We can only estimate what proportion of the dying cancer population needs hospice or palliative care. Most Western estimates lie in the region of 60% to 80%. So for Singapore, we have made a great deal of progress in achieving coverage of cancer patients, but the services need to be expanded to cover the rest and to cater for the growing numbers of cancer patients as our population ages.
Coverage of patients with AIDS
One challenge that affects all hospices is that of patients with diagnoses other than cancer, in particular, patients with HIV or AIDS. Recently in Singapore, the Ministry of Health has approached the in-patient hospices to take in HIV/AIDS patients, and discussions are taking place to come to grips with this growing problem. Among the issues being discussed is whether it is desirable or feasible in our country to mix AIDS patients with cancer patients in the existing hospices, or whether a separate institution should be set up for AIDS patients. In the UK in 1997, out of 223 in-patient hospices, 6 units comprising 123 beds are operated exclusively for HIV/AIDS patients. An unknown number of other hospices admit a small proportion of such patients. A few months ago, I visited an in-patient palliative care unit in Vancouver which comprised 10 cancer and 10 AIDS beds, where the patients are entirely integrated in the same open wards. Though this worked well in Vancouver, I feel that it will be difficult to achieve in Singapore.
Coverage of patients dying from other causes
Apart from AIDS, in-patient hospices are being asked more and more to take in other non-cancer cases, such as patients with neurological disorders, like Motor Neurone Disease. The public is now asking why only cancer patients are privileged to receive palliative care, while others dying of terminal heart, lung or kidney disease, diabetes or stroke, do not receive the symptom control and the emotional support that are given to cancer patients. The scope of palliative care is being expanded and extended beyond the traditional areas. Progressively we have to come to grips with these challenges with regard to the types of diseases we should be covering.
