Palliative care needs to be integrated into dentistry, says M.R. Rajagopal

Palliative care, often misunderstood as solely end-of-life care, is a holistic approach focused on improving the quality of life for patients and their families facing life-limiting illnesses. In India, despite a growing burden of non-communicable diseases, particularly cancer, palliative care services remain significantly underdeveloped and underutilized. This gap is particularly pronounced in specialized areas, such as addressing the long-term sequelae of cancer treatments. Head and neck cancers, for instance, are highly prevalent in India, largely due to lifestyle factors like tobacco and alcohol consumption. While primary treatments like surgery, radiation, and chemotherapy aim to cure, they often leave survivors with debilitating oral health challenges that severely impact their ability to eat, speak, and maintain social interactions.

The recent launch of a new Department of Palliative Care Dentistry by Pallium India in Thiruvananthapuram, Kerala, marks a significant step towards addressing this critical, yet often-overlooked, aspect of patient care. This initiative, spearheaded by Dr. M.R. Rajagopal, widely regarded as the 'father of palliative care in India,' is designed to specifically cater to the oral health needs of head and neck cancer survivors. These survivors frequently suffer from conditions such as xerostomia (dry mouth), mucositis, osteoradionecrosis (bone death due to radiation), trismus (difficulty opening the mouth), dental caries, and fungal infections, all of which compromise their quality of life long after their primary cancer treatment concludes. The integration of specialized dental care into palliative services acknowledges that comprehensive care extends beyond disease eradication to encompass the patient's overall well-being and dignity.

Several key stakeholders are involved in and benefit from this initiative. Foremost is **Pallium India**, a pioneering non-governmental organization that has been at the forefront of advocating for and delivering palliative care services across India since its inception. Their commitment reflects a deep understanding of patient needs and systemic gaps. **Dr. M.R. Rajagopal**, as the Chairman of Pallium India, provides the vision and leadership, highlighting the urgent need to integrate palliative care into all aspects of healthcare. The primary beneficiaries are the **head and neck cancer survivors**, who will now have access to specialized care tailored to their unique oral health challenges. **Dental professionals** involved in this department will gain specialized skills and contribute to a more holistic healthcare paradigm. Ultimately, the **Indian healthcare system** as a whole benefits from this model, as it sets a precedent for integrated, patient-centric care.

This development holds immense significance for India. Socially, it addresses a profound need for dignity and improved quality of life for a vulnerable patient population. Head and neck cancers account for a substantial portion of all cancers in India, with high morbidity rates. By focusing on oral health in palliative care, this initiative directly contributes to reducing suffering and enhancing the daily lives of thousands. Economically, better palliative care, including specialized dental support, can potentially reduce the burden on families and the healthcare system by preventing complications and managing symptoms more effectively, leading to fewer emergency visits and hospitalizations. Politically, such initiatives can serve as catalysts for policy changes, encouraging the government to prioritize and fund comprehensive palliative care services, including specialized sub-disciplines. The **National Health Policy 2017** already emphasizes universal access to quality healthcare and includes palliative and rehabilitative care as key components, aligning perfectly with this initiative.

Historically, palliative care in India began primarily as a charitable movement in the 1980s and 90s, with pioneers like Dr. Rajagopal driving its development. The **National Programme for Palliative Care (NPPC)**, launched in 2012, was a governmental acknowledgment of its importance, aiming to integrate palliative care into the existing healthcare system. However, implementation has been slow and uneven. This new department in Thiruvananthapuram serves as a concrete example of how specialized palliative care can be effectively implemented at a local level, potentially inspiring similar models across the country.

The future implications are substantial. This initiative could serve as a blueprint for integrating palliative care into other medical and dental specialties. It may also influence dental education, prompting the inclusion of palliative care principles and specialized training for managing chronic oral health issues in cancer survivors. With the rising incidence of non-communicable diseases, a holistic and integrated approach to healthcare, championed by efforts like this, is crucial for India to achieve its health goals. From a constitutional perspective, the right to health, implicitly guaranteed under **Article 21 (Right to Life and Personal Liberty)**, is further strengthened by access to comprehensive palliative care, which ensures a life with dignity. Furthermore, **Directive Principles of State Policy (Article 38 and 47)** mandate the state to promote the welfare of the people and improve public health, making such specialized care a moral and constitutional imperative. This move by Pallium India is not just about dental care; it's about upholding human dignity and advocating for a more compassionate and equitable healthcare system for all.