Demand for palliative care is surging worldwide as people live longer but unhealthier lives
That's where palliative care, which aims to improve patients' quality of life and relieve pain from serious and often incurable illnesses, comes in.
It can include everything from breathing exercises to painkilling drugs, and can take place at home, in hospice, in a nursing home, or at the hospital – ideally long before someone is on death's doorstep.
Yet a new study has found that millions of people lack access to palliative care, even as demand continues to rise worldwide.
The number of people in need of palliative care has surged by 74 per cent over the past three decades, reaching 73.5 million in 2021, according to the study, which was published in The Lancet Global Health.
Four in five of these people are in lower-income countries, where the need for palliative care has grown by 83 per cent since 1990. But demand has also risen by 46 per cent in high-income countries during that time.
'Life expectancy is increasing, but healthy life expectancy is not keeping pace,' Dr Libby Sallnow, a palliative care physician who leads the Marie Curie Palliative Care Research Department at University College London in the UK and was not involved with the new study, told Euronews Health.
While many palliative care patients have terminal conditions, it is different from hospice or end-of-life care.
The global research team identified demand for palliative care by tracking the number of people with 'serious health-related suffering,' or those with health-related pain or an impact on their quality of life that cannot be relieved without professional help.
How palliative care needs have changed
Demand for palliative care has evolved over time, the study found.
Since the 1990s, infectious diseases have waned as a driver – despite a brief global uptick during the COVID-19 pandemic – largely due to a decline of infections in lower-income countries.
Meanwhile, the need for palliative care because of cancer, heart disease, dementia, and other chronic conditions has grown in recent decades, particularly in high-income countries, the report found.
Today in low-income countries, most patients in need of palliative care are women ages 20 to 49. In higher-income countries, it's mostly women ages 70 and up, likely related to dementia.
'People are living for longer with more illness and more serious health-related suffering,' Sallnow said.
'We see a need to manage this much earlier in the life course [and not just] the last few days or weeks' of someone's life, she added.
Worldwide, children also make up a smaller share of people grappling with serious health-related suffering. That percentage fell from 25 per cent in 1990 to 14 per cent in 2021, the report found.
That's 'a real achievement,' Sallnow said.
Gaps in access
It's not the first report to identify a major gap in palliative care services.
Last year, the World Health Organization's (WHO) European office, which spans 53 countries, raised the alarm about the estimated 4.4 million people in need of palliative care in the region who die each year. That toll is expected to rise in the coming years.
Nearly four in 10 of these patients have cancer, while a third have heart disease, 16 per cent have dementia, and 6 per cent have chronic lung diseases, the organisation said.
The European Association for Palliative Care recommends that countries have two specialised palliative services per 100,000 people.
Across Europe, that average is 0.79, according to a 2021 study that found that more than half of European countries had limited resources for palliative care.
The new report described the lack of access to palliative care globally as 'one of the most neglected and inequitable facets of health systems'.
The WHO pointed to a handful of barriers, including the lack of specialised palliative care doctors and medical training, low awareness of how palliative care can help patients, and legal restrictions on opioid painkillers.
Meanwhile Sallnow wants to see palliative care 'decoupled' from cancer or end-of-life care, and instead integrated into other medical specialties.
'The first step is for healthcare to recognise that death is inevitable and the aim of medicine is not only to avoid death, it is also to relieve suffering,' Sallnow said.
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