What fills the gap

Among 153 informal end-of-life caregivers, care averaged 57 hours per week and caregivers lost 25 hours of paid work. Women bore about twice the unpaid care costs of men, and 98% of caregivers received no financial compensation.⁵³⁷

Most Armenian patients die at home, and families carry care, often acting in place of psychologists. Residents reported that diagnosis and prognosis are commonly told to the family instead of the patient, sometimes at relatives' request.⁴⁶⁷

Rural and remote Aboriginal people in the Northern Territory expressed a strong wish to die at home connected to land and family. Reasons included belief in 'death country', passing sacred knowledge to the right family member, and having the 'right person' in the family provide care.⁴⁹⁹

At two tertiary hospitals, 83.1% of caregivers of patients with advanced cancer showed medium to high intensity of withholding the truth from the patient. This was highest among adult children caring for terminally ill parents.³⁸²

In a nationwide survey, adults aged 60 or older were more likely to prefer home care and home death, and only 1.7% of community patients had health insurance. In two Dhaka palliative centres, families paid 73.5% of inpatient palliative care costs out of pocket.^359,372

In interviews with family members and primary care professionals in municipalities far from large centers, living the final moments with family at home was valued. The study found serious discontinuity of care for people dying at home in the public system.⁵³³

Nunavut patients and families described extensive medical travel for cancer and end-of-life care and a preference for care within the community with family involved. Staff with strong community ties were valued. Scope is 10 interviews.⁴⁹²

For people experiencing homelessness and poverty, the 'family' caregivers were often living in the same conditions, and almost half were street family or friends. Their care included finding food and shelter alongside other tasks.⁴⁹¹

At a Santiago palliative care unit, 75% of 207 family caregivers were women, 82% cared for the patient daily and 31% cared alone; caring alone was linked to high-intensity burden. In the rural Los Lagos case, daughters took turns at night and learned to manage oxygen, pulse oximetry and a clinical bed at home.^539,538

Migrant workers caring for a parent with terminal cancer described filial piety as both a resource and a requirement for secrecy, including about the parent's prognosis. Oncology nurses at a rural Henan county hospital reported that filial piety complicated communication and decisions, often leading to overtreatment, while financial limits further affected care.^481,482

After discharge from the National Cancer Institute in Bogota, patients and family caregivers manage symptoms at home and bear considerable costs for care supplies plus administrative fees. In a sample of 190 primary caregivers from hospitals and home care programs, most were women and the mean time as caregiver was 33.79 months.^525,526

Family caregivers of older cancer patients at two Egyptian pain and oncology services showed notable strain and widespread dissatisfaction with care. Among 500 family caregivers of children with cancer in Port Said, most identified lack of caregiver training and poor communication with the health team as barriers.^439,440

Lung cancer patients at three tertiary hospitals described family encouragement as a trigger for seeking care. Families sold assets, borrowed money and took on debts to pay for treatment.⁴²⁷

Family members provide much of the care for dying relatives at home, and many cut working hours or leave work. In an online survey, 304 of 320 caregivers wrote about needing workplace flexibility, financial compensation for lost working time, and help with administrative barriers.⁵¹²

In the oldest community clinic in Malappuram, 96% of patients had a caregiver at home and 85% of these caregivers were female. Caregivers, mainly women caring for relatives, described the work as physically demanding, psychologically stressful and socially restrictive.^376,375

Family caregivers in West Java traveled a mean 164.7 km to accompany patients to appointments, and finding financial support was their top unmet need. Patients and caregivers in Jakarta and Yogyakarta valued implicit or family-mediated communication of bad news.^390,391

Most home-based care for advanced cancer is carried by women in the family. Female caregivers in Isfahan described depression, anxiety, mental exhaustion and death anxiety, and asked for counseling and preparation for mourning.⁴⁵⁶

At one Baghdad children's hospital, 72% of caregivers of children with leukaemia met the study threshold for depression, with higher rates among younger caregivers and with longer illness and frequent admissions.⁴⁶²

In a nationwide survey of 532 bereaved families who used home care services, 60% of family caregivers had sleeplessness and 35% depressed mood in the last month of the patient's life. Being the patient's spouse was linked to caregiver psychological symptoms.⁵⁰²

