As a young physician considering a career in the new field of medical oncology, I was particularly attracted to the need to incorporate the skills of palliative care in the practice of oncology. It is remarkable that, under the leadership of Charles Olweny, a Ugandan oncologist, we, healthcare professionals in high-income countries, had consent forms for chemotherapy back in the late 1980's, defining the goals of therapy as being either "cure, life prolongation or palliation"!
So palliative care has been both an important and essential part of my oncology career. Even my earliest medical student rotations were with surgical oncologists, who at that stage were the primary physicians giving anti-cancer therapy to patients with solid tumors. The good surgeons were able to seamlessly integrate palliative care into their practices.
As I have moved forward in my own practice as an oncologist, my career has moved more and more towards palliative care, with a focus on the patients who are approaching the end of life. No this is not those "at" the end of life, but those transitioning. It is that area of grey within which many of our patients so struggle emotionally and spirituality.
But my patients over the years have been those who have access to quality cancer services through their privilege (or is it fortune) of living in high-income countries. This access to palliative care, often provided through hospices, is something that we take for granted, as we do cancer care.
Yet for most of the world, access to either palliative care or cancer care is not available. Most people present with advanced cancer where there are few oncologists, including surgeons, and little access to chemotherapy and radiotherapy. There are places in the world where women undergo a mastectomy because it is not possible to receive timely radiotherapy after a recommended lumpectomy.
This is where Universal Health Coverage (UHC) becomes critical. UHC is defined as "ensuring that all people have access to needed promotive, preventive, curative, rehabilitative and palliative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services."
Palliative care has to be part of UHC. Health systems, whether national, regional or local, need to ensure that the suffering for those with advanced cancer and other advanced diseases is addressed. The World Health Organization's efforts toward UHC do not determine who pays for this coverage but, importantly, states that final hardship should not result.
So, on this World Hospice and Palliative Care Day, we call for the integration of palliative care within UHC, ensuring that we don't leave those suffering behind. To recall the words of Mahatma Gandi, “A nation’s greatness is measured by how it treats its weakest members.”