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Palliative care in Saudi Arabia: Two decades of progress and going strong

Article  in  Journal of Health Specialties · April 2014

DOI: 10.4103/1658-600X.131749

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Short Review Article

Palliative care in Saudi Arabia: Two decades of

progress and going strong
Sami Ayed Alshammary1,2, Alsuhail Abdullah1, Balaji P Duraisamy1, Mahmoud Anbar1
1
Palliative Care Unit, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, 2Centre for Postgraduate Studies in Family Medicine, Ministry
of Health, Riyadh, Saudi Arabia

Abstract
Palliative care is a relatively new medical speciality in Saudi Arabia, but it has shown tremendous growth in the last two
decades. Nevertheless, there are challenges to this development. The paper reviews these barriers in context of the growing
need for palliative care and possible ways to overcome these challenges.

Keywords: Cancer, life-threatening diseases, multidisciplinary team, pain, palliative care

Introduction highest incidence were cancers of the breast, thyroid,

large bowel, non-Hodgkin lymphoma and leukaemia.[1]
Palliative care is a specialty of its own consisting of
comprehensive multidisciplinary healthcare delivery By 2030, the cancer burden in Saudi Arabia is expected
to patients with a wide range of life-threatening and to grow by 5 to 10 folds. This result is predicted by
life-shortening diseases, including cancer. The major the changing demographics, with the age group most
goal is to relieve symptoms of suffering like physical affected by cancer being the middle-aged and elderly.[2]
pain, psychosocial and spiritual problems affecting the
quality-of-life for patients as well as family. Palliative One study showed that 92% of cancer patients surveyed
care has a vital role in providing comfort to patient and had suffered pain, either from the disease itself or from
family during active interventions like chemotherapy the treatment regimen.[3]
and radiation therapies.
The palliative care service in Saudi Arabia was started
In 2008, the Saudi Cancer Registry recorded 11,946 over two decades ago at the King Faisal Specialist Hospital
cases of cancer in Saudi Arabia.[1] The age-standardised and Research Centre (KFSH&RC) in Riyadh by Dr.
incidence was 76.8/100,000 males and 79.4/100,000 Isbister.[4] From that time, the field has slowly expanded.
females. Among these, the most common cancer in The service currently comprises of an 8-bed tertiary
men was colorectal cancer, followed by non-Hodgkin palliative care unit, consultation service throughout the
lymphoma, leukaemia, and cancers of the liver, lung hospital, outpatient clinics, home healthcare program,
and prostate. On the other hand, the leading types and both an outreach and fellowship programmes.
of cancer for women starting with those having the
Challenges
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One of the difficulties with regards to cancer care in the
www.thejhs.org
Kingdom is that institutions sufficiently equipped to deal
with such conditions are located far from one another.[5]
DOI:
10.4103/1658-600X.131749
Most cancer cases in the country are diagnosed when
already at an advanced stage - the tumour burden and size
Address for correspondence: causing severe symptoms while being practically incurable,
Dr. Sami Ayed Alshammary, Palliative Care Unit, Cancer and therefore the only quality-care left is palliative care.
Comprehensive Center, King Fahad Medical City, For this reason alone, the imperatives for strengthening
P. O. Box 13534, Riyadh - 11414, Saudi Arabia. the underdeveloped palliative care system become even
E-mail: [email protected] more pressing. The existence of an effective palliative care

Journal of Health Specialties / April 2014 / Vol 2 | Issue 2 59

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Alshammary, et al.: The dawn of palliative medicine in Saudi Arabia

system significantly benefits cancer patients that are in regarding opioid use and basic palliative care,
terminal stages, and suffering from considerable pain.[6] emphasising the safe use of such medication.

Policy affecting opioid availability Policy changes

Another concern about pain management in Saudi Arabia There is a great need for expansion of palliative
is the country’s highly restrictive policies concerning care services to the secondary level hospitals in the
pain medication. The per capita consumption of community and as part of home healthcare. There is a
morphine in the country according to World Health need to change current rules and regulation to make the
Organization statistics in 2011 is about 0.35 mg. In necessary drugs available from these services.
comparison with the global mean consumption of 6.11
mg. This comparison clearly shows that people in Saudi Opioid availability
Arabia are provided with much lower doses of pain Education and policy amendments must be followed
relief than people in other countries.[7] due to the increase in opioid availability in the market.
Integral to this process, is the fact that more physicians
The challenge of opioid availability is due to the need to be trained regarding the safe use of these
lack of training and experience of non-palliative care medications for such efforts to bear fruit.
physicians in safely using such medication.
As has been reasoned above, despite the heavy workload
The infrastructure of primary healthcare services of palliative care services, education and research
in Saudi Arabia is yet to be fully developed. Family remain important. The educational component operates
Physicians, even today, do not have the privilege to at many levels. A Palliative Care Fellowship started in
provide or refill palliation prescriptions. KFSH&RC in 2001 as a local fellowship, and in 2012
the programme expanded to King Fahad Medical City.
Cancer patients typically receive medical care through The fellowship programme will now be given full
polyclinics or at emergency departments. Very few accreditation by the Saudi Commission for Health
patients have their own Family Physician. Therefore, Specialists as a Saudi Palliative Medicine Fellowship.
patients who are seen once a month in an outpatient clinic Eighteen fellows (4 from other GCC countries) have
do not have continuing medical care in between clinic successfully completed the fellowship as of this date.
visits, other than that of a local emergency department.[4]
References
Public awareness
1. Saudi cancer registry. Overview of cancer incidence 2008. In:
Most Saudis, though being concerned about cancer,
Cancer Incidence Report Saudi Arabia 2008. Saudi Ministry of
have very limited knowledge about cancer related pain Health 2011; p. 16-32.
and also have numerous misconceptions regarding the 2. Ibrahim E, Bin S, Banjar L, Awadalla S, Abomelha MS. Current
use of opioids for pain relief.[3] Concerns include risk and future cancer burden in Saudi Arabia: Meeting the challenge.
of addiction, risk of side-effects and the social stigma. Hematol Oncol Stem Cell Ther 2008;1:210-5.
3. Gray AJ, Ezzat A, Volker S. Developing palliative care services
There were already over fifteen cancer centres in the for terminally ill patients in Saudi Arabia. Ann Saudi Med
country, each with its own palliative care department. 1995;15:370-7.
However, this progress is inadequate, as the need for 4. Nixon A. Palliative care in Saudi Arabia: A brief history. J Pain
palliative care has grown more rapidly than the services Palliat Care Pharmacother 2003;17:45-9.
the institutions offer. The increasing need for palliative 5. Zeinah GF, Al-Kindi SG, Hassan AA. Middle East experience
care can be simply related to a better understanding in palliative care. Am J Hosp Palliat Care 2013;30:94-9.
of patients’ pain and symptomatic management, 6. Al-Shahri MZ. Cancer pain: Progress and ongoing issues in
and hence, providing a better quality-of-life. The Saudi Arabia. Pain Res Manag 2009;14:359-60.
development of palliative care in the country has shown 7. Pain and Policy Studies Group: 2011 EMRO Consumption
society that pain caused by disease and its treatment of Morphine. International Narcotics Control Board; World
Health Organization population data 2013. Available from:
can be significantly reduced with proper management.[5]
http://www.painpolicy.wisc.edu/sites/www.painpolicy.wisc.edu/
files/EMRO_morphine_2011%20[Compatibility%20Mode].pdf
Way forward [Last accessed on 2014 Mar 15].
The solution has three dimensions:
How to cite this article: Alshammary SA, Abdullah A, Duraisamy BP, Anbar
Education M. Palliative care in Saudi Arabia: Two decades of progress and going strong.
It is important to invest in the education of physicians, J Health Spec 2014;2:59-60.

nurses, and other healthcare professionals, particularly Source of Support: Nil, Conflict of Interest: None declared.

60 Journal of Health Specialties / April 2014 / Vol 2 | Issue 2

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