In three Jordanian tertiary hospitals, care decisions typically involved physicians, family members and key figures such as the spouse or eldest male relative. Some caregivers and providers withheld details from patients at the family's request, consistent with a regional review finding families tend to favor concealment.^441,443

Most end-of-life care in Kenya is given at home, mostly by women in the family. Caregivers linked to a mission hospital clinic described role overload, financial stress and little preparation for end-of-life care, with female caregivers especially vulnerable. Bereaved women caregivers in Nairobi described family dynamics shaping talk about death and advance decisions.^400,401

At one Beirut center, 58.8% of 165 seriously ill adults preferred to die at home, and this preference was linked to having family caregivers and social support. Family caregivers described staying present, meeting personal and medical needs and managing finances, with caregiving underpinned by religious values and duty.^463,464

Women at the end of life in rural Malawi depended on family and community care that was both critical and precarious, and all participants in one NGO program faced food insecurity. Among 308 family caregivers at two rural hospitals, one a mission hospital, 41.9% had psychological distress and 57.1% reported social support.^416,417,418

In a case report from an NGO hospice in Kuala Lumpur, adult children cared for their dying mother at home as a filial duty. With training and phone support, they gave anticipatory subcutaneous morphine injections, while also experiencing anticipatory grief and worry about overdose.³⁰¹

In 2017 death records, 57.8% of cancer deaths in Mexico (age-adjusted) occurred at home, and rural residents were more likely to die at home. In Mexico City interviews, 75% of caregivers were women, mostly spouses or adult children.^523,524

Among 150 family caregivers of cancer patients aged 70 or older in Rabat, economic resources were exceeded in 78.7%, and 56% used bank credit or sold property. Relatives took part in treatment decisions for 86% of patients.⁴⁴⁴

In two rural districts, 81% of primary caregivers of people with palliative needs were women, most often daughters-in-law and wives. Families gave most support, followed by neighbours, and only 38% reported any support from health professionals.³⁸⁴

Informal caregivers of people with advanced cancer in Nigeria, Uganda and Zimbabwe reported handling most medical, physical, financial and emotional needs. They described sacrifices in employment, finances, health and social life.⁴³³

In Bacau County, parents of children with life-limiting illnesses reported feeling abandoned by the curative system and stressed the importance of pain control, safety and community support. Parents and NGOs named needs for respite for carers, financial and administrative help, and spiritual counselling.⁵²⁰

In two rural western districts, relatives, mostly women, provide medication, wound care, feeding and emotional support at home with little training, and many buy medicines privately when they have money. Caregivers described prayer groups and family as informal but inconsistent support, and asked for training, financial aid and steady medical follow-up.^406,407

Key informants described death in precolonial Rwanda as accepted and marked in family gatherings as an accomplishment (kusa ikivi), and death from cancer as now often seen as a bad death. The authors suggest traditional values can be reconciled with medical end-of-life care.⁴⁰⁸

Family members carry much of the load in home-based care: in one Jeddah palliative home-care service, 63.3% of caregivers were female and 80.0% reported at least moderate burden. A Riyadh home health care survey of 384 informal caregivers found burden linked to care duration, relationship to the patient and unemployment.^453,454

In two semi-rural communities, HIV home-based care fell mainly on poor, unemployed and unmarried women who were also homemakers and breadwinners. Men were largely absent, and caregivers faced physical strain, emotional problems and elevated HIV and TB risk.⁴³⁵

Bereaved Korean families described adult children's responsibility to care for aged parents at home as both a burden and a main motive for caregiving. In one home hospice service, 85.1% of patients wished to die at home, but only 31.5% of them did, and the primary caregiver's relationship to the patient was linked to place of death.^504,505

In Seville primary care, family caregivers of palliative patients often keep a pact of silence about the terminal diagnosis, sometimes using deceit to conceal it while suspecting the patient already knows. The study links this practice to harder coping with death and mourning.⁵¹⁶

Among 226 informal caregivers of patients with advanced cancer at one hospital, 60% were female and 49% had elevated depressive symptoms. Symptoms were linked with caregiving hours, financial strain and lower family and social support.³⁸⁷

