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Symptom control problems in an Indian hospice

L J de Souza1, Z M Lobo

  • 1Tata Memorial Hospital, Bombay, India.

Annals of the Academy of Medicine, Singapore
|March 1, 1994
PubMed
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.

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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.

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