dying from cancer at home in Thailand

[PoorSucker]

8 minutes ago, PoorSucker said:

My father in-law got a hospital bed at home and nurse came every week.

Small village in north Chiang Mai.

Died from stomach cancer

But he preferred the ganja tea I made for him.

[Sheryl]

5 hours ago, faraday said:

 

Tramadol for injection is also available.

 

I was prescribed this twice by my Orthopaedic doctor.

 

I havr have had a medical career & self-administered it.

 

It was very effective.

 

Doing a muscle injection (IM) is not difficult, at all, but training is needed.

 

Perhaps @Sheryl might give her opinion, please. 

Tramadol will usually not suffice for end stage cancer pain.

 

Morphine or similar is necessary. Can be gotten, though through public hospitals can be a hassle and insufficient  in dose (especially gor a Westerner....Thais are unusually sensitive to any sort of depressents so norm here is quite low doses).  Privately, if under the care of a Westrrn-trained palliative specialist (there are some especially in Bangkok) adequate oral pain meds can be obtained and sometimes skin patches (they keep going off market here for some reason). 

 

The problem, as I explained previously, occurs when the patient can no longer take oral pain killers or they are no longer sufficient -- and in most cases that will occur.  Cannot get IV narcotic at home here.  Also the various other physical discomforts that arise in the dying process (e.g. choking on secretions, nausea  agitation) will usually go  untreated or undertreated at home.  Except at a  few private residential  hospices  there is a lack of expertise in handling these. Proper hospice care is more complex than people may imagine. Needs detailed protocols, special training and professional oversight. 

 

OP needs to consider:

 

1.  Can he afford private care? If not, I would absolutely recommend staying abroad.

 

2  What sort of support system does he have in Thailand and how well prepared is the person who would be primarily responsible for coordinating his care? How well do they understand the hospice concept? How well equipped are they to advocate assertively with doctors? Hiring in home care givers is fine,   but someone has to arrange and supervise this, as the patient will become unable to do this himself  as the dying process proceeds .

 

3. How firmly wedded to the idea of dying at home (vs just dying in Thailand) is he and why? Is it more important than dying comfortably? Would he be open to moving into a residential hospice facility once completely bedridden and/or needing IV pain killers etc?  (Should plan for/set that up in advance, and be under the care of a palliative specialist from that facility from the start so that whoever is in charge of their care can effect the move easily when the time comes).  As previously mentioned, there are some good options in Bangkok. 

 

A lesser consideration but worth mentioning -- arrangements after death will be easier if it occurs in such a facility. Otherwise will have to let the police into the home and they will try to insist on taking the body for autopsy at the family's expense.  Stressful business and not at all the same as when a Thai dies. 

 

[Cameroni]

10 hours ago, Lorry said:

My experience how ordinary Thais die is pretty similar to what @connda wrote.

They die in agony. All they get is paracetamol tablets.

 

That's my experience how they die in the West too. My grandmother just died aged 94. The hospital divesteritself off of her, and just sent her home, as my mother was willing to take care of her and give her morphine. It was still a horrendous death in agony according to my mother's eye witness account.

 

Even with fantastic health insurance and additional money hospitals eventually give up on those who cannot be saved.

[PoorSucker]

12 hours ago, fvw53 said:

Pathum Thani

https://www.koonhospital.com/ seems to have palliative care in Pathum Thai

[PoorSucker]

4 minutes ago, Sheryl said:

Morphine or similar is necessary

How about Codein, got it my pharmacy here in Pattaya for my shingles I suffering from right now.

[connda]

15 minutes ago, PoorSucker said:

Yes, Tramadol and Codein is aviable at my pharmacy here in Pattaya, have shingles right now so I know.

Codeine (I'm assuming Codein is a misspelling, but if it's a brand name then apologies) is a class 2 narcotic, requires a prescription, and is usually only available though hospitals via a prescription from a doctor, and here in Thailand, that would be dispensed at the hospital pharmacy. Get caught with it without a prescription, it's jail time. It's illegal. Same as people who get diazepam or lorazapam or other benzos OTC at a Thai pharmacy.  No prescription, it's jail time. What happens to the pharmacy?  Well, TIT - this is Thailand.  A hand-slap and a brown envelope probably. I know of pharmacies that will sell tranquilizers OTC but I can't say I've ever come across a pharmacy selling Codeine. I get them from a doctor, i.e., I have a prescription.  Use them on rare occasions for sleep. I wouldn't buy them from a pharmacy - too much potential risk. Thailand's narcotics laws are no joke.