In northern Tanzania, supportive husbands paid for care, took on caregiving and gave emotional support, while unsupportive husbands withheld money or abandoned wives, which delayed diagnosis and treatment of breast cancer.⁴¹⁵

In a small qualitative study of 10 older people in the palliative stage, family caregivers described caring to repay the older person's past kindness. They adjusted their care so the person would not feel abandoned or a burden, and followed Thai ancestral traditions so the person could die peacefully.⁴⁷²

In a Manisa study, family members cared for people with terminal cancer at home with their own means because hospice services were absent. In one hospital palliative unit, 8 family caregivers described emotional strain and physical exhaustion and drew on spiritual beliefs and peer support.^320,447

Family members, often adult children, carry physical, psychological and social caregiving work alongside role conflict and health system tensions. At Hospice Africa Uganda, 46% of 161 family caregivers had depressive symptoms, and 64% of caregivers were female.^395,396

Home and community-based palliative care is often unavailable, and caregivers are mainly family members who face emotional strain; older adults and caregivers were reported to cope through acceptance, spirituality and self-reliance. Before the war, opioid supply met only 7% of national palliative need.¹⁹⁴

British Muslim family carers took on washing, feeding and toileting at home and shared health decisions across siblings. Concern that services would not meet faith or language needs led many families to avoid hospital admission. Scope is 12 participants.⁴⁹⁵

On Great Plains reservations, clinicians reported that only one of three Indian Health Service sites studied had hospice access, and extended family networks (tiospaye) carry day-to-day care of seriously ill relatives. Families may also bring traditional practices such as smudging to the bedside. Scope is 3 reservations in one region.^483,484

Across interviews in Hanoi, Ho Chi Minh City and Dak Lak, a good death was usually described as dying at home surrounded by family. Families keep at least one member beside the dying person, and dying outside the home is linked to the belief that the spirit becomes a wandering soul. Where specialist services exist mainly in major cities, the family becomes the main caregiver at the end of life.⁴⁶⁹

Family caregivers of people with advanced cancer describe faith in God as giving them strength to cope with caregiving. In one survey of 50 family members, positive spiritual or religious coping was very high in 76%, and the authors report these resources were mostly ignored by the care team. In two favelas, prayer and connection with God were sources of comfort while organized religious attendance was mostly low.^534,535,536

At a Buddhist assisted chanting association housed in a Shenzhen hospital, volunteers provide 24-hour continuous recitation of Amitabha Buddha's name for the dying and after death. Patients, families and volunteers described companionship, peace, acceptance of death and relief of financial burden.⁴⁸⁰

Parents whose child died of cancer described grief as a process that ends in being spiritually reconnected with their child. Parents of children with leukemia in Bogota said religious beliefs help give meaning to the illness; both studies are small (18 and 10 parents).^527,528

Ethiopian patients with lung or breast cancer often used holy water, herbal remedies or traditional healers before or alongside hospital care. In a survey of 1177 adults starting HIV treatment in Oromia, many believed holy water could cure HIV, a belief linked to Orthodox Christian religion.^427,428,429

Among Muslim immigrants and their descendants in North Rhine-Westphalia, families often treat caring for a relative until death as an obligation and may decline outside care services. Religious framings such as hope for a miracle or illness as a test shaped treatment decisions, and participants asked for Muslim support services and spiritual care; one professional described death insurance and repatriation of the body as part of prepared practice.⁵¹³

Muslim women with advanced breast cancer described prayer, dhikr, Qur'anic recitation and religious gatherings as central coping resources. Muslim patients with advanced lung cancer at one hospital included dying in religious ways and in a desirable place in their idea of a good death.^388,389

Rinsho-shukyo-shi, Japanese interfaith chaplains, provide religious and spiritual care in some settings. In one university hospital palliative care unit, 10 of 15 patients interviewed said the chaplain's role was necessary for end-of-life care.⁵⁰³

Many patients in Jordan viewed cancer as a divine test. Children with advanced cancer and their families in Jordan and Turkey used religion as a coping mechanism, described as Tawakkul.^441,442

Nineteen patients with stage 4 cancer at the National Cancer Institute Malaysia described spirituality as a source of strength when facing a poor prognosis. They asked for culturally sensitive end-of-life discussions and better spiritual care.⁴⁷⁹

