Palliative care in cancer has always been a major issue especially in low-income and middle-income countries where a high percentage of advanced stage and incurable cases apply to the clinics. However, despite the importance of palliative and supportive care approaches, unfortunately most resources have been devoted to expensive treatments without realistic or expected curative intention in many occasions. Little attention has been given to an organized and rationale palliative care and also to the training of health staff and public.
The picture is no different, than above, in Turkey as far as palliative and supportive care methods are concerned. Although big improvements have been made in clinical oncology, there have not been any legal arrangements and regulations such as improvements of patients' rights especially article 14 where terminal sedation rights are discussed. It all started with the efforts of Turkish Oncology Group Society about 10 years ago and the Palliative Care Subgroup of this society has managed to organize 4 meetings around Turkey with the aim of raising awareness and improving the understanding and availability of services across the country and also encourage discussions to support improved knowledge networks. Then we see the establishment of Palliative Care Society in 2006 who wanted to cooperate with ESMO Palliative Group. Some small consultation services were organized in Government, University and private hospitals but probably with sparse resources that are managed by a few dedicated health care professionals and committed volunteers. We also see hospice-like establishments called “Hope Houses.” Finally, the Ministry of Health and especially the Cancer Control Department have started a 2-year program in cooperation with the European Regional Office of World Health Organization to develop a National Cancer Control Program in 2008, and a Palliative Care Action Plan was established within this program in 2009, most probably after the Palliative Care Workshop which was organized between April 26 and 28, 2009. We hope that soon the necessary legal arrangements and regulations will follow these successful attempts.
We, as Dokuz Eylul University, Institute of Oncology, decided to establish the first University Palliative Care Unit and Program under the Department of Clinical Oncology.
Our proposition was discussed at the University Senate and approved by the majority and the decision was sent to the Higher Education Council in Ankara. Our aim is to create a platform where we can:
- Prepare MS and PhD programs in Palliative and Supportive Care,
- Cooperate with the medical faculty in pregraduate and postgraduate education,
- Cooperate with the Cancer Control Department of Ministry of Health,
- Help in public education and organize home care,
- Develop comprehensive center with inpatient and day care facilities and hospital consultancy programs.
A multidisciplinary team has already started to meet weekly to create the necessary future programs.