Need for Palliative Care in DR-TB Patients

The current TB treatment strategy is based on a patient-centred approach to treatment and alleviation of patients' suffering that has been restricted mostly to its physical aspects. However, difficulties faced by patients and families affected by life-threatening diseases span across physical, psychological, social and spiritual aspects. Therefore, a more holistic approach to patient treatment requires broadening to a patient-centric care approach with palliative care services.

Palliative care would be necessary for the care of:

• Patients who are chronically ill with extensive drug resistance and extensive fibro-cavitary or disseminated bilateral lung disease
• Patients who have failed regimen for Extensively Drug-resistant Tuberculosis (XDR-TB) or mixed pattern resistance
• Patients for whom the World Health Organization (WHO)-recommended regimen cannot be designed even with new drugs.

There is significant suffering associated with Drug-resistant TB (DR-TB) illness and its treatment. This kind of burden increases the possibility of TB patients not being able to adhere to treatment which many times results in the treatment failing to cure them. 

Delivering palliative care to alleviate the suffering of patients during Multidrug-resistant TB (MDR-TB) treatment, especially when all possibilities of treatment have failed, is an ethical imperative. 

Thus, the need for palliative and end-of-life care is being increasingly recognized as an important part of the continuum of care for DR-TB patients.

Resources

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, 2021.
• Companion Handbook to the WHO Guidelines for the Programmatic Management of Drug-resistant Tuberculosis, 2014.

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