Catholic patients and caregivers in Mexico City described prayer and faith in God as a main way of coping with suffering; one caregiver said prayer is stronger than medicine. The study drew on 68 participants from social security clinics.⁵²⁴

In one Marrakech oncology department, 71% of patients used complementary medicine, most often religious therapy (60%). The main reason was reducing psychic pain, and only 5% discussed it with their doctors.⁴⁴⁵

Breast cancer survivors at one Jos teaching hospital relied on strong religious belief and on traditional healers to cope, given little formal psychosocial support. Clinicians saw cultural and religious beliefs as barriers to treatment.⁴³²

Family caregivers at a Karachi hospice described seeking God's kindness and grace, family honor and selfless service as sources of strength while caring for a dying relative. Spirituality was a major coping resource amid limited resources.³⁷⁸

Sixty Christian and Muslim adults in Rizal Province folded prayer, sacred texts, communal worship and religious support into medication routines, chemotherapy, dialysis and chronic disease care. Families, faith communities and spiritual leaders gave practical help and guidance, and participants kept spiritual support distinct from clinical treatment.⁴⁷⁵

Romanian hospice nurses described family-centered hospice care that integrates Christian Orthodox tradition as death approaches. At one regional cancer centre, religious involvement among 124 adults with cancer was high; spiritual well-being was linked to lower anxiety and depression, while religious commitment showed no independent link.^518,519

Women are the primary caregivers for children in Saudi Arabia, and 24 female caregivers of children at end of life described Islamic beliefs and practices as supporting them through the child's dying.⁴⁵¹

Buddhist patients at a national cancer hospital pain unit often understood cancer pain as the result of karma from previous births. Many increased religious practice after falling ill, such as offering flowers and lighting oil lamps to the Buddha, and described it as a source of relief.³⁸⁶

Among 150 palliative inpatients at Ocean Road Cancer Institute, 90% expressed a need for religious practices, mostly prayer, and access was linked to better perceived well-being. Most patients interviewed were Christian or Muslim, and themes included spirituality in coping and in seeking health care.^412,413

Twelve Thai patients with terminal cancer described Buddhist practices, including clean living and making merit, as part of how they came to accept death. Letting go and finding calm before dying were central to their idea of a peaceful death.⁴⁷³

At one Ankara cancer center, prayer was the most frequent complementary practice, reported by 1,433 of 1,499 surveyed outpatients.⁴⁴⁸

British Muslims with palliative care needs reported mixed support from mosques and Muslim community groups during COVID-19, from welfare packs and volunteer transport to none at all. Interviews across the UK found Islamic virtues of hope and acceptance shape how many Muslim patients and families approach dying.^495,496

African American older adults in Denver described their church as a trusted place for health resources and spiritual and social support during chronic illness. In one hospice study, community clergy offered connection to the congregation and a trusted person, while hospice chaplains focused on present needs, and the two rarely interacted.^485,486

An ethnography at one hospice in Buenos Aires province, 2016 to 2020, observed volunteer teams working alongside nursing professionals in daily end-of-life care. The author describes the hospice's care as emphasizing integrality, holism and respect for the sick person's autonomy.³¹⁶

A compassionate community project in Rio Grande enrolled family carers in monthly meetings called Comunidade Cuidador alongside primary care teams, running 8 training programmes in 2015 with an average of 10 carers. A compassionate community in two favelas also supports patients receiving palliative care and their caregivers. Both reports come from the programs' own teams or partners.^531,536

The All with You (Todos Contigo) compassionate city method, which builds community care networks through community promoters, has been adopted in four Colombian cities: Cali, Medellin, Fusagasuga and Bogota. The description comes from the method's developers.⁵²⁹

Three home-based palliative care programs in Addis Ababa and Yirgalem relied on voluntary caregivers alongside family caregivers. Patients and caregivers said the programs focused on symptoms, with limited psychosocial, spiritual and economic support.⁴³⁰

Trained hospice volunteers in inpatient hospices and palliative care units describe their role as small acts of kindness, creating a family-like atmosphere, and attentive presence that respects silence or refusal. Evidence comes from interviews with 16 and 12 volunteers.^508,509

