palliative care. The first ever Indian Fellow in Paediatric
Palliative Care completed his training in 2012. The Open
Society Institute generously supported this fellowship
The future plans for the service include strengthening the
existing programme especially in terms of care at home both in
the urban environment and in rural areas. We intend to forge
links within India and the wider region as well as in more
developed countries to develop the best systems to help
children. We envisage also continuing efforts in education and
In India, it is estimated that less than 0.4% of those that
require it have any access to palliative care.12 The National
Cancer Control Programme of India in 1987 referred to
palliative care as a priority. However, most large cancer
hospitals in India, including 18 of 29 government-designated
lead cancer centres do not have personnel trained in palliative
care or are familiar with proper opioid use. In addition, most
programmes that do exist lack paediatric expertise and thus
deprive children and their families of the benefits of palliative
care. Palliative care programmes specifically designed to
address the needs of children are few and far between.
We feel we have demonstrated that integration of palliative
care into a paediatric oncology programme is possible with a
smooth transition to good end-of-life care if needed. The
increase in opioid consumption points to improvement in pain
management. However, further studies need to be undertaken
in this setting to quantify changes in the children's quality of life.
If all paediatric nurses and doctors (both general and
oncology) receive some palliative care training we could hope
to significantly improve the quality of life for children with
cancer and other life-threatening diseases. To that end we
suggest that centres of excellence in specialist children's
palliative care be set up in other regions and developing
countries to provide service, training, advocacy and research.
The integrated programme developed at MNJ could serve as a
model and we hope to make some progress in this endeavour
next year. l
Dr Gayatri Palat is PAX Program Director, India for the Two Worlds
Cancer Collaboration, Canada. She is a consultant in the
Department of Pain and Palliative Medicine at the MNJ Institute of
Oncology and Regional Cancer Centre, Hyderabad, India and
Secretary of the Pain Relief and Palliative Care Society in
Hyderabad, India. Dr Palat is also a member of the Board of
Directors for the International Association for Hospice and
Dr Stuart Brown, MRCGP, FRACP, DABHPM is Director, PAX,
INCTR Canada and practises at the Abbotsford Regional Hospital
and Cancer Centre, Canada.
124 CANCER CONTROL 2014
2007 2008 2009 2010 2011 2012
Figure 2: Number of paediatric consultations by the MNJ palliative care
team by year
1. Human Rights Watch. 'Please do not make us suffer any more…': access to pain
treatment as a human right. 2009. Available from
2. Barr R, Riberio R, Agarwal B, Masera G, Hesseling P, Magrath I. Pediatric oncology in
countries with limited resources. In: Pizzo PA, Poplack DG, editors. Principles and practice of
pediatric oncology, 5 th ed. Philadelphia: Lippincott Williams and Wilkins; 2006. p. 1605-
3. Arora RS, Eden TO, Kapoor G. Epidemiology of childhood cancer in India. Indian J Cancer.
4. Central Bureau of Health Intelligence. Mortality Statistics in India 2006. New Delhi,
2007. Available from: http://cbhidghs.nic.in/mortality%
5. Stiller C, editor. Childhood cancer in Britain: Incidence survival, mortality. Oxford;Oxford
University Press: 2007.
6. Ries L, Smith M, Gurney JG, et al., editors. Cancer incidence and survival among children
and adolescents: United States SEER program 1975-1999 [NIH (Pub. No. 99-4649].
Bethesda (MD): National Cancer Institute, SEER program; 1999. Available from:
7. American Academy of Pediatrics Task Force on Pain in Infants, Children, and
Adolescents. The assessment and management of acute pain in infants, children, and
adolescents. Pediatrics. 2001;108(3):793-7.
8. World Health Organisation. WHO definition of palliative care. Available from
9. World Health Organization. Cancer pain relief and palliative care in children. Geneva,
Switzerland: World Health Organization; 1998.
10. Committee on Bioethics and Committee on Hospital Care. Palliative care for children.
11. Brown S, Belgaumi A, Ajarim D, et al. Loss to follow-up of patients with malignant
lymphoma. Eur J Cancer Care 2004;13(2):180-4.
12. Rajagopal MR, Joranson DE. India: opioid availability - an update. J Pain Symptom