Introduction & TB Overview

Introduction:

The word “palliate” is derived from the Latin word “pallium”¹ meaning cloak i.e. an encompassing care that “cloaks” or protects the people from the misery of symptoms of the disease, whether cure is possible or not. It is person focused and seeks to address the issues which are of utmost concern to the person with illness at that stage.

The World Health Organization (WHO)² defines palliative care as "an approach that improves the quality of life of patients (adults and children) with life threatening illness and their families through the prevention and relief of suffering by means of early identification, impeccable assessment and treatment of pain and other physical, psychosocial or spiritual problems ".

The definition of the palliative care by the Expert group is as follows “A comprehensive multi-disciplinary medical, psychosocial and spiritual approach to identify, evaluate and implement measures to alleviate/minimize the sufferings of people with Pulmonary and Severe forms of extra pulmonary TB, to improve their quality of life, from diagnosis to End of life care”.

There is a misconception that palliative care is only beneficial in the terminal stage of an illness when the role of life-prolonging or curative treatment has terminated. However, the true meaning of palliative care is that it should aim at relieving suffering in all stages of the disease and is not limited to end-of-life care only. Palliative care may be provided along with curative or life-sustaining remedies. 

TB Overview:

Tuberculosis (TB) is a contagious bacterial infection primarily affecting the lungs, though it can spread to other organs. It is characterized by symptoms such as persistent cough, dyspnea, chest pain, weight loss and hemoptysis. The disease is both preventable and curable, with early diagnosis and treatment being crucial for control and prevention. The discovery of TB chemotherapy, along with intensified efforts at prevention and cure, resulted in dramatic reductions in TB mortality; but on the other hand, disease has become more complicated and difficult to handle situations have arisen in the form of recurrent TB, Post TB Lung Disease (PTLD) and Drug Resistant tuberculosis.

TB is among the top ten contributors to the global burden of serious health-related suffering. According to the WHO Global TB report 2023, TB was the world’s second leading cause of death from a single infectious agent in 2022 after COVID-19. India accounts for nearly a quarter of the disease burden. In India, in the year 2022, 2,820,000 people were estimated to have developed TB, of which 48,000 were HIV-positive and 1,10,000 were MDR/RR-TB.² Treatment success rate for TB in India was 87% for new and relapse cases registered in 2021, 78% for HIV positive TB cases registered in 2021, 69% for MDR/RR-TB initiated on second line treatment in 2020 and 64% for Pre-XDR/XDR TB cases initiated on treatment in 2020. Estimated deaths due to TB in the country for 2022 were 342,000.