Palliative care began in Vietnam in 2001, but steady growth in palliative care services and education commenced several years later when partnerships for ongoing training and technical assistance by committed experts were created with the Ministry of Health, major public hospitals, and medical universities. An empirical analysis of palliative care need by the Ministry of Health in 2006 was followed by national palliative care clinical guidelines, initiation of clinical training for physicians and nurses, and revision of opioid prescribing regulations. As advanced and specialist training programs in palliative care became available, graduates of these programs began helping to establish palliative care services in their hospitals. However, community-based palliative care is not covered by government health insurance and thus is almost completely unavailable. Work is underway to test the hypothesis that insurance coverage of palliative home care not only can improve patient outcomes but also provide financial risk protection for patients' families and reduce costs for the health care system by decreasing hospital admissions near the end of life. A national palliative care policy and strategic plan are needed to maintain progress toward universally accessible cost-effective palliative care services.

Little is known about the prevalence of cancer pain in many developing countries. We report a hospital-wide survey of pain in a tertiary cancer center in Hanoi, Vietnam. All inpatients and outpatients age 18 years or older were approached for participation in the study. Data were collected using the Brief Pain Inventory. Results showed a 70% response rate. Prevalence of moderate to severe pain was 50% (89/178), with 23% reporting severe ratings of pain at its "worst" and 33% reporting severe impairment in their ability to work due to pain. Only 1% and 40% reported total and partial pain relief from medications, respectively. This study is among the first to provide a representative view of pain in a tertiary cancer treatment center in Hanoi, Vietnam. The findings provide empirical support for the need for better programmatic efforts to improve relief of cancer pain in developing countries, including Vietnam.