middle-income countries, evidence linking this development to international indicators of palliative care progress is insufficient. It is likely that strengthening patient-family partnerships, promoting shared decision-making, and advocating for patient rights contribute to alleviating the human suffering from cancer.

The conduct of this review is supported by an unrestricted grant from the End-of-Life Care in India Task Force (ELICIT). ELICIT supports end-of-life education, research, and policy.