[proton]

2 hours ago, faraday said:

At bigger Pharmacies

 

such as?

[PoorSucker]

5 minutes ago, connda said:

can't say I've ever come across a pharmacy selling Codeine. I get them from a doctor, i.e., I have a prescription.  Use them on rare occasions for sleep. 

My pharmacy here in Pattaya, Xanax, Valium, Codeine, Tramadol... No problem

Xanax is better for sleep

 

I have social security in Thailand, so free if I go to the doctor.

[Thingamabob]

1 hour ago, connda said:

Substandard (by Western standards) palliative care readily available in most parts of Thailand.  It's still in the stone-ages and is hampered by Thai elites/leaders aversion to drugs that are effective by using the excuse that those drugs "might be abused" so therefore they must be made difficult to obtain, for example, that's why you can't have morphine drips in a home setting.  You might "abuse" your morphine while your dying.  Heaven forbid.

The poster was asking for a recommendation as to whether or not he should return to his home in Thailand. If he is able to pay for whatever treatment/medication he needs I would say he should return

to Thailand.  BTW morphine is available for home use, at a price.

[PoorSucker]

1 minute ago, Thingamabob said:

 BTW morphine is available for home use, at a price.

My late FIL liked the ganja tea I made for his stomach cancer

[Sheryl]

54 minutes ago, PoorSucker said:

How about Codein, got it my pharmacy here in Pattaya for my shingles I suffering from right now.

Codeine (which comes only in oral form) would also not be enough for advanced cancer pain.  At that stage one needs morphine or related drugs like fentanyl.

 

Are you sure you got codeine from a pharmacy? It is a schedule 2 narcotic in Thailand and sale allowed only from hospitals and clinics.

[Sheryl]

14 minutes ago, Thingamabob said:

The poster was asking for a recommendation as to whether or not he should return to his home in Thailand. If he is able to pay for whatever treatment/medication he needs I would say he should return

to Thailand.  BTW morphine is available for home use, at a price.

Oral morphine is certainly available and not necessarily expensive. Even government hospitals will prescribe it for home use in terminal situations (though not necessarily in enough dose and quantity).

 

I have never seen or heard of IV morphine drips in the home (and I know wealthy people who certainly tried). If you do, please share the details. By PM if not here.

[Sheryl]

59 minutes ago, PoorSucker said:

My pharmacy here in Pattaya, Xanax, Valium, Codeine, Tramadol... No problem

Xanax is better for sleep

 

I have social security in Thailand, so free if I go to the doctor.

Your pharmacy is breaking the law, big time.  (not for the tramadol. But for the rest). And so are you, in buying these over the counter.

 

What does Social Security have to do with buying meds from a private pharmacy?

[Sheryl]

18 minutes ago, Thingamabob said:

The poster was asking for a recommendation as to whether or not he should return to his home in Thailand. If he is able to pay for whatever treatment/medication he needs I would say he should return

to Thailand. 

 

I would not necessarily agree, there are other considerations, as I outlined. Money is essential but not sufficient.

 

He will not remain in a condition able to direct his care and supervise paid attendants. 

 

Someone else has to be willing and able to do that, if he is set against going into a private facility even in the last stages.

[Sheryl]

1 hour ago, PoorSucker said:

https://www.koonhospital.com/ seems to have palliative care in Pathum Thai

Yes, I discussed and linked to this in my first post.

 

Looks quite good but I have no first hand feedback.

 

However OP needs to clarify if he would accept this at some stage since his original post specified dying at home.  That, much harder to manage as things progress, and needs a capable person to manage it.

 

Besides Koon, as I previously said, St Louis has a wing for palliative care and I have had good feedback on it.  https://www.saintlouis.or.th/clinics/palliative-care-center/40

[steven100]

very sad topic indeed,   I am sorry for the OP and his cancer,  it's a horrible disease and you think with all the great doctors and billions of dollars spent on it that a cure would have been found. 

 

I hope you find peace and harmony fvw....    god be with you.. 

