Palliative Care in the Middle East


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Lidia Schapira, MD, FASCO

Michael Silbermann, DMD, PhD

It’s not about religion or politics, but rather about humanity, interpersonal relationships, peace, and setting aside prejudices.

—Michael Silbermann, DMD, PhD

While some seek peace in the Middle East through political means, others are looking to help patients with cancer find peace through palliative care. This endeavor is bringing oncology professionals together across the region’s national borders and cultural boundaries to implement solutions and improve patient care.

 

In the Middle East, cancer has become an increasing burden, more so than in the United States. While the cancer mortality incidence ratio is 0.38 in the United States, it is 0.58 in the world, and a staggering 0.66 in the Middle East.1 As most of the countries in the Middle East are considered low- to middle-income, health resources are usually scarce and unreliable, limiting the availability of preventive and screening measures. As a result, when patients are diagnosed with cancer, it tends to be in the late stages of the disease.2

Michael Silbermann, DMD, PhD, the Executive Director of the Middle East Cancer Consortium (MECC), believes that palliative care is often the best form of treatment in these cases; however, it is not always offered or utilized. Access to pain medicines in the region is limited, and even when drugs and palliative care services are available to patients, they are not always accepted.

Additionally, stigmas related to beliefs about the hereditary or genetic aspects of cancer can often deter patients from accepting treatments, let alone seeking medical help. Stigmas concerning pain medications and mental health issues related to a cancer diagnosis can often lead to patients keeping their condition a secret and choosing to forgo any palliative care.

Moreover, “cancer isn’t a patient’s only concern in the Middle East,” said Lidia Schapira, MD, FASCO, a speaker at the MECC Conference in the United Arab Emirates in November 2014. She pointed out that the limitations of care and treatment are directly affected by the political and often violent conflict in the region. Dr. Schapira also serves as an ASCO faculty member at the International Palliative Care Workshops in Turkey, as a member of the International Development and Education Award Working Group, and as an Associate Editor for Cancer.Net, ASCO’s patient information website.

This dire situation is one that ASCO and MECC seek to resolve by offering training and resources for oncology professionals. Dr. Silbermann believes that through the development of palliative care programs and better communication between oncology professionals and patients, palliative care will become more widely accepted in the region. MECC has helped in initiating palliative care programs in many Middle Eastern countries. “In many cases these countries don’t recognize each other,” says Dr. Silbermann, “but it’s not about religion or politics, but rather about humanity, interpersonal relationships, peace, and setting aside prejudices.”

Overcoming Barriers to Care

One of the biggest hurdles to overcome is a lack of communication and understanding of cultural and faith differences between providers and patients. MECC trains oncology providers to have more open, and ultimately, more fruitful discussions with patients in the region. Dr. Silbermann offers the following suggestions on how oncologists can overcome cultural, faith, and communication barriers to provide the best possible care to their patients in the Middle East:

1. Become aware of any sensitivity. Start by listening to the patient’s concerns and asking questions about what he or she wants their cancer care to look like. “Personalized medicine isn’t just genetics,” said Dr. Silbermann, who suggests oncology professionals ask patients some personal questions so they can better get to know their patients and learn what barriers to care and treatment they may face.

While the United States is a “death denying” culture, according to Dr. Schapira, other cultures have a different perspective on death. Dr. Schapira believes that patients should be given choices for “mapping out their care based on what gives their lives meaning.” By better understanding the cultural and religious beliefs of patients, oncology professionals may be able to offer alternative solutions, while still respecting the patient’s customs and faith.

2. Involve the patient’s family. “In the Middle East, it’s not uncommon for families to know the diagnosis before the patients,” Dr. Silbermann said. In many cases, the family tries to shield the patient from their prognosis and hides the disease from them. While this would be considered unethical in the United States, it demonstrates the importance of the family’s role in a patient’s treatment. Collective care involving the family is often paramount, so include the family, with the patient’s permission, whenever possible.

3. Provide resources and options, especially those that are family- and community-oriented. Some patients from the Middle East may be wary of Western medicine and may seek to rely more on the support of their family or religious community. One of MECC’s primary tasks is to build trust with communities and families. Oncology professionals should support their patients’ choices, while helping to dispel misconceptions and advocating for the best care and treatment. Additionally, oncology professionals should provide resources and options for home care and help find community support groups for patients.

To learn more about palliative care and find tools for your practice as well as resources for patients, visit www.asco.org/practice-research and select “Palliative Care in Oncology.” ■

References

1. GLOBOCAN 2012: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012. http://globocan.iarc.fr

2. Silbermann, M, ed. Palliative Care to the Cancer Patient: The Middle East as a Model for Emerging Countries. Nova Science Pub Inc.; 2014.


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