Page 0125

palliative care. The first ever Indian Fellow in Paediatric

Palliative Care completed his training in 2012. The Open

Society Institute generously supported this fellowship

programme.

Future plans

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

advocacy.

Conclusion

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

Palliative Care.

Dr Stuart Brown, MRCGP, FRACP, DABHPM is Director, PAX,

INCTR Canada and practises at the Abbotsford Regional Hospital

and Cancer Centre, Canada.

PALLIATIVE CARE

124 CANCER CONTROL 2014

130 223

1532

2922

3057

3404

2007 2008 2009 2010 2011 2012

Figure 2: Number of paediatric consultations by the MNJ palliative care

team by year

References

1. Human Rights Watch. 'Please do not make us suffer any moreā€¦': access to pain

treatment as a human right. 2009. Available from

http://www.hrw.org/sites/default/files/reports/health0309web_1.pdf

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-

17.

3. Arora RS, Eden TO, Kapoor G. Epidemiology of childhood cancer in India. Indian J Cancer.

2009 Oct-Dec;46(4):264-73.

4. Central Bureau of Health Intelligence. Mortality Statistics in India 2006. New Delhi,

2007. Available from: http://cbhidghs.nic.in/mortality%

20Statistics%20in%20India%202006.htm.

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:

http://www.seer.cancer.gov.

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

http://www.who.int/cancer/palliative/definition/en/

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.

Pediatrics. 2000;106;351-7.

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

Manage. 2007;33:615-22.

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