Germany has a wide network of volunteer hospice homecare services; a 2012 survey went to 1,332 of them. Their volunteer training includes spiritual care, often taught by trainers with pastoral care or theology backgrounds, and outpatient hospice services also accompany residents in nursing homes, the second most frequent place of death.^510,511

In Kerala's home-based programmes, local volunteers work alongside doctors and nurses and describe themselves as mediators between families and the programme. A survey of two rural Alappuzha wards found a shortage of trained volunteers and infrequent staff visits among the reported gaps.^375,127

Community health volunteers chosen from within their own communities number about 1.5 million, and some are trained in palliative care to follow patients at home under primary care supervision. A tradition of mutual assistance within tiered neighbourhood units supports neighbour help with basic care and daily needs.⁷¹

Stakeholders described volunteers as "the missing link in the health system" in a palliative care landscape that relies on charitable support. They called for legal frameworks, standard training and organizational models to make volunteer roles sustainable.⁴⁵⁷

Community palliative home care in Malaysia began in 1991 through hospices run by voluntary organizations, and several NGO hospices now operate. The authors note these services are mainly limited to urban areas because of limited resources, staff and networks.³⁰¹

Korean hospice volunteers described acting as a mediator in conflicts between patients and medical staff and building a meaningful connection with the community. In a survey of 93 volunteers, altruism and civic responsibility were the top motivations.^506,507

In Sevilla, the Sevilla Contigo compassionate city program used community promoters to build care networks around people with advanced illness. Among 83 participants, the average number of people involved in care rose from 3.6 to 6.1; the evaluation was done by the foundation that runs the program.^514,529

Vic (Barcelona province) set up a compassionate city program led jointly by the City Council and the university palliative care chair. In its first year it ran 19 activities with 1,260 attendants and trained 147 people, with volunteer care for vulnerable people planned for the second year.⁵¹⁵

Hospice Africa Uganda trained community volunteer workers to support patients in their own homes and identify people who need care, acting as a bridge to the hospice. Volunteers cited a cultural wish to help others and gained standing in their communities. A 2026 study of eight volunteers in Wakiso District reported gaps in training, supplies, transport funds and phones with data.^392,393,394

During the war, the Kyiv-based volunteer network Inspiration Family used social media to guide displaced cancer patients through referral and evacuation and helped over 100 patients receive treatment abroad in the first 3 months. The NGO Athena runs a patient hotline and peer-support Facebook group, and the foundation Tabletochki runs paediatric palliative care programmes.¹⁹⁴

In a Weston-super-Mare compassionate community model, a health professional helps a dying person and carer match practical tasks to people in their own network, and helpers may later join a local volunteer force. A case study of one UK Compassionate City found leadership, funding and evaluation shaped whether such work could be sustained. The Weston article is a conceptual description by its developers.^493,494

A church-based program trained 37 lay members of 3 African American churches as comfort care supporters who visit ill congregants to talk about advance care planning and end-of-life care. Post-training, 94% felt prepared for the role; the evaluation was done by the curriculum developers.⁴⁸⁷

Community volunteers attached to health facilities in Ndola provide home-based palliative care and reported lack of resources, training, coordination and transport. In a rural program, youth anti-AIDS club members were trained as adjunct caregivers who helped with chores and personal care, though clients wanted material help they could not give.^422,423

In 6 rural Noongar communities in Western Australia, an Aboriginal health worker and a researcher shared advance care planning information at community events and home visits. Western Australian palliative providers said cultural safety training did not replace the need for an Aboriginal worker on the team.^500,501

In a Dhaka urban slum, a program led by community health workers provides children with chronic conditions free medication, supplies, food, caregiver training and psychological support. Of 25 caregivers, 96% could not do paid work because of their child's needs.³⁸³

In a Rio Grande pilot, a Family Health Strategy team with 6 community health agents used the agents' knowledge of local households to identify people needing palliative care, finding 51 patients in the first round. National survey data show about 70% of households with a person needing home care received home visits, with fewer visits where social vulnerability was higher.^530,532

Four First Nations communities in Ontario and Manitoba built their own palliative care programs, led by Elders, Knowledge Carriers, community leaders and First Nations health workers, so people could receive care at home. In Naotkamegwanning, the Wiisokotaatiwin pilot served six clients in 10 months and worked around a federal-provincial funding gap. Evaluations were done by the research partners.^489,490

