Palliative care: Not just for people with cancer

Categories: Care.

In the early days of the hospice movement the great majority of patients cared for had a diagnosis of cancer. This is still true in many countries where palliative care is just emerging. Cancer patients have heavy symptom burdens, including moderate to severe pain in about 84% of cases[1]. Prognostication is also easier to do in cancer as the trajectory of decline in metastatic cancer is more predictable than with many other progressive non-malignant diseases. 

For these reasons and because resources for palliative care are limited in most countries, there has been a focus on cancer in hospice and palliative care. However when we look at the real need for palliative care in a population we find that the greater need is for those suffering from non-cancer diseases such as heart failure, chronic obstructive pulmonary disease, stroke, dementias, liver and kidney failure, motor neuron diseases, and other less common conditions. For children there are many that have congenital anomalies, neonatal conditions, endocrine disorders, and other illnesses specific to childhood.

 In a report that will soon be released by the World Health Organization and the WPCA, the estimated percentage of patients needing palliative care at the end-of-life with cancer is only about one-third of the total. In the United States, where hospice care has been covered by insurance benefits since the early 1980’s, the National Hospice and Palliative Care Organization reported that only about 35% of patients admitted to hospices had a primary diagnosis of cancer in 2010[2]. Thus 65% of persons admitted had a non-cancer diagnosis. 

The WHO collaborating center for palliative care and public health policy in Barcelona, Spain reports that about 1.5% of the entire population at a given time would benefit from palliative care in the country[3]. The largest group of those needing palliative care in that report were the frail elderly, many with multiple chronic conditions.

While the needs of cancer patients for palliative care are great, we can say that when the real needs for palliative care are met in a country the great majority of the patients will have diagnoses other than cancer. 


[1] Higginson, I. J. Palliative and Terminal Care Health care needs assessment: The epidemiologically based needs assessment reviews. A. R. Stevens, J. . Oxford and New York, The Wessex Institute for Health Research and Development, 1997.

[2] National Hospice and Palliative Care Organization. NHPCO Facts and figures on hospice care in America, 2012 Edition.

[3] Gómez-Batiste X, Martínez-Muñoz M, Blay C, et al. BMJ Supportive & Palliative Care Published Online First: 00 Month 0000 doi:10.1136/bmjspcare-2012-000211

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