THE 54-year-old gastric cancer patient, surnamed Xiao, was finally able to sleep peacefully at night.

The cancer cells metastasizing in Xiao's abdomen, had been torturing him with unbearable pain for a year, with his nights spent tossing and turning in bed.

His remaining days in the world were few, as the cancer had developed into its terminal stage and no medical measures could save his life.

"Each time I heard his groaning, my heart was stung," said Xiao's wife. "We just hoped some pain-relief methods could be taken to help reduce the agony for him."

With Xiao unable to find a place in hospital, his wife's modest hopes seemed doomed to disappointment. Yet a telephone call to Xinhua Hospice met the family's needs. The hospice, which provides pain-relief medicines and advice through home visits, has helped more than 1,700 terminal cancer patients die with less pain and more dignity than others less fortunate.

Changing roles

Shanghai's Xinhua Hospice was established in 2001 and now cares for more than 500 patients like Xiao each year. Funded by the Li Ka-shing Foundation and the Shanghai Xinhua Hospital, the hospice is the only one of its kind in the Shanghai-Zhejiang-Jiangsu province area.

After watching the terrible last days endured by his father, a victim of lung cancer, the Hong Kong business magnate Li Ka-shing donated 100 million yuan (US$12 million) and set up a foundation to help terminal cancer patients who could not afford proper medical treatment. The foundation gives 1 million yuan to each hospice annually and 20 such hospices are now operating across the Chinese mainland.

Hospices used to be places of shelter for travellers and were usually maintained by religious orders. Since the 1960s, they have become homes for poverty-stricken sick patients, especially those who are terminally ill.

Patients in the terminal stage of cancer are afflicted with agonizing pain, which drives some of them to dreams of ending their lives through suicide or euthanasia.

"However, such choices are actually avoidable, as the pain can be effectively relieved if the patients are properly treated," said Chen Qiang, head of Xinhua Hospice and director of the Oncology Centre of Xinhua Hospital.

After being accepted by Xinhua Hospice, patients can obtain various medicines under the principle of "three-ladder analgesic treatment", a pain-relief method recognized and promoted by the World Health Organization since the early 1980s. In this method, the patient receives increasingly stronger medications as the disease advances and pain becomes more acute.

Experts have pointed out that such treatment reduces pain to a bearable level for more than 90 per cent of patients.

"However, the method has not being widely practiced in Shanghai, as most terminal patients are tended by their families at home, with little guidance from medical professionals, and even some doctors are not familiar with the treatment," Chen told the Shanghai Star.

Spiritual support

Besides making efforts to reduce the physical suffering of the patients, hospice care also tries to satisfy the spiritual needs of the helpless patients. In addition to the medical professionals from Xinhua Hospital, the hospice service team has more than 100 volunteers, mainly university students and white-collar workers, providing assistance for the patient's family.

Li, a former patient of the hospice, was one of those to receive help from these volunteers. After years of fighting with the disease, her family was reduced to extreme poverty, unable to afford a computer necessary for her son to pass exams. After hearing this story, a volunteer from Xinhua Hospice had lent his own laptop to the family and tutored Li's son.

"What the patients need is more than just medicines," said Sun Ying, a social worker in the hospice, adding that dealing with the spiritual needs of the patient is an indispensable part of bringing comfort and dignity to them.

Limited medical funds

Although Chen and his colleagues have being advocating the hospice concept for four years, they are still "lonely soldiers" - without any local followers in the city.

"Hospice services are in great need with the city's rising number of cancer patients and limited medical resources," said Lu Zhengyu, an expert from the Shanghai Municipal Centre for Disease Control and Prevention.

Statistics from the centre reveal that there were more than 110,000 cancer patients in Shanghai by 2002, accounting for 0.88 per cent of the city's total population, while up to 20,000 of those patients were in the terminal stage at one time.

The situation is estimated to be worse now as the city's population continues to age. Experts predict the number of cancer patients in the city will exceed 200,000 by 2020, amounting to 1.5 per cent of the total population.

Most terminal cancer patients are unable to get a ward bed in local hospitals due to the city's limited medical resources, which forces them to die in their own homes, sometimes with little outside help.

Some experts believe a lack of funding is the main obstacle to hospices thriving in the city. While all the services are delivered free of charge, the medicines provided to the patients are very expensive.

"According to our experience, the cost of running a hospice is not as high as most people believe," said Chen.

The average expense to Xinhua Hospice for each patient was only around 1,000 yuan (US$121), since most medical costs were covered by the city' medical insurance system and all the staff are volunteers.

Chen agrees that money is a key stumbling block to hospice success, but believes that social apathy toward the terminally ill is the main reason for the slow development of hospice services in Shanghai.

After all, he noted: "Most people would rather donate money for patients who are likely to recover rather than to 'useless' dying people."