When curative treatment is no longer an option, patients with advanced cancer and other conditions may feel as if they are facing a void.  After the surgeon and the oncologist have done all they can, the patient and their family still require care and treatment, albeit of a different sort. It may seem as if there is medically nowhere to turn. These patients, their loved ones and surprisingly often, their doctors, are left asking "Where can I seek help?" 

Patients who receive a referral for hospice care are sometimes deterred by the misconception that hospice care is merely "better than nothing". Well-run hospice care, however, can be invaluable for patients at this stage.

The modern hospice movement has its roots in the work of British physician Dame Cicely Saunders. It was her belief that "we do not have to cure to heal." She pioneered work with the dying and founded the first modern hospice, St. Christopher's Hospice, in London in 1967. The success in treating terminally-ill patients that followed established St. Christopher's as a centre of learning in this new field of medical care. The ideas developed at St. Christopher's now form the philosophy & principles of hospice care. 

The philosophy of hospice care is to treat the patient and his/her family together as the unit of care, affirming and supporting the role of the family in preparing for and managing life while facing terminal illness. Accordingly, hospice services address key aspects of holistic care. Firstly, the patient receives specific medical treatment aimed at pain and symptom management. Support and education for the primary caregiver(s) are also provided. The family is enabled and encouraged to participate in the patient's care. Finally, the hospice promotes understanding and acceptance of the difficult process ahead. By alleviating the physical and psychological burden of care, hospice services allow the patient and the family to focus together on the quality of life.

The organization of modern hospices and their role in the overall healthcare system varies from country to country. In affluent countries like UK, hospices are well-integrated with the formal healthcare system, employing qualified physicians and nursing staff specially trained in hospice/palliative care. Funding for the hospices comes mainly from the government or non-governmental organizations (NGOs). Although hospice care is for all forms of terminal illness, typically 90% of patients are cancer patients. Services offered by most hospice centres include the following -

In Malaysia, the local hospice movement has been in existence for more than 10 years. These hospices are largely run by NGOs set up by medical and non-medical volunteers. There are about 20 such non-profit, non-governmental organizations, "loosely" associated with each other. Each organization is independently responsible for its own activities and has to raise its own funds for its work.  The better-established hospices are in major cities such as Penang, Kota Kinabalu and Kuala Lumpur, where it has been easier to create awareness & support in wealthier and better-educated populations. These organizations have full-time paid staff (doctors, nurses and office support) and centres for outpatient care. Except for having inpatient hospice hospitals, these hospices provide services similar to those available in more affluent countries. Most NGOs that operate in the smaller towns such as Klang, do not have the same resources, and services are usually provided by volunteer doctors and nurses. Hospice care is also now provided for in some state hospitals, as the Ministry of Health has recognized its importance and given priority to developing this area of medical care. There are plans to establish more palliative care units in state hospitals throughout the country.

In spite of this, it should be emphasized that the overall extent and quality of local hospice services still lag far behind the more affluent countries. Less than 10% of patients with advanced cancer receive proper palliative care in Malaysia. Urgent steps should be taken to improve this situation -

"If not days to their life, add life to their days."  Healing is more than just cure. When extending life is no more an option, care must continue to preserve quality of life till the end.