Palliative Care in Urological Malignancies: An Indian Perspective

The number of cases of advanced urological cancers and the consequent demand for palliative care are on the rise, especially in areas where access to cancer and supportive care is still limited. The purpose of this review was to summarise the existing evidence concerning palliative care for urological malignancies in India and to point out the gaps that are relevant to clinical practice. A PubMed search was undertaken using terms relating to palliative care and the renal or kidney, urothelial or bladder, prostate, testicular and penile cancers. Only studies that were carried out in India or involved Indian populations and were published from 2019 onwards were considered, with nine studies meeting the stated eligibility criteria. The available evidence addressed quality of life, palliative radiotherapy, the management of refractory bone pain, ^177Lu-PSMA therapy, malignant urinary obstruction, cancer-related fatigue and some metastatic situations. Nevertheless, the body of evidence was small and heterogeneous, with several studies including mixed cancer populations and consisted of individual case reports. Major difficulties included scarce resources, high treatment costs, geographical barriers and inadequate palliative-care infrastructure. There is a need for larger prospective and multicentre studies in order to establish effective and equitable palliative-care pathways for patients with advanced urological malignancies in India.