NNCTR/INCTR (Nepal) Palliative Care Initiative

Doctors strive to make cancer patients comfortable in the final stages of disease.

At the last INCTR Annual Meeting in Brussels there were a number of meetings regarding palliative care. The general feeling was that INCTR was in a unique position to encourage and promote the development of palliative care.

A Palliative Care Sub-committee was formed and several members were able to meet in London in August with Dr Robert Twycross, Emeritus Clinical Reader in Palliative Medicine at Oxford University. At that meeting we felt that because INCTR already has a presence in Nepal, via the Nepalese Network for Cancer Treatment and Research, NNCTR/INCTR (Nepal), and in particular has recently successfully initiated a cervical cancer-screening program, we should explore the possibility of a palliative care initiative in Nepal.

By way of background, Nepal is an emerging country with a population of 23 million. The terrain varies from plains in the south to rugged mountains in the north. There are many ethnic groups in the country; 82% of the population are Hindu and 8% Buddhist. IARC estimates the mortality rate from cancer in Nepal to be 11,500 persons per year. We know that persons with advanced malignancy have many severe symptoms including pain and that 70% of these patients require opioids. Nepal, then, has many thousands of patients and their families who would benefit immensely from the development of palliative care.

As chairman of the Palliative Care Sub-committee, I was fortunate to be able to visit Nepal in November and met with a number of people who were passionately interested in the care of patients dying with advanced cancer. These, amongst others, included Dr Surendra B. Bade Shrestha, Dr Monahar Lad Shrestha, Dr Arati Shah, Dr Sudip Shrestha, Dr Y.P. Singh, Dr Pradeep Vaidya and Mr Roy Kline. I was able to visit the Tribhuvan Teaching Hospital, (TU) Hospice Nepal, the Bhaktapur Cancer Care Centre and the Scheer Memorial Hospital in Banepa all of which are in or near to Kathmandu.

At the Hospice Nepal and the Bhaktapur Cancer Care Centre, a strong start has been made in palliative care. At Hospice Nepal, which has been open for only about three months, there are 8 to 10 beds, with plans to increase this number. Full-time palliative care nurses work at the hospice and the two oncologists, who do daily ward rounds, are based at TU Teaching Hospital. The hospice was built through local donations.

Bhaktapur Cancer Care Centre is a 25-bed oncology hospital run by two oncologists who carry out chemotherapy and radiotherapy. They estimate that at any particular time, five patients are receiving ‘purely palliative care.' Even those receiving treatment in the hope of achieving tumor regression, or even cure, generally have very advanced cancer and are highly symptomatic. Plans are in place to rebuild the in-patient wards and to develop a dedicated unit of about 10 beds for palliative care.

The Scheer Memorial Hospital in Banepa houses the Kathmandu University Medical School, which has a strong emphasis on community medicine and outreach to small rural communities. It is also the location of the NNCTR/INCTR (Nepal) office. The administrative and medical staff feel that there is strong need for a palliative care unit at their hospital.

At the TU teaching hospital, plans have been made for a Home Hospice Program.

Like all visitors to the Kingdom of Nepal, I was impressed by the kindness and hospitality of all whom I met. I was just as impressed however, by the strong commitment to palliative care that I encountered in all the people I spoke to, especially those mentioned earlier. INCTR and NNCTR/INCTR (Nepal) plan to push forward with the development of a program for the care of dying cancer patients. With time and effort we feel that this will help many thousands of patients. It is also hoped that such a program might serve as a model for other INCTR collaborating sites.