End-of-Life Care in Latin America

Abstract

Cancer has become a global pandemic with disproportionately higher mortality rates in low- and middle- income countries, where a large fraction of patients present in advanced stages and in need of end-of-life care. Globally, the number of adults needing end-of-life care is greater than 19 million, and up to 78% of these patients are living in low- and middle- income countries. In the Americas alone, more than one million people are in need of end-of-life care, placing an enormous burden on local health systems, which are often unprepared to meet the challenge presented by this complex patient population. In Latin America, cancer care is characterized by the presence of vast inequalities between and within countries, and the provision of end-of-life care is no exception. Disparities in access to advanced care planning, with a lack of provision of adequate palliative care and pain medication, are common in the region. These shortcomings are related in large part to inadequate or inappropriate legislation, lack of comprehensive national palliative care plans, insufficient infrastructure, lack of opportunities for clinical training, unreliable reporting of data, and cultural barriers. This report reviews the current status of end-of-life care in Latin America, focusing on identifying existing deficiencies and providing a framework for improvement.

Challenges on the provision of palliative care for patients with cancer in low- and middle-income countries: a systematic review of reviews

“…Concerning the geographical focus of the reviews, reviews (n = 4) originated from Middle Eastern countries [34,40,49,52] and LMICs (n = 3) [33,35,39]. The other seven reviews focused on specific countries including Jordan [32], Latin America [46], Indonesia [48], Turkey [50], India [53], Palestine [51], and Kenya [47].…”

“…With regards to the origin of the authors, seven authors were from developed countries [33,35,39,46,49,52,53]; including two from the USA [35,46], two from the UK [52,53], and one each from Australia [39], Canada [33] and Israel [49]. As for the year of publication, the number of publications increased significantly in the last 4 years [32,33,39,40,[46][47][48]. Only two reviews were published before 2010 [52,53].…”

“…This includes a shortage of nursing staff [50], especially the shortage of trained female nurses [32], and few specialised ancillary personnel [32]. Moreover, there was a lack of professional training programmes for HCPs [46,[49][50][51], including the failure to offer basic training to staff [32] and little collaboration/partnership between health organisations [40].…”

Palliative care in women's cancer care: Global challenges and advances

“…4 It was also acknowledged that while LMICs share the biggest proportion of cancer burden, with one-third of global cancer care needed in Sub-Saharan Africa, the lack of access to appropriate technology, health systems, services, radiology, pathology, and anticancer therapies results in poor outcomes and survival in those diag- Disparities in access to adequate pain management, symptom management, and advanced planning and education continue throughout the region. 6 A major issue in LMICs for cancer care and palliation is access to essential medicines, including medicines such as oral morphine.…”

Identifying patients for palliative care in primary care in Brazil: Project Estar ao Seu Lado’s experience

“…Participation of children and caregivers in the care is necessary in the context of primary health care, and more so for people in the Latin American culture who need palliative care. 32 The need for support and planning of interventions and support of carers and families who care for the elderly has already been described in Brazil. 33 However, the involvement and support of the caregivers at the primary care level in Brasil needs further consideration.…”