Malignancy in AIDS: institutional management or home care?

ABSTRACT

In India, the first sero-positive person was reported from Chennai in 1986 and the first case of AIDS from Mumbai 1987. Since then the epidemic is growing steadily and WHO/UNAIDS estimate that by the year 2000 AD India has around 3-5 million people suffering from HIV/AIDS and this is the largest burden of HIV in single country. Over 40% of all patients with HIV infection will develop malignant disease at sometime during their course of illness. AIDS and malignancy together constitute a deadly combination. The authors recommend that the care of patients having malignancy with AIDS should be mainly at home rather than in an oncology center. This will ensure the patient's and family's comfort as most of the specialized cancer centers in India are at a considerable distance away from patient's homes. Frequent visit to a cancer center will exhaust the patient and attendants emotionally, physically and financially. This is especially true because irrespective of the pains taken by the family and the specialists, a cure is an unlikely possibility. Only one specialist from oncology and one primary health physician, who are completely aware of the patient's physical, psychological, financial and social background, should be responsible for the care of a patient having malignancy with AIDS in India. The main advantages of the home care of such patients are patient's and family's comfort; lesser mental, physical, social, emotional and financial agony; and minimum need for institutional care, which may be instituted as and when necessary.