[Sheryl]

5 hours ago, Drumbuie said:

 

No hospices? Not true. Here's one :-  https://qscbc.org/en/qscbc-foundation/

 

 

This is not a hospice.

 

It is a  center for diagnosis and treatment of breast cancer.

 

There are some (few) hospices in the Western sense here, as I previously described. But not many.

 

There are also foundations/temples that provide very basic, unskilled custodial care to homeless people with terminal illnesses. But I would nto really call that "hospice" in the palliative sense.

 

 

[mr336]

19 hours ago, connda said:

Not at home they didn't.  You don't have to believe me.  Wait for Sheryl to check in.  The locals here who die of cancer and are in extreme pain will be send from our Amphur hospital to a provincial government hospital, in this case Lamphun Government Hospital were they'll be administered enough morphine to keep them out of extreme agony - but not to keep them comfortable.  I've seen the conditions average Thais die in here in Thailand and it's not pretty or dignified.

My GF's mom just died 3 days ago of cancer from a lump in her neck area. She was given Morphine pills to take home. They operated 5 months ago and was followed up with Radiation. She was operated on in Korat so not a small town hospital. I'd bet she would still be alive and much better off if she didnt have the procedures. She died at home with an infected hole in her neck living her last few weeks suffering with the doctors saying there's nothing they can do. It was heart wrenching. Very ugly and far from dignified. A horrific eye opener for me I wouldn't wish on my enemy.

[Thingamabob]

24 minutes ago, Sheryl said:

 

I would not necessarily agree, there are other considerations, as I outlined. Money is essential but not sufficient.

 

He will not remain in a condition able to direct his care and supervise paid attendants. 

 

Someone else has to be willing and able to do that, if he is set against going into a private facility even in the last stages.

You make an important point. So much depends on personal circumstances when facing a terminal illness. I should have added a lot will depend on the ability/willingness of those around him in Thailand to take full responsibility for his well- being if and when he becomes unable to do so himself. 

[Lorry]

2 hours ago, connda said:

You might "abuse" your morphine while your dying. 

Your relatives might sell it.

Why waste something on dying grandma, if you could sell it on the black market?

[steven100]

3 hours ago, ChipButty said:

but all of a sudden he died one morning

hmm ....seems a bit strange,   and she was obviously there at the time.   foul play perhaps .. 

[Unamerican]

6 hours ago, Drumbuie said:

No hospices? Not true. Here's one :-  https://qscbc.org/en/qscbc-foundation/

But this is a very, very specialised one!! 

[PoorSucker]

1 hour ago, Sheryl said:

Your pharmacy is breaking the law, big time.  (not for the tramadol. But for the rest). And so are you, in buying these over the counter.

 

What does Social Security have to do with buying meds from a private pharmacy?

Yes, breaking the law.

Know it.

Social security card gives it for free, but have to wait 3h to see doctor, I work.

Paying 600 baht is worth it at this pharmacy.

I make 5000-7000 baht per day, so waiting 3h costs ,I only work 6h/Day

 

My pharmaceutical is is Katoy, kicked out from med school

[Magictoad]

22 hours ago, fvw53 said:

I am 82 years old and I live in Thailand since 1987.

Last year during holidays in my home country (EU) a bladder cancer was detected. Since then I have undergone TURBT, cistectomy, radiotherapy but the cancer always came back and now as a last option immunotherapy will be tried.

If this does not work I would prefer to be no longer a burden for the friends where I am now staying and return to Thailand to dy in my own house.

However I do not know if in Thailand there is palliative care at home 

What do Forum members recommend?

 

Yes there is ranging from your personal home help to the large nursing home which provides full medical services.  It's about 70 K Thai baht a month

[Sheryl]

3 hours ago, PoorSucker said:

https://www.koonhospital.com/ seems to have palliative care in Pathum Thai

 

I duscussed this place in my post.

 

Not in Pathum Thsni however.

 

Thonburi side of the tiver near Rama III. 

[PPMMUU]

 

Palliative care is officially part of the Thai government hospital services, and in reality, the situation is not far behind. Several government hospitals have palliative care departments, and some even have dedicated doctors and nurses for this purpose. However, hospice services are rarely available. Most end-of-life care patients in Thailand are cared for by relatives at home. I assume you may not have such relatives, but perhaps you can