In rural Los Lagos, the primary care home program for people with severe dependency (PADPDS) supported an older man with advanced lung cancer to stay at home, with home visits, oxygen and possible access to morphine patches through primary care. The program has no specific end-of-life guidelines, although teams often care for people in terminal stages. This is one ethnographic case the authors describe as exceptional.⁵³⁸

In Addis Ababa, the link from facility to household care was weakened by opioid scarcity, a lack of community volunteers and health extension workers not linking patients to services. Home-based centers had limited enrollment capacity.²⁹³

Palliative units under local self-government bodies have grown since Kerala's 2008 policy and deliver home visits through primary health centres. A statewide survey of 200 providers found none of the government units could prescribe oral morphine and 60% had no full-time trained physician.^377,121

In rural western Kenya, 105 community health volunteers trained in palliative care evaluated 1,443 patients and referred 154 in the following month, including teleconsults with providers. Evaluation was done by the program team.⁴⁰⁴

In rural Neno District, a Partners In Health and government program links hospital, clinic and home care, with referrals to community health worker support and socioeconomic assistance. Many patients reported needing income or food, and 72% of enrollees lived more than five kilometres from a clinic. Evaluations were done by program partners.^419,421,420

A statewide domiciliary palliative care program run from eight health clinics in Sarawak saw 113 patients with terminal illness in its first year, most with advanced cancer. Most patients (72%) received care in urbanized locations, and the authors call for more rural and indigenous outreach.⁴⁷⁸

Kibagabaga District Hospital in Kigali trained 481 community health workers, one per village, who had identified 432 patients by June 2014 for the district palliative team. The national plan also began training a new cadre of home-based care practitioners. Both reports come from people running these programs.^409,58

A Jeddah home health care team had nurses start subcutaneous fluids at home for advanced cancer patients, with family caregivers monitoring and disconnecting the infusion. The pilot covered 9 patients.⁴⁵⁵

A small study of male caregivers from a hospice and three home-based care organisations in rural KwaZulu-Natal found they provided gender-appropriate care to male patients. Some female patients were wary of male caregivers.⁴³⁶

The INTecum home-based end-of-life social care program gives families a case manager. Interviewed caregivers (75) said knowing they could count on the case manager, and the speed of the service, reduced stress; support was weaker at transitions between home and hospital.⁵¹⁷

A regional palliative care network run from Kilimanjaro Christian Medical Centre uses community health workers for home visits to cancer patients. During early COVID-19, 74% of 78 of these workers said more patients were relying on local healers, and 92% felt home visits should continue.⁴¹⁴

One district hospital in Khon Kaen created a full-time, 24-hour community caregiver cadre, selected through a community-led process, for dependent patients at home. The model combined Buddhist-integrated spiritual care with five funding streams, and since 2020 it has been scaled to 22 districts across 15 provinces.¹¹⁶

Nurses in a state hospital Home Health Services Unit deliver end-of-life care at home and described learning palliative skills through apprenticeship after starting with insufficient training. Single-site study of 12 nurses.⁴⁵⁰

In Mbale and Jinja, community systems built around HIV care provided personal, livelihood, nutritional and bereavement support and strengthened referrals into palliative care.³⁹⁹

In remote villages of Donetsk region, the NGO EMERGENCY employs locally recruited community health workers who make door-to-door visits, monitor chronic disease treatment, and arrange home-based care for bedridden people, linked to nurse-led clinics. This is a program description by the implementing NGO.⁵²¹

Family physicians in primary care provide general palliative care at home; in Uzhhorod, fatigue and pain were the main symptoms among 219 such patients. A pre-2022 analysis reported that the absence of mobile palliative teams required family doctors to provide this care at home with limited training.^522,198

People in UK homeless hostels seldom receive palliative care, so the burden falls to hostel staff. London pilots embedded palliative specialists in 4 hostels for two half-days a month and trained hostel staff, with reported gains in partnership working and confidence. Evaluations involved the organizations that ran the models.^497,498

