Mumbai centre to focus on pain relief to better quality of life for end stage patients
Doctors describe palliative care as ‘adding life to years and not adding years to life’
Last week, a Mahim-based hospital started city’s first palliative care centre, which along with cancer will extend the facility to patients with medical conditions such as human immunodeficiency virus (HIV), chronic obstructive pulmonary disease, neurodegenerative diseases, kidney problems and heart diseases.
Unlike other modes of treatment, which focus largely on curing end stage patients with life-threatening diseases, palliative care aims at relieving them of pain by treating the symptoms and giving them and the care givers emotional, psychological and spiritual support.
Dr Jayathi Deodar, a psychiatric oncologist, described palliative care as ‘adding life to years and not adding years to life’.
PD Hinduja Hospital, Mahim, where the facility was inaugurated on October 14, is providing inpatient and out-patient palliative care services. The hospital officials plan to start home-based palliative care in the next two months.
Dr Roop Gursahani, consultant neurologist at the hospital, who was instrumental in starting the service, said there is a huge unmet need for palliative care in India, for chronic ailments other than cancer.
“Palliative care is a medical discipline that focuses more on relief than cure that is essential during the last years of life. The major hurdle in providing palliative care in India for chronic medical ailments has been lack of awareness, coupled with manpower shortage that specialises in this discipline,” said Gursahani.
Recalling a 79-year old patient he examined by him a month ago, Gursahani said the woman was diabetic, one of her kidneys was deteriorating and suffered from recurring urinary tract infection.
“When I saw her a month ago, I believed that she had less than a week left. But the woman has survived. As she enters the final years of her life, the patient is an example from lakhs of patients in the India who need end of life care,” he said.
Dr Mary Muckaden, head of department, palliative medicine for cancer patients, Tata Memorial Hospital, Parel, which started city’s first palliative care centre in 1996, said, around 175 to 275 patients per lakh in India need palliative care, but less than 1% get it.
“In India, the healthcare system is attenuated to provide care for acute diseases such as malaria, dengue and so on, but what about chronic diseases such as diabetes and cardiovascular diseases?,” Muckaden said.
Universally, the tradition of palliative care started for cancer patients, said doctors. But they highlighted that there is an urgent need for palliative care for diseases other than cancer.
An estimate by the World Health Organisation’s, Global Burden of diseases study 2008, shows that universally, 42.7% of the deaths happen because of cardiovascular diseases, highest compared to any other ailment.
Dr Naveen Salins, associate professor and consultant, department of palliative medicine, TMH, said that worldwide, the need for palliative care for non-cancer diseases is more than double of what is needed for cancer. However, yet, cancer in the pivot of all palliative care services in India.
“The distress level of patients with chronic diseases is similar to that of cancer patients. Since cancer patients, diagnosed at late stages, die sooner, the disease has been the focus of palliative care,” he added.
Doctors said that the facility will only be within the reach of those who can afford it.
“At present, palliative care in the public sector is non-existent. The focus in public hospitals, in the coming years, must shift from treating acute disease to chronic diseases, of which, palliative care will need to be an important component,” Dr Salins said.
Gursahani added that specialists and general physicians will have to learn how to handover the patient to the other side (palliative care specialists) with compassion and grace.
World Health Organisations definition of Palliative Care
Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
How does palliative care works
Provides relief from pain and other distressing symptoms
Affirms life and regards dying as a normal process
Intends neither to hasten, nor postpone death
Integrates the psychological and spiritual aspects of patient care;
Offers a support system to help patients live as actively as possible until death;
Acts as a support system to help the family cope during the patients illness and in their own bereavement
Uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated
Will enhance quality of life, and may also positively influence the course of illness;
Is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.