Early next month on October 9, health care persons around the world will come together to observe World Palliative Care Day. As this is a comparatively recent specialised medical service which not many understand. The Sunday Observer asked Community Consultant Physician, Palliative Care Unit, National Cancer Control Program ( NCCP) Dr Irosha Nilaweera to define what Palliative Care is in layman’s language for the benefit of our readers.
She said, “Palliative care is a specialised medical care focused on relief of physical symptoms including the pain, as well as psychological, social and spiritual problems of the patient with a life-threatening illness such as cancer. The goal is to improve quality of life for patient and the family. Palliative care is appropriate at any age and at any stage in the illness. It can be provided along with curative treatment. Palliative care begins at the point of diagnosis, continues throughout the rest of patient journey /and extends beyond death into bereavement care.”
Asked why many terminally ill patients with advanced diseases and little or no prospect for cure and who are already being treated for relief of their symptoms, needed this specialised Care, Dr Nilaweera said, “Palliative care neither hastens nor prolongs death of the patient. It ensures quality of life among palliative patients and their caregivers and family members.
Advanced diseases are characterised by many physical, psychological, social and spiritual manifestations which can affect the quality of life (related to disease or treatment). Patients with advanced diseases and their families have complex needs that have to be address to minimise distress and prevent deterioration of quality of life of them.”
When inquired whether Palliative Care went beyond care for people with life limiting illness to their families and friends well, Dr Nilaweera quoted the WHO definition, Palliative Care ( PC) is for patients with life limiting diseases and their families.
Hopsice Care is another term we have come across in the care of very ill patients. What is the difference between Palliative Care and Hospice Care? Or are they the same? We asked.
She said, “Palliative care services are available in three settings (3H) -hospital, hospice and home.
Palliative care services at the hospice
Hospice is a dedicated institute where supportive care is provided for the patients’ emotional, social, and spiritual needs in addition to the care for the remaining physical symptoms following active disease specific treatment. Hospice care provides comfort and quality of life by continuing the care prescribed in the management plan to reduce the suffering of pain and other symptoms rather than cure.
The concept of holistic care is practised at the hospice level with special emphasis on symptom management and end of life care by inter-disciplinary teams. There are seven hospices managed by NGOs islandwide.
Asked to comment on the fact that Sri Lanka was a country where many patients with cancer and other terminally ill cases were treated at home by their relatives and immediate families who couldn’t afford to admit them to private hospitals or because the High Dependency Units of state hospitals had run out of beds/wards to accommodate the inflow of such patients, she said, “Only few palliative care patients may need specialist care during the disease trajectory and majority of patients’ total palliative care can be offered at the community.
The contribution of community palliative care services in coordination with primary and specialist care is essential as the majority of palliative care patients live balance period of their life at their home.”
New Global Breast Cancer Initiative poised to reduce preventable deaths
Compiled by Carol Aloisius
The World Health Organization (WHO) in collaboration with the International Agency for Research on Cancer (IARC) and the International Atomic Energy Agency (IAEA) launched the Global Breast Cancer Initiative (GBCI) this year as another major global initiative of cancer control.
Already another two global initiatives related to cancer have been launched in recent years including Global Initiative for Childhood Cancer (GICC) commenced in year 2018 and the Global Strategy to Accelerate the Elimination of Cervical Cancer, commenced in year 2020.
“It is expected that global attention/momentum will be there in the coming years for the GBCI too,” Consultant Community Physician, National Cancer Control Program (NCCP), Ministry of Health, Dr Suraj Perera told the Sunday Observer.
Commenting on the goals and objectives of the latest global initiative with regard to raising awareness and reducing preventable breast cancer deaths, Dr Suraj Perera said, “The objective of global initiative is reducing global breast cancer mortality by 2.5 percent per year until 2040, thereby averting an estimated 2.5 million deaths of women across the world. Already some of the developed countries have achieved more than 80 percent 5-year survival rate. However, in some of the developing countries it is less than 50% still,” he added.
To our query as to how they were setting about achieving these objectives, he told Medi Snips, “The WHO has proposed three pillars for action towards achieving objectives of GBCI, which we will be strictly adhering to. They are (i) health promotion, (ii) timely diagnosis, (iii) comprehensive treatment and supportive care. Under the pillar i (health promotion) Organising public education to raise awareness about the signs and symptoms of breast cancer, reducing risk factors such as avoiding obesity, alcohol intake and encouraging breast feeding.”
He said, “The emphasis is on early diagnosis. That is, diagnosis and commencement of a definite treatment process within three months of the symptoms appearing.”
Asked what the treatment was like, he said, “This is where the Pillar 3 comes in. Under this pillar, we will focus only on comprehensive treatment and supportive care. That means access to all the different types of treatment services we offer tour patients according to their specific needs. They include surgery, chemotherapy and radiotherapy. We follow it up with rehabilitation support for women after treatment.”
On Supportive Care and what it means, he said, “This is where Palliative Care plays an important role. The idea of this approach as a treatment is to help reduce pain and discomfort and add quality to those with more advanced cancer.”
The objective of global initiative is reducing global breast cancer mortality by 2.5 percent per year until 2040, thereby averting an estimated 2.5 million deaths of women across the world. Already some of the developed countries have achieved more than 80 percent Five-year survival rate
on responsible pet ownership, how to prevent dog bites, and what immediate measures to take after a bite. We also need to scale up dog vaccination,” he said.