BMJ 2003;326:368 ( 15 February )

Primary care

Dying from cancer in developed and developing countries: lessons from two qualitative interview studies of patients and their carers

Scott A Murray, senior lecturer in general practice, ^a Elizabeth Grant, community health adviser, ^b Angus Grant, director of medical education, ^b Marilyn Kendall, research fellow. ^a

^a Division of Community Health Sciences, University of Edinburgh, Edinburgh EH8 9DX, ^b Chogoria Hospital, PO Box 35, Chogoria, Meru, Kenya

Correspondence to: S A Murray Scott.Murray{at}ed.ac.uk

Objective: To describe the experiences of illness and needs and use of services in two groups of patients with incurable cancer, one in a developed country and the other in a developing country.
Design: Scotland: longitudinal study with qualitative interviews. Kenya: cross sectional study with qualitative interviews.
Settings: Lothian region, Scotland, and Meru District, Kenya.
Participants: Scotland: 20 patients with inoperable lung cancer and their carers. Kenya: 24 patients with common advanced cancers and their main informal carers.
Main outcome measures: Descriptions of experiences, needs, and available services.
Results: 67 interviews were conducted in Scotland and 46 in Kenya. The emotional pain of facing death was the prime concern of Scottish patients and their carers, while physical pain and financial worries dominated the lives of Kenyan patients and their carers. In Scotland, free health and social services (including financial assistance) were available, but sometimes underused. In Kenya, analgesia, essential equipment, suitable food, and assistance in care were often inaccessible and unaffordable, resulting in considerable unmet physical needs. Kenyan patients thought that their psychological, social, and spiritual needs were met by their families, local community, and religious groups. Some Scottish patients thought that such non-physical needs went unmet.
Conclusions: In patients living in developed and developing countries there are differences not only in resources available for patients dying from cancer but also in their lived experience of illness. The expression of needs and how they are met in different cultural contexts can inform local assessment of needs and provide insights for initiatives in holistic cancer care.

What is already known on this topic? Cancer treatment is a priority and is well developed in the United Kingdom There is an increasing burden on inadequately funded health services in developing countries What this study adds The experience of dying from cancer in Scotland contrasts starkly with that experienced in Kenya Inequalities in provision of palliative care persist between developed and developing countries Despite the availability of resources in the United Kingdom, people still have major areas of unmet needs Consideration of patients' experiences and provision of care in contrasting cultural settings can highlight gaps in frameworks of cancer care

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© 2003 BMJ Publishing Group Ltd
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