A medical respite home served homeless people approaching the end of life; among 20 residents surveyed, 90% had substance use disorders and symptom frequency was high. Many worried about receiving too little (55%) or too much (40%) care at the end of life.⁴⁸⁸

Civil society community home-based care programs grew from mutual support among settlement residents to care for people dying of AIDS, and later shifted toward chronic care, while reduced donor funding now threatens this capacity. In Lusaka, home-based care organisations looked after at least half of TB patients. At a rural mission hospital, living in a village with volunteer home-based care was not linked to better HIV treatment outcomes.^424,425,426

In the rural Los Lagos household studied, the family practiced the Catholic faith and used local herbs alongside visits from the primary care team. This comes from a single case.⁵³⁸

In an exit survey of 433 cancer patients at traditional health practitioner outlets, herbal medicine was the most used remedy, sought for unresponsive conditions, inaccessible biomedical services and second opinions. Among 201 traditional practitioners, 85.5% based palliative decisions on the patient's state after consulting caregivers, and 83% combined examination, conventional tests, herbal medicine, follow-up or referral.^402,403

Some patients and caregivers described traditional remedies such as purifications by healers and shamans, holy water, and herbs for pain relief. Others were cautious about using remedies without reliable information.⁵²⁴

At the Beni Mellal regional oncology center, 36.6% of 530 cancer patients used traditional herbal medicine. Use was more likely among women, those with positive beliefs about it and those influenced by relatives' social norms.⁴⁴⁶

In focus groups in Ibadan, patients described turning to traditional and faith-based healers for financial reasons, convenience and a fit with their spiritual beliefs. Patients and healers both said they wanted closer collaboration with hospital doctors.⁴³¹

Adults on hemodialysis at two units attributed their illness to supernatural causes and chose traditional medicine for kidney disease. Families at first tried to dissuade patients from dialysis, and patients seemed reluctant to discuss end-of-life care.³⁷⁹

Across more than 30 focus groups in several regions, Filipinos used traditional medicine before, alongside and after biomedical treatment. Traditional medicine was also described as a last resort when biomedical treatment fails.⁴⁷⁶

At one Jeddah oncology center, 52.9% of 293 patients used complementary practices, most commonly Zamzam water, Quran recitation, water read upon Quran and black seed. Only 5.8% delayed medical treatment to use them.⁴⁵²

Palliative care nurses and home-based care workers in rural South Africa reported that patients valued traditional rituals around illness, dying, death and bereavement. They suggested training traditional healers in palliative care, while noting healers could foster a false sense of longevity.⁴³⁴

Some patients used Sinhala medicine from a vedamahaththaya, Ayurvedic kashaya, massage or ritual practices alongside clinic pain medication. Family members helped, for example by applying oils or massaging a patient's legs during pain.³⁸⁶

At a northern referral center, 70.5% of 302 patients with cancer had used herbal medicine, most before seeing a doctor, and 77.5% did not tell their doctors. Reasons included belief in cure, hope of symptom relief, lack of cancer services and tradition. In interviews, 18 of 20 women with breast cancer first sought care from traditional healers.^410,411

Family caregivers of people with AIDS in rural Southern Thailand moved between modern medicine, traditional and folk medicine, supernatural healing rites, religious performances and home remedies. This narrative study followed eight caregivers and predates wide antiretroviral access.⁴⁷⁴

Among 67 women with gynecologic cancer at one hospital, 61.2% used complementary therapies, most often herbal remedies, alongside standard treatment. Information came mainly from friends and family, and 56.1% of users had discussed it with their physician or nurse.⁴⁴⁹

At a referral hospital in Mbarara, 56.8% of patients with cancer used herbal medicine, and use was more likely with stage III or IV disease. At the Uganda Cancer Institute, 69.9% of children with cancer used traditional or complementary medicine, mostly spiritual practices and herbal remedies alongside conventional treatment.^397,398

In a survey of 658 patients with non-communicable diseases at two tertiary facilities, 48.6% reported current herbal medicine use and 96% of users had not told their healthcare providers. Potential herb-drug interactions were flagged for 31.3% of users.⁴⁷⁰

Iranian cancer patients described managing their own pain with opium (Taryak) and tobacco, herbal and home remedies, massage, heat and cold, and spiritual practices. Small qualitative sample of 14 patients.⁴⁵⁸

