Development of palliative care in Saudi Arabia: three decades of expertise

doi:10.15406/jcpcr.2025.16.00572

Journal of

eISSN: 2373-633X

Cancer Prevention & Current Research

Case Series Volume 16 Issue 1

Development of palliative care in Saudi Arabia: three decades of expertise

Sami Ayed Alshammary MD

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Department of Palliative Care, King Fahad Medical City, Saudi Arabia

Correspondence: Sami Ayed Alshammary, Department of Palliative Care, Comprehensive Cancer Center, King Fahad Medical City, Riyadh and Centre for Postgraduate Studies in Family Medicine, Ministry of Health, Riyadh, Saudi Arabia

Received: February 17, 2025 | Published: February 25, 2025

Citation: Alshammary SA. Development of palliative care in Saudi Arabia: three decades of expertise. J Cancer Prev Curr Res. 2025;16(1):25‒26. DOI: 10.15406/jcpcr.2025.16.00572

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Abstract

Palliative care is one of the six care systems in Saudi Arabia and has undergone significant growth over the past thirty years. However, challenges persist regarding this development. This paper examines these obstacles in the context of the rising demand for palliative services and explores potential strategies to address them

Keywords: life-threatening diseases, multidisciplinary team, Cancer, pain, palliative care

Introduction

Palliative care, a specialty that has significantly expanded in Saudi Arabia, offers comprehensive multi-disciplinary healthcare to patients dealing with life-threatening and life-limiting diseases, including cancer. Its primary goal is to relieve symptoms of suffering, such as physical pain and psychosocial and spiritual issues that affect the quality of life for patients and their families. The palliative care service in Saudi Arabia, which began over three decades ago at the King Faisal Specialist Hospital and Research Centre (KFSH&RC) in Riyadh under Dr. Isbister, underwent significant changes in 2016 when the Ministry of Health (MOH) launched the Palliative Care/Last Phase Initiative as part of the Transformation of Healthcare - Vision 2030. By 2030, cancer care in Saudi Arabia is expected to grow five to tenfold, driven by changing demographics, with the age group most affected by cancer being middle-aged and elderly individuals. The palliative care community in Saudi Arabia viewed this as a substantial opportunity to develop the specialty nationally. The advancement of palliative care/last-phase interventions has been lengthy, meticulous, and successful.

The role of virtual communication in developing palliative care should not be underestimated. The use of virtual meetings, consultations, teaching, and home visits between specialized palliative care teams in centers of excellence and those at peripheral healthcare facilities has significantly contributed to this development. This innovative approach has demonstrated its impact on the advancement of palliative care in Saudi Arabia.

Today, palliative care services are not merely a luxury for a select few but an essential need for everyone. They are available in primary healthcare facilities across each health cluster nationwide, with secondary facilities, tertiary care hospitals, and even virtual healthcare offering palliative care options through inpatient units and consultation services, as well as outpatient clinics and community palliative care teams. The first hospice care service was launched in March 2018 in the Second Riyadh Health Cluster. Since then, it has swiftly expanded, highlighting the inclusivity and accessibility of the services and providing reassurance about the ongoing improvements in healthcare.

Morphine and other potent opioids, once scarce, are now readily available in all MOH facilities across the kingdom. This notable improvement in opioid availability reflects progress in pain management in Saudi Arabia. According to World Health Organization statistics from 2011, the per capita consumption of morphine in the country was approximately 0.35 mg, compared to the global average of 6.11 mg. This comparison clearly indicates that patients in Saudi Arabia received much lower doses of pain relief than those in other countries. However, as a result of the national initiatives in place, the most recent annual opioid consumption reported for methadone is 7.2 mg in Morphine Equivalence (ME) per capita. This advancement in opioid availability is a positive sign for the future of pain management in Saudi Arabia, fostering hope among the audience regarding ongoing healthcare improvements.

