By Dr. Qurat. Ul. Ainn Hashmi
Abstract:
Introduction: Cancer remains a major contributor to
morbidity and mortality in Pakistan, with many patients
diagnosed at advanced and non-curable stages. The majority
experience severe pain and psychological issues and social
distress yet access to palliative care is minimal. Integrating
symptoms control and supportive care into oncology practice is
essential to reduce suffering and enhance quality of life. This
study aimed to evaluate the current landscape of palliative care
in Pakistan, identify barriers to its expansion, and propose
evidence-based strategies for improvement.
Methods: A narrative review methodology was employed to
gather and analyze relevant literature and national data.
Research articles published between 2018 and 2025 were
retrieved from PubMed, Google Scholar, and WHO databases
using the keywords “palliative care,” “cancer Pakistan,”
“hospice,” and “opioid access.” Additional information was
obtained from national cancer control plans, GLOBOCAN
statistics, and all palliative care guidelines issued by Pakistani
institutes. Studies and documents addressing service provision,
workforce training, opioid availability, and policy development
were included. The extracted data were categorized
thematically into five domains: service availability, human
resource capacity, opioid regulation, community awareness,
and policy framework. International models from comparable
low-and middle-income countries were reviewed to identify
adaptable and sustainable approaches for Pakistan.
Results: The review highlights significant gaps in Pakistan’s
palliative care infrastructure. Only a few private and tertiary
care centers in major cities offer partial palliative services,
while rural and district hospitals lack even basic pain
management facilities. Home-based and community programs
are largely absent. Key challenges include morphine access due
to restrictive regulations, workforce shortages, minimal training in pain and symptom management, lack of
coordination among health sectors, and minimal public
awareness. However, positive developments are emerging,
including pilot training modules for primary care physicians,
paramedics, volunteers, advocacy by oncology societies, and
the introduction of palliative care concepts in medical
curricula. Moreover, international experiences demonstrate
that integrating essential palliative packages into primary care,
task-sharing with nurses and community health workers can
substantially improve coverage even with limited resources.
Conclusion: Palliative care is a vital and urgent component of
cancer management in Pakistan. To meet patient needs, it must
be formally integrated into the national cancer control strategy
with specific funding, policy support, and training programs.
Regulatory reforms for opioid accessibility, communitybased
hospice initiatives, and interdisciplinary collaboration are
necessary to ensure equitable, compassionate, and quality care
for all cancer patients.