Cancer patients throughout Sindh, including the provincial capital Karachi, are encountering significant hardships due to the absence of a single public sector hospital that offers comprehensive cancer treatment services under one roof. This critical gap forces many patients to navigate a complex and disjointed healthcare system, requiring them to visit multiple hospitals for different stages of their treatment, such as surgery, chemotherapy, and radiotherapy. Moreover, a large number of terminally ill patients are deprived of proper palliative care, which is essential to alleviate their pain and improve quality of life during their final days.
The fragmented nature of cancer care in Sindh means that patients are frequently shuffled between various medical institutions, causing delays in receiving timely treatment. This not only prolongs the suffering but also adds a heavy financial and emotional burden on families already grappling with the devastating diagnosis. With Pakistan recording over 180,000 new cancer cases annually, Sindh bears a substantial share of this burden due to its dense population and relatively better diagnostic capabilities that detect cancer cases more frequently than other provinces.
Despite Karachi being the largest city in Pakistan and a major healthcare hub for the province, no government hospital currently provides an all-encompassing cancer care package that includes surgery, chemotherapy, radiotherapy, and palliative care services. Patients often initiate treatment at one facility but are compelled to seek other components of their therapy elsewhere, leading to confusion and inefficiency in their care journey.
A poignant example of this systemic failure is the case of a 55-year-old man from Hyderabad diagnosed with stomach cancer. After his diagnosis, he was referred to the Sindh Institute of Urology and Transplantation (SIUT) in Karachi. However, his experience was marked by multiple referrals: from SIUT’s Reagent Plaza facility to its main hospital near Civil Hospital Karachi, then to Jinnah Postgraduate Medical Centre (JPMC), followed by the Karachi Institute of Radiotherapy and Nuclear Medicine (Kiran), and finally back to JPMC. At Kiran, the patient was informed that his cancer had metastasized to other organs, reaching stage four, rendering curative treatment impossible. Subsequently, JPMC oncologists advised his family to seek palliative care at the Aga Khan University Hospital, as no public hospital in Sindh offers dedicated palliative services for terminal cancer patients.
The health official who shared this case highlighted the tragic outcome: after days of being shuffled between hospitals, the patient returned home to Hyderabad, where he is now awaiting death without adequate symptom relief. This heartbreaking story underscores the immense suffering caused by the lack of integrated cancer care and palliative services in the province’s public health system.
One of the most pressing challenges is the unavailability of effective pain management options in public hospitals. Essential medications such as oral and injectable morphine, which are considered the gold standard for managing severe cancer pain, are rarely stocked. Similarly, fentanyl patches, used for chronic cancer pain relief, are difficult to obtain due to stringent regulatory controls and supply shortages. Many hospitals either do not keep these medicines in inventory or face bureaucratic hurdles in procuring them, leaving patients to endure excruciating pain without adequate relief.
Officials within the Sindh health department acknowledge that cancer treatment services are scattered across multiple institutions in Karachi. For instance, JPMC offers cancer surgeries and chemotherapy, with financial assistance programs like Pakistan Bait ul Maal helping patients who cannot afford costly medicines. The hospital also houses one of the country’s major radiotherapy units. However, it lacks a structured palliative care program, leaving a critical gap in end-of-life care for cancer patients.
Despite the growing cancer burden, Sindh has yet to establish a comprehensive public sector cancer hospital that integrates diagnosis, surgery, chemotherapy, radiotherapy, and palliative care under one roof. This is notable given the provincial government’s substantial investment in specialized procedures such as bone marrow transplants at institutions like Dow University of Health Sciences and the National Institute of Blood Diseases in Karachi. The absence of a unified cancer treatment center highlights a pressing need for policy reform and infrastructure development.
Repeated efforts to obtain comments from Sindh Health Minister Dr. Azra Pechuho were unsuccessful, though she has previously emphasized that Sindh boasts some of the best healthcare facilities in Pakistan. She has also pointed out that the province’s health sector achievements often go unrecognized. Meanwhile, patients and their families continue to bear the brunt of a fragmented system, frequently resorting to selling assets, borrowing money, or relying on charitable organizations to finance ongoing treatment.
Health experts warn that without the establishment of integrated cancer treatment centers and accessible palliative care services in public hospitals, thousands of patients in Sindh will continue to face immense challenges. These include not only difficulties in accessing timely and complete treatment but also the inability to find relief from the severe pain and symptoms associated with advanced stages of cancer. Addressing these gaps is crucial to improving cancer care outcomes and reducing the suffering of patients and their families across the province.
