David Warr, MD on Supportive Care in Pakistan Print Email

David Warr, MD: Spreading the Word about Supportive Care

MASCC member and Past President David Warr, MD, recently gave two presentations at the 17th Annual Shaukat Khanum Cancer Symposium, held in Lahore, Pakistan, November 2-4, 2018: “Evolving Concepts of Supportive Care in the (Neo)Adjuvant Setting” and “Breast Cancer and Oncofertility.” Among the issues David discussed was the distinction between supportive and palliative care, stressing the MASCC ideal of supportive care. He also discussed supportive care best practices in the adjuvant setting, including antiemetics, pain, febrile neutropenia, and alopecia.

Few studies have addressed the status of supportive care in Pakistan, a country with high cancer morbidity and limited health resources. Most Pakistanis have little or no knowledge of cancer screening, detection, and diagnosis, and treatments. Those who do seek care are often beyond cure (2). A few studies have addressed quality of life of Pakistani cancer patients, for example documenting the psychological impact of the disease and severe detriments in quality of life. In one study (3), one third of cancer patients were found to be depressed, primarily those receiving multimodality treatment or facing financial issues.

A 2017 study by Chagani et al (1) documented poor quality of life (QOL) among adult cancer patients undergoing chemotherapy treatment in Karachi and identified emotional and physical wellbeing as severely affected domains of QOL. Female gender, occupational status, post-chemotherapy side effects, lack of socialization, and discrimination were significant determinants of poor QOL. The MASCC position is that supportive care is designed to prevent or minimize adverse effects of cancer and its treatment, including physical, psychological, and emotional effects, all along the cancer trajectory. Through numerous examples, David stressed the importance of supportive care as an integral part of treatment to maintain to patients’ wellbeing, even in the early stages of cancer treatment. Introducing strategies to alleviate physical and psychological effects of the disease can improve both treatment outcomes and quality of life.


  1. Chagani et al. Quality of Life and Its Determinants in Adult Cancer Patients Undergoing Chemotherapy Treatment in Pakistan. Asia Pac J Oncol Nurs 2017:4(2):140-6
  2. Jamshed A et al. Improving Cancer Care in Pakistan. South Asian J Cancer 2013:2(1):36-7.
  3. Rashid YA et al. Psychosocial Impact of Cancer on Adult Patients. JPMA 2012:62(9):905-9.