Background and Context:
The need for palliative care in middle and low resources countries, including Egypt, is emerging .The Gharbiah Cancer Society (GCS) is a nonprofit, nongovernmental hospital, located in Tanta, the Capital of the Gharbiah governorate in the mid-Nile Delta. The Society provides acute care to patients with cancer including surgery, chemo-, and radiotherapy. Review of 9 year-data of Gharbiah population-based cancer registry from 1999 to 2007 revealed 3480 cancer cases/year, with Age Standardized Rate (ASR) of 161.7/100,000 for males & 120.8/100.000 for females.
About 70 % of cases present in advanced stages (III&IV) with liver cancer the most frequent cancer in male and breast cancer as the most frequent cancer in females. The GCS started a comprehensive palliative care services in April 2011 with 10-bed inpatient unit and 6 days/week outpatient clinic. All palliative care equipment were provided by public donations.
Through collaboration with National Cancer Institute, Bethesda, Maryland and the San Diego Hospice and the Institute for Palliative Medicine and Middle East Cancer Consortium , a fellowship training program was developed for a medical oncologist in palliative medicine and End-of-Life Care training course for nurses.
The program succeeded in convincing local health authorities to increase the recommended opioids dose and to allow more physicians to prescribe opioids for cancer pain. In a period of 24 months, symptom management and palliative care were provided to 195 patients with advanced malignancies. The opioids consumption was increased by 30 folds.
Outcomes/What was learned:
The Major challenges for the program were inadequate public and health professionals awareness of palliative care services and lack of vehicles and finances to cover home visits. The initial results of the program warrant allocating more resources for coverage of a large number of trainees and instituting a home visits program.