Awareness and Utilization of Palliative Care Among Advanced Cancer Patients in Asia



      To date, little is known about palliative care (PC) awareness and utilization in low- and middle-income countries (LMICs) in Asia.


      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.


      This cross-sectional study analyzed 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.


      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%).


      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.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pain and Symptom Management
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sung H
        • Ferlay J
        • Siegel RL
        • et al.
        Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.
        CA Cancer J Clin. 2021; 71: 209-249
        • Goudas LC
        • Bloch R
        • Gialeli-Goudas M
        • Lau J
        • Carr DB.
        The epidemiology of cancer pain.
        Cancer Invest. 2005; 23: 182-190
        • Gramling R
        • Stanek S
        • Han PK
        • et al.
        Distress due to prognostic uncertainty in palliative care: frequency, distribution, and outcomes among hospitalized patients with advanced cancer.
        J Palliat Med. 2018; 21: 315-321
        • Arai D
        • Sato T
        • Nakachi I
        • et al.
        Longitudinal assessment of prognostic understanding in patients with advanced lung cancer and its association with their psychological distress.
        Oncologist. 2021; 26: e2265-e2273
        • Vehling S
        • Kissane DW.
        Existential distress in cancer: a lleviating suffering from fundamental loss and change.
        Psychooncology. 2018; 27: 2525-2530
        • Malhotra C
        • Malhotra R
        • Bundoc F
        • et al.
        Trajectories of suffering in the last year of life among patients with a solid metastatic cancer.
        J Natl Compr Canc Netw. 2021; 1: 1-8
        • Higginson IJ
        • Evans CJ.
        What is the evidence that palliative care teams improve outcomes for cancer patients and their families?.
        The Cancer Journal. 2010; 16: 423-435
        • Sun V
        • Grant M
        • Koczywas M
        • et al.
        Effectiveness of an interdisciplinary palliative care intervention for family caregivers in lung cancer.
        Cancer. 2015; 121: 3737-3745
        • Payne S
        • Chan N
        • Davies A
        • et al.
        Supportive, palliative, and end-of-life care for patients with cancer in Asia: resource-stratified guidelines from the Asian oncology summit 2012.
        Lancet Oncol. 2012; 13: e492-e500
        • Sankaranarayanan R
        • Ramadas K
        • Qiao Y-l
        Managing the changing burden of cancer in Asia.
        BMC medicine. 2014; 12: 1-17
        • An AR
        • Lee J-K
        • Yun YH
        • Heo DS.
        Terminal cancer patients’ and their primary caregivers’ attitudes toward hospice/palliative care and their effects on actual utilization: a prospective cohort study.
        Palliat Med. 2014; 28: 976-985
        • Chang H-T
        • Lin M-H
        • Chen C-K
        • et al.
        Medical care utilization and costs on end-of-life cancer patients: the role of hospice care.
        Medicine (Baltimore). 2016; 95: e5216-e5222
        • Ozdemir S
        • Malhotra C
        • Teo I
        • et al.
        Palliative care awareness among advanced cancer patients and their family caregivers in Singapore.
        Ann Acad Med Singapore. 2019; 48: 241-246
        • Yun YH
        • Lee MK
        • Kim SY
        • et al.
        Impact of awareness of terminal illness and use of palliative care or intensive care unit on the survival of terminally ill patients with cancer: prospective cohort study.
        J Clin Oncol. 2011; 29: 2474-2480
        • Park S-J
        • Nam EJ
        • Chang YJ
        • Lee Y-J
        • Jho HJ
        Factors related with utilizing hospice palliative care unit among terminal cancer patients in Korea between 2010 and 2014: a single institution study.
        J Korean Med Sci. 2018; 33: e263
        • Matsuyama RK
        • Balliet W
        • Ingram K
        • et al.
        Will patients want hospice or palliative care if they do not know what it is?.
        J Hosp Palliat Nurs. 2011; 13: 41-46
        • Kumar P
        • Casarett D
        • Corcoran A
        • et al.
        Utilization of supportive and palliative care services among oncology outpatients at one academic cancer center: determinants of use and barriers to access.
        J Palliat Med. 2012; 15: 923-930
        • Yan Y
        • Zhang H
        • Gao W
        • et al.
        Current awareness of palliative care in China.
        The Lancet Global Health. 2020; 8: e333-e335
        • Jacob J
        • Palat G
        • Verghese N
        • et al.
        Health-related quality of life and its socio-economic and cultural predictors among advanced cancer patients: evidence from the APPROACH cross-sectional survey in Hyderabad-India.
        BMC palliative care. 2019; 18: 94
        • Hsu C-P
        • Chen H-W
        • Lee S-Y
        • Tsou M-T.
        Knowledge and attitude toward hospice palliative care among community-dwelling aged Taiwanese—analysis of related factors.
        International Journal of Gerontology. 2012; 6: 105-111
        • Hagerty R
        • Butow PN
        • Ellis P
        • Dimitry S
        • Tattersall M.
        Communicating prognosis in cancer care: a systematic review of the literature.
        Ann Oncol. 2005; 16: 1005-1053
        • Chittem M
        • Maya S
        • Chawak S.
        Nondisclosure of a cancer diagnosis and prognosis: recommendations for future research and practice.
        Indian J Cancer. 2021; 58: 158
      1. Mori M, Morita T. End-of-life decision-making in Asia: a need for in-depth cultural consideration. In: SAGE Publications Sage UK: London, England, 2020.

        • de Pentheny O'Kelly C
        • Urch C
        • Brown EA.
        The impact of culture and religion on truth telling at the end of life.
        Nephrol. Dial. Transplant. 2011; 26: 3838-3842
        • Riffin C
        • Kenien C
        • Ghesquiere A
        • et al.
        Community-based participatory research: understanding a promising approach to addressing knowledge gaps in palliative care.
        Ann Palliat Med. 2016; 5: 218
        • Rosa WE
        • Elk R
        • Tucker RO.
        Community-based participatory research in palliative care: a social justice imperative.
        Lancet Glob. Health. 2022; 7: e104