SHORT REVIEW ARTICLE
Year : 2014 | Volume
: 2 | Issue : 2 | Page : 59--60
Palliative care in Saudi Arabia: Two decades of progress and going strong
Sami Ayed Alshammary1, Alsuhail Abdullah2, Balaji P Duraisamy2, Mahmoud Anbar2,
1 Palliative Care Unit, Comprehensive Cancer Center, King Fahad Medical City; Centre for Postgraduate Studies in Family Medicine, Ministry of Health, Riyadh, Saudi Arabia
2 Palliative Care Unit, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
Sami Ayed Alshammary
Palliative Care Unit, Cancer Comprehensive Center, King Fahad Medical City, P. O. Box 13534, Riyadh - 11414
Palliative care is a relatively new medical speciality in Saudi Arabia, but it has shown tremendous growth in the last two decades. Nevertheless, there are challenges to this development. The paper reviews these barriers in context of the growing need for palliative care and possible ways to overcome these challenges.
|How to cite this article:|
Alshammary SA, Abdullah A, Duraisamy BP, Anbar M. Palliative care in Saudi Arabia: Two decades of progress and going strong.J Health Spec 2014;2:59-60
|How to cite this URL:|
Alshammary SA, Abdullah A, Duraisamy BP, Anbar M. Palliative care in Saudi Arabia: Two decades of progress and going strong. J Health Spec [serial online] 2014 [cited 2020 Aug 6 ];2:59-60
Available from: http://www.thejhs.org/text.asp?2014/2/2/59/131749
Palliative care is a specialty of its own consisting of comprehensive multidisciplinary healthcare delivery to patients with a wide range of life-threatening and life-shortening diseases, including cancer. The major goal is to relieve symptoms of suffering like physical pain, psychosocial and spiritual problems affecting the quality-of-life for patients as well as family. Palliative care has a vital role in providing comfort to patient and family during active interventions like chemotherapy and radiation therapies.
In 2008, the Saudi Cancer Registry recorded 11,946 cases of cancer in Saudi Arabia.  The age-standardised incidence was 76.8/100,000 males and 79.4/100,000 females. Among these, the most common cancer in men was colorectal cancer, followed by non-Hodgkin lymphoma, leukaemia, and cancers of the liver, lung and prostate. On the other hand, the leading types of cancer for women starting with those having the highest incidence were cancers of the breast, thyroid, large bowel, non-Hodgkin lymphoma and leukaemia. 
By 2030, the cancer burden in Saudi Arabia is expected to grow by 5 to 10 folds. This result is predicted by the changing demographics, with the age group most affected by cancer being the middle-aged and elderly. 
One study showed that 92% of cancer patients surveyed had suffered pain, either from the disease itself or from the treatment regimen. 
The palliative care service in Saudi Arabia was started over two decades ago at the King Faisal Specialist Hospital and Research Centre (KFSH&RC) in Riyadh by Dr. Isbister.  From that time, the field has slowly expanded. The service currently comprises of an 8-bed tertiary palliative care unit, consultation service throughout the hospital, outpatient clinics, home healthcare program, and both an outreach and fellowship programmes.
Availability of service
One of the difficulties with regards to cancer care in the Kingdom is that institutions sufficiently equipped to deal with such conditions are located far from one another. 
Most cancer cases in the country are diagnosed when already at an advanced stage - the tumour burden and size causing severe symptoms while being practically incurable, and therefore the only quality-care left is palliative care. For this reason alone, the imperatives for strengthening the underdeveloped palliative care system become even more pressing. The existence of an effective palliative care system significantly benefits cancer patients that are in terminal stages, and suffering from considerable pain. 
Policy affecting opioid availability
Another concern about pain management in Saudi Arabia is the country's highly restrictive policies concerning pain medication. The per capita consumption of morphine in the country according to World Health Organization statistics in 2011 is about 0.35 mg. In comparison with the global mean consumption of 6.11 mg. This comparison clearly shows that people in Saudi Arabia are provided with much lower doses of pain relief than people in other countries. 
The challenge of opioid availability is due to the lack of training and experience of non-palliative care physicians in safely using such medication.
The infrastructure of primary healthcare services in Saudi Arabia is yet to be fully developed. Family Physicians, even today, do not have the privilege to provide or refill palliation prescriptions.
Cancer patients typically receive medical care through polyclinics or at emergency departments. Very few patients have their own Family Physician. Therefore, patients who are seen once a month in an outpatient clinic do not have continuing medical care in between clinic visits, other than that of a local emergency department. 
Most Saudis, though being concerned about cancer, have very limited knowledge about cancer related pain and also have numerous misconceptions regarding the use of opioids for pain relief.  Concerns include risk of addiction, risk of side-effects and the social stigma.
There were already over fifteen cancer centres in the country, each with its own palliative care department. However, this progress is inadequate, as the need for palliative care has grown more rapidly than the services the institutions offer. The increasing need for palliative care can be simply related to a better understanding of patients' pain and symptomatic management, and hence, providing a better quality-of-life. The development of palliative care in the country has shown society that pain caused by disease and its treatment can be significantly reduced with proper management. 
The solution has three dimensions:
It is important to invest in the education of physicians, nurses, and other healthcare professionals, particularly regarding opioid use and basic palliative care, emphasising the safe use of such medication.
There is a great need for expansion of palliative care services to the secondary level hospitals in the community and as part of home healthcare. There is a need to change current rules and regulation to make the necessary drugs available from these services.
Education and policy amendments must be followed due to the increase in opioid availability in the market. Integral to this process, is the fact that more physicians need to be trained regarding the safe use of these medications for such efforts to bear fruit.
As has been reasoned above, despite the heavy workload of palliative care services, education and research remain important. The educational component operates at many levels. A Palliative Care Fellowship started in KFSH&RC in 2001 as a local fellowship, and in 2012 the programme expanded to King Fahad Medical City. The fellowship programme will now be given full accreditation by the Saudi Commission for Health Specialists as a Saudi Palliative Medicine Fellowship. Eighteen fellows (4 from other GCC countries) have successfully completed the fellowship as of this date.
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