The future of palliative care in the Islamic world.

Cancer in the developing world, of which the Islamic world is a substantial component, is characterized by far more advanced stages at diagnosis, fewer allocated resources for prevention and treatment, and higher incidence than in countries with more developed health systems.1 The top five cancers in the emerging world are (in descending order) stomach, lung, liver, breast, and cervix, and in developed countries the most common cancers are those of the lung, colorectum, breast, stomach, and prostate.2 In Indonesia, which has an estimated total cancer incidence of about 300,000 cases per year, only 10% are seen in the health care system.3 Similarly, only one cancer unit is available for about 120 million people in Bangladesh.4 Because preventive and curative services for cancer control are underdeveloped in many Islamic countries, the development of palliative care services is a more realistic option for most patients in these countries who have cancer. The available health care services in the Islamic world clearly do not meet patients' needs, and there is little sign that this situation will improve in the foreseeable future. Even if palliative care development is placed on an Islamic country's health care agenda, such development might be handicapped by technical and economic constraints. However, despite this gloomy picture, there are signs that palliative medicine is beginning to take off in the Islamic world. For example, the medical use of morphine for cancer pain control has been steadily increasing during the past few years in many Islamic countries.5 Once a palliative care program takes root in an Islamic country, it usually grows into a thriving service.3,6,7,8,9,10