As a result of the national plans in place, the latest reported annual opioid consumption is 7.2 mg of Morphine Equivalence (ME) per capita, excluding methadone.¹

Education

Investing in the education of physicians, nurses, and other healthcare professionals is vital, especially concerning opioid use and basic palliative care, with an emphasis on the safe use of such medications. In 2018, extensive education was provided for 21 palliative multidisciplinary teams (MDTs), which included physicians, nurses, social workers, physical therapists, occupational therapists, spiritual advisors, clinical pharmacists, and others. MDT education encompasses theoretical and clinical disciplines and culminates in a certificate recognized by the Saudi Commission for Health Specialists (SCFHS). Training occurred at the Palliative Care Center of Excellence at King Fahad Medical City (KFMC). In March 2021, the final group of students completed their training in the Kingdom.

The Specialization Training Program for Physicians in Palliative Medicine was established in the Kingdom. The program was first launched by the GCC in 2000, marking a significant milestone in the development of palliative care in the region. It is now a two-year Palliative Medicine Fellowship Program officially recognized by the SCFHS. Since establishing the Specialization in Palliative Medicine in 2000, the SCFHS has acknowledged physicians who are now part of the two-year Palliative Medicine Fellowship. Since 2000, physicians have been specializing in palliative medicine for one year. The first fellow graduated from this program in 2001; most faculty members were Canadian then. In 2014, the SCFHS officially recognized the two-year Palliative Medicine Fellowship. The total number of Palliative Medicine Fellowship graduations this year was 27, and we expect 31 to graduate next year.

The government sponsors approximately 40 international scholarships for Palliative Medicine fellowships. Most graduates are from North America and are now leading their departments. From 2020 to 2023, a palliative care nursing specialist was established as part of the Makken project, a significant initiative backed by the MOH and accredited by the SCFHS. This program has graduated 93 students from all MOH health clusters, representing an important advancement in the development of palliative care in Saudi Arabia.

The current national palliative care plan is part of the MOC Vision 2030, a comprehensive healthcare development strategy that comprises a national initiative, national palliative guidelines (1st edition in 2018 and 3rd edition in 2025), and national palliative care standards (2021). The country has over 100 specialized palliative care consultants, with 2.6 physicians per 1,000 inhabitants from 2014 to 2018.¹

The Kingdom’s first pediatric palliative care hospice under the Ministry of Health (MOH) was launched in May 2019 and is named Alyamamh. The Ministry of Health has significantly contributed to the development of palliative care, including the new allocation of funds for Palliative Care (2016) in the national health budget. The availability of morphine and other potent opioids in all MOH facilities across the kingdom further evidences this commitment. The most recent reported annual opioid consumption—excluding methadone—in Morphine Equivalence (ME) per capita is 7.2,^1,2 highlighting the Ministry's critical role in advancing palliative care and encouraging the audience to recognize the efforts made.

In a significant development, 2021 will mark the inclusion of palliative care in national health insurance plans in Saudi Arabia. This initiative reflects a strong commitment to making palliative care services more widely accessible, fostering optimism about the future of healthcare. Furthermore, centers of excellence for palliative clinical care, education, and research, such as KFMC, will be established. Grants to support palliative care research will be provided through the Saudi Society of Palliative Care (SSPC), a vital entity in promoting palliative care nationwide and other centers.

Public awareness

Most Saudis, while concerned about cancer, have limited knowledge about cancer-related pain and palliative care services and hold many misconceptions regarding the use of opioids for pain relief.³ Their concerns include the risk of addiction, potential side effects, and social stigma. There are currently over fifteen cancer centers in the country, each equipped with a palliative care department, and 21 palliative units exist within each Ministry of Health health cluster. The growing demand for palliative care is closely linked to a better understanding of patients’ pain and symptom management, highlighting the need to improve the quality of life. The advancement of palliative care in the country has demonstrated to society that pain and suffering caused by the disease and its treatment can be significantly alleviated with proper management.^4,5

Conclusion

Palliative care in Saudi Arabia is expanding and reaching all levels of healthcare. From empowering patients and their families to primary, secondary, and tertiary care, palliative care services are becoming more accessible and comprehensive. This year, we are set to celebrate over three decades of palliative care services and 25 years of the Palliative Medicine fellowship, supported by the Minister of Health and the Saudi Society of Palliative Care. We believe that the WHO will improve the ranking of Saudi palliative healthcare services due to the significant advancements and investments in palliative care across the Kingdom.