During the post-2019 crisis, Lebanese expatriates carried suitcases of medicines to local NGOs, and a home-care NGO collected unused medicines from discharged or deceased patients for redistribution. The same NGO gave families emergency kits with morphine, midazolam and antiseizure drugs to manage symptoms at home.³²⁷

When social security pharmacies were out of stock, patients bought prescribed medicines themselves, at one thousand to two thousand pesos per medicine, and some borrowed money. National opioid stock covers less than one-third of need, and wealthier states have far more access than poorer ones.⁵²⁴

For 24% of rural residents with palliative needs, the nearest facility was a private pharmacy, locally called a medicine shop, which the authors describe as unregulated. Some people had chronic conditions diagnosed and followed up there, and 45% said worry about cost kept them from seeking care at times.³⁸⁵

At one Islamabad hospital, tramadol (69%) and codeine with paracetamol (68%) were the most prescribed cancer pain drugs and no strong opioids were used. The author links this to restrictive regulation, cost and limited availability.³⁸¹

Interviews with 17 providers, patients, caregivers and regulators described limited oral morphine availability, strict regulation, fear of addiction and the association of morphine with impending death. Scarce palliative and home care services added to these barriers, and the study title quotes the phrase "I wait for leftover morphine".⁴⁷¹

Cancer patients from Nagorno-Karabakh treated in Yerevan during the 2023 blockade paid out of pocket for medicines, travel and lodging. Some stayed with extended family or friends, while others used hostels or government emergency shelters.⁴⁶⁸

Among 181 patients in active cancer treatment, 71.3% paid out of pocket and 44.2% took loans for care, most often to cover diagnostic procedures. 74.5% reported a moderate or heavy economic burden on the household.⁴⁶⁶

In one Malappuram programme, the local community supports the service through economic contributions and practical help to patients. This finding comes from a single district programme.³⁷⁵

Home care nurses in northwest Iran named insurance coverage and charity support as financial needs of patients receiving cancer care at home.⁴⁵⁹

Iraqi patients who travel to Lebanon for cancer care fund it by drawing on extended networks (43 of 60), selling possessions and homes (18 of 60 sold homes), donations and debt. Conflict-related hospital destruction, specialist exodus and treatment shortages push families toward private and cross-border care paid out of pocket.^460,461

In a 2022 Beirut hospital survey, 69.60% of cancer patients paid for medication themselves and 11.20% relied on donations. Authors note patients rely on social media fundraising, telethons and diaspora remittances, and a leading home palliative care NGO runs on community donations and family support.^465,327

At Indus Hospital in Karachi, which treats patients free of cost, zakat made up 34% of all philanthropic donations between 2007 and 2012, and 98% of donations were raised locally. The data concern surgical care and come from the hospital's own researchers.³⁸⁰

Among 101 patients with HER2-positive breast cancer, 90.9% faced catastrophic health spending. Households coped by leaving work, borrowing money from friends and selling assets.⁴⁷⁷

In a KwaZulu-Natal surveillance area, households spent on average the equivalent of a year's income on an adult's funeral, and about as many households borrowed for the funeral as had insurance. Financial diaries from 181 poor households showed nearly all held funeral insurance, yet 61% were underinsured.^437,438

A national cancer pain campaign in 2025 used a web platform and a volunteer clinical network to give more than 100 free consultations, virtual and in person, across 13 provinces. The figures are reported by the organizing professional society.²³⁸

The Indonesian Cancer Foundation in Jakarta runs a 24-hour palliative call center staffed by nurses and doctors. It reported 731 teleconsultations with remote delivery of symptom medicines during the COVID-19 pandemic.⁷¹

A telehospice pilot in Eldoret gave 30 discharged cancer patients weekly phone calls, a 24-hour hotline and comfort kits of medicines. Participation in weekly calls was 100%, and 10 participants died at home during the eight weeks.⁴⁰⁵

A Lebanese home palliative care NGO offers a 24-hour phone line to an assigned nurse and scaled a telephone support program into telemedicine during COVID-19. Families were trained by video to give medicines and monitor symptoms, which the team also relied on during the 2024 war and displacement.³²⁷