Palliative Care means providing support and care for patients in the last phase of their disease, so that they can live as fully and comfortably as possible. The fact that cure is no longer a reality does not mean that care cannot be made available and Palliative Care provides care and support not only to the patients but also to their family or caregivers, looking after their physical, emotional, social and spiritual needs.

The concept of Palliative Care has developed in the last decade with the medical community also recognizing the importance of this aspect of cancer care. Experts from the fields of Anesthesiology, Oncology, Psychology and Psychosocial work have all contributed immensely to the growth of Palliative Care. At KKF it has always been an integral part of our Counseling and Patient Care activities.

Most of the patients are put off cancer medication except medication for pain and mental agony Such medicine is given by the doctor on need basis. The care of palliative patients requires trained and experienced care-takers who are highly qualified and have positive attitude and patience to treat the palliative patient with the dignity , love and support required. KKF volunteers are not only highly trained but also have personal regards for human life as well as highly motivated.

Our volunteers are available to take special care of such patients at their homes to fulfill their needs which are varied. They are prepared at all times. Some examples of their services are feeding the patients, reading religious and other books as desired by the patient , playing music for them or simply talking to them or listening to them patiently, thus fulfilling their need of belonging as well as helping them pass their time fruitfully, temporarily forgetting their pain.

What are the implications of these circumstances for palliative care? According to official estimates, at any one time 2.5 million people have cancer in India; 180,000 new cases occur annually. Approximately 80 percent of patients present with late-stage disease. Yet, 80 percent of the funds under the Cancer Control Programme continue to be spent on treatment facilities. The remaining 20 percent goes toward cancer awareness programs and cancer detection facilities. Palliative care figures nowhere in the equation.

Given a choice, most people would prefer to spend the last days of their lives at home surrounded by their loved ones and a lifetime of memories. In India, families are large and have strong ties. Family involvement in care results in better physical care and brings family members closer together, and home-based palliative care makes good economic sense for everyone involved. Because most cancer patients in India exhaust practically all of their financial resources by the time they conclude their treatment options, they cannot afford the cost of further hospitalization. Palliative care is also cost-effective for the government, which, given its limited resources, finds it difficult to justify building in-house facilities for patients with terminal cancer. Moreover, home care reduces the pressure on overextended medical personnel.

• It is not possible for patients to travel to a clinic for treatment.
• Staying at home helps patients maintain already strong family ties.
• The patient and his family can get the services of the health care worker.
• Home-care is cost-effective for the patients family.
• Home care reduces the pressure on already overwhelmed medical facilities.

• Stigma of cancer
• Ignorance about palliative care among the medical community and the public
• Limited trained personnel, because palliative care is not included in medical curricula
• Complete lack of government support toward palliative care financing or infrastructure
• Restricted access to oral morphine as a result of cumbersome licensing procedures
• Reluctance on the part of medical caregivers to prescribe oral morphine even when available, and fear among practitioners and patients of using morphine
• Refusal by medical caregivers, patients, and family members to admit or to accept that curative treatments are no longer useful
• Limited counseling services—and no bereavement counseling—for patients and families
• Collusion between medical practitioners and families to avoid informing patients of their prognoses
• Patients and families becoming victims of unscrupulous practitioners of alternative or indigenous systems of medicine who promise a cure for a price.

It is not unusual for the family to forsake the palliative patient especially in the lower middle class and poor families and there are very few alternatives available for them as palliative homes are expensive and hard to maintain requiring dedicated staff to look after them.

We have observed that fewer than half of our patient families belong to the socioeconomic middle class, which would give them the resources to buy analgesics and other drugs, but not the resources necessary for a prolonged hospitalization. The other half of our patients are poor and cannot buy even inexpensive analgesics. In the absence of a social support system, it becomes increasingly difficult for one earning family member to provide optimal patient care, buy medicines, and look after the family needs. This often leads to the exhaustion of family savings with subsequent debt. For these reasons, KKF is committed to providing free home care service as well as free medicines, nutritional supplements, and food rations to palliative patients who need them.