healthmedicinet

Cancer has been the leading cause of death worldwide for more than two decades. In
Africa, it is an emerging public health issue, with estimated 715,000 new cases and
542,000 deaths in 2008 only 1], 2]. Roughly, half a million people die of cancer in sub-Saharan Africa every year 3]. The FMOH (Ethiopia) estimated that there could be more than 150,000 cancer cases
in Ethiopia each year though available data was limited 1], 4]. About 2013 adult cancer patients visited the Tikur Anbesa Specialized Hospital (TASH)
in 2012 with in Addis Ababa city administration 4]. Comprehensive cancer registration and population-based measurement of cancer burden
are yet to be done in Ethiopia 1].

World Health Organization (WHO) defined palliative care (PC) as an approach that improves
the quality of life (QOL) of patients and their families facing the problem associated
with life-threatening illness, through the prevention and relief of suffering by means
of early identification and impeccable assessment and treatment of physical symptoms;
psychological symptoms; social needs that include interpersonal relationships, caregiving,
and economic concerns; and spiritual needs 5]–8]. Its goal is to prevent and relieve suffering and to support the best possible QOL
for patients and their families, regardless of the stage of the disease or the need
for other therapies 5], 9], 10]. So, PC services are appropriate and should be available for all patients from the
time of diagnosis with a life-threatening or debilitating conditions simultaneously
with standard chemotherapy 9], 10]. But, most African PC researches and services were focused on patients with HIV/AIDS
rather than patients with cancer 11].

PC has become an important part of the continuum of care for cancer patients. Many
studies supported these as QOL 7], 12], 13], 14], 15], 16]. Services of PC must be individually integrated into specific care settings (such
as, hospital, nursing home, assisted living, and/or home care) 9]. Survivors may experience a wide range of side effects that persisted for a long
period. These side effects can reduce cancer survivors’ QOL 17]. Lack of public awareness about early detection, treatment of invasive cancer and
PC services are barriers in countries with limited cancer treatment services (such
as, Ethiopia) 18].

Patients with cancer could encounter from pain and weight loss up to anxiety and confusion
as physical symptoms 19]. These symptoms often have a major impact on patients’ QOL. Good control of these
symptoms are one of the most important aspects of care to patients and requires comprehensive
interdisciplinary services 20]. These symptoms are infrequently treated by conventional care. So, PC programs have
been developed to fill this gap in client care 21].

In India, PC policy established for the first time to facilitate the community-based
home care initiatives under the leadership of local self-governments (LSGs) of Kerala
state 22]. This service was only available in a few towns and three hospitals with the use
of morphine in Tanzania. There is still no formal training program in Tanzania for
any discipline of oncology. Clients, therefore, forced to travel to the abroad for
the services and treatment need 23].

Studies outside home observed that 60.6 % clients with cancer had received medical
care, which included drugs for their symptoms and specific diseases. 69 (66.3 %) had
received some forms of supportive services like cash or kinds. Four had received water
beds, two received walkers, and one received wheel chair. 31 (29.8 %) received catheter
care which included putting, changing, or bladder wash during this period. Seven (6.7 %)
were receiving ulcer care and two (1.9 %) were receiving infection care 24].

Nigerian study showed that 66 % of cancer patients were given a charity home by a
philanthropic group to accommodate patients referred from far distance. All the patients
were glad to have been introduced to PC service of the hospital. About 83 (46.6 %)
clients however regretted non availability of similar service as home based for continuum
of care. At the time of this review, about 65 (36.5 %) had gone back to their respective
home base from where they were referred with symptoms well controlled, 102 (57.3 %)
reported dead, and 11 (6.2 %) were still in PC services. Majority of patients (48.88 %)
with PC services were in 41–60 age bracket 25].

As New York and other USA studies suggested, PC services were significantly associated
with significantly lower likelihood of ICU use and lower in-patient costs compared
to usual care 26]. These cost-related barriers to PC services are growing due to declines in coverage
by employer-sponsored health insurances; increases in health insurance premiums, deductibles,
and copayments; and rising costs of medical care in USA 27].

Kuwait study showed that cancer patients were significantly older than others (P  0.0001).
The patients were predominantly married (62.4 %), formally not employed (such as:
housewives, 82.9 %), and only 31.5 % had up to high school education. Although the
cancer patients were significantly more likely to be divorced or widowed (P  0.001),
there were no significant differences in occupation and education of patients 28]. In other study, older people are less likely to use PC by trained provider [OR ranged
from 0.33 (0.15–0.72) to 0.82 (0.80–0.82)] 29]. Therefore, the objective of this study was to assess knowledge, utilization and
accessibility of PC services by the perspectives of clients in TASH, Addis Ababa,
Ethiopia.