Palliative care in Kerala. Problems at presentation in 440 patients with advanced cancer in a south Indian state.

A new palliative care unit in Kerala, a southern state of India, treated 440 patients' with advanced cancer in the first 15 months of operation. This paper presents an analysis of the problems these patients presented with. Besides the physical problems due to the disease, these patients were found to have a multitude of other concerns peculiar to the region. Lack of financial resources and facilities for follow-up, concerns about the welfare of the family in the absence of proper state-sponsored social security schemes and lack of proper communication between doctors and patients were the major problems that the patients faced. The availability of numerous systems of alternative medicine and a hope for cure even at a late stage of the disease meant that many patients depended on these alternative therapies as their main form of treatment.