Editor—The article by Murray et al prompts me to highlight a less quoted cause of misery of patients with advanced cancer.1
The World Health Organization estimated that in 2020, 20 million new cases of cancer will be diagnosed each year and 75% of these will occur in nations that between them have only 5% of resources. India, with only 20 dedicated cancer centres and 13 hospices, has around 3 million patients with cancer at any one time, of whom 80% are incurable.2 In India one in 10 deaths is related to cancer, and only 3% of the people who need palliative care receive it.3
Many patients become victims of alternative medicine practitioners,4 and those few who escape are required to visit government hospitals that are overcrowded and under-funded. Patients with advanced cancer are made to feel less deserving of medical efforts in non-paying settings. They are welcome in private hospitals, and they commonly undergo unwarranted investigations and interventions. Forceful promotion and incentives are promoting the use of chemotherapy to improve “quality of life” in hopeless cases.
This institutionalisation of death, commercialisation of suffering, and prolongation of lucrative illness is becoming rampant. Most patients are not even referred to a palliative care specialist because offering false hopes fetches more money than giving solace to the patient and his or her relatives. The prevalent practice of the “anecdote based medicine” emanates from lack of multidisciplinary cancer centres, continuing medical education, political will, infrastructure, and poor availability of morphine. Palliative care, counselling, home care, rehabilitation, psychotherapy, breaking bad news sensitively, and communication skills are sparsely practised.5 Medical students aim for a lucrative private practice; those opting for studies in prevention and palliation are considered academically unsound.
Competing interests: None declared.
References
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