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Symptom control problems in an Indian hospice
1Tata Memorial Hospital, Bombay, India.
Annals of the Academy of Medicine, Singapore
|March 1, 1994
Summary
Palliative care in India faces challenges like limited morphine and patient non-compliance, particularly with head/neck and gynecological cancers. Strategies are needed to improve symptom control in resource-limited settings.
Area of Science:
- Palliative Care
- Oncology
- Global Health
Background:
- Symptom control is central to palliative care, but socio-economic challenges in developing countries present significant hurdles.
- India's first hospice has admitted over 2000 patients in six years, providing valuable insights into palliative care delivery.
- High incidence of head and neck cancers (50%) and gynecological cancers (24%) are observed, linked to prevalent tobacco use.
Purpose of the Study:
- To highlight the problems encountered in providing palliative care in a developing country context.
- To present solutions and strategies implemented to overcome these challenges.
- To share experiences from a high-volume hospice in India.
Main Methods:
- Retrospective analysis of over 2000 hospice admissions over six years.
- Identification of prevalent cancer types and associated challenging symptoms.
- Evaluation of medication availability, patient compliance, and family dynamics.
Main Results:
- Head and neck cancers present with severe pain, dysphagia, fungation, and trismus; 25% utilize feeding tubes for nutrition and medication.
- Gynecological cancers involve pain, bleeding, ulceration, and fistulae.
- Inadequate morphine availability and patient/family non-compliance complicate pain management.
Conclusions:
- Palliative care in resource-limited settings requires innovative approaches to symptom management.
- Addressing challenges like medication access and patient adherence is crucial for effective care.
- Balancing hospice care with home-based care presents a difficult but important choice for patients.