Palliative care: a peaceful, humane global campaign is needed

Although it might be tempting to compare the outcome of Nixon’s projected war on cancer to that of the political cold war that was being pursued relentlessly at the time—tense, inconclusive, and enormously costly—Douglas Hanahan’s paper reminds us of some of the successful sorties that have been made against cancer in the intervening four decades. Notable victories have been achieved against some diseases, such as testicular cancer and childhood acute lymphoblastic leukaemia; oncologists have arguably led the way in medicine by devising targeted therapeutic agents and developing biomarkers to guide diagnosis and treatment; and cancer screening and vaccination programmes have been deployed at vast scale in high-income countries.

It seems unlikely, however, that Nixon imagined the global threat that cancer now represents, described by Paolo Vineis and Christopher Wild in their article. Low-income and middle-income countries are facing a greatly increased burden of cancer, and Vineis and Wild emphasise the importance of prevention in reducing risk and controlling cancer incidence, a theme underlined by the recent World Cancer Report 2014. In a third paper, Michel Coleman illustrates the importance of accurate data in understanding patterns of cancer incidence, treatment, and survival. While progress has been made in diagnosis and treatment of cancer, much remains to be done when treatment fails, and a further dimension to the global cancer issue is provided by theGlobal Atlas of Palliative Care at the End of Life, published on Jan 28 by the World Palliative Care Alliance and WHO.

Palliative care for patients with cancer has emerged as an important subspecialty in high-income countries in the past 20—30 years, but the need for such care is now recognised to be much broader, both medically and geographically. The Atlas estimates that the 19·2 million adults requiring palliative care worldwide suffer from a wide range of disorders, including cardiovascular diseases (about 38% of the total), cancer (34%), and chronic obstructive pulmonary disease (10%), with the remainder including patients with AIDS, diabetes, and neurodegenerative and other diseases. 22% of adults in need of palliative care are estimated to be in high-income countries, with 70% in middle-income countries and only 8% in low-income countries. Some 96% of the people requiring palliative care are adults, with the remaining 6% being children, about 1·2 million in total.

To view the full article, please visit The Lancet.