Awareness and utilization of palliative care among advanced cancer patients in Asia

Context: To date, little is known about palliative care (PC) awareness and utilization in low- and middle-income countries (LMICs) in Asia. Objectives: This study aimed to investigate PC awareness and its predictors, utilization of PC services, and perceived utilization barriers among advanced cancer patients from select hospitals in Asian LMICs. Methods: This cross-sectional study analysed data of 759 advanced cancer patients at major hospitals of four LMICs in Asia (i.e., Bangladesh, Philippines, Sri Lanka, and Vietnam). The predictors of PC awareness were investigated using multivariable logistic regression. Results: Overall PC awareness was 30.8% (n=234). Patients with higher education (OR=1.0; CI=1.0,1.1), from upper-middle or high-income households (compared to low-income) (OR=2.0; CI=1.2,3.3), awareness of disease severity (OR=1.5; CI=1.0,2.2), and higher pain severity (OR=1.1; CI=1.0,1.2) had higher odds of PC awareness. Compared to patients who perceived themselves as being very informed about disease trajectory, those who were unsure (OR=0.5; CI=0.3,0.8) or uninformed (OR=0.5; CI=0.3,0.9) had lower odds of PC awareness. The PC utilization rate was 35.0% (n=82) among those with PC awareness, and 47.8% (n=66) among patients recommended PC by a healthcare professional (n=138). The most cited PC utilization barriers were currently receiving anti-cancer treatment (n=43; 33.9%), and having insufficient information about PC (n=41; 32.3%). Conclusion: The low awareness of PC services in these major hospitals in Asian LMICs highlights that more effort may be required to promote the awareness of PC in this region. The efforts should especially focus on those from disadvantaged groups to reduce the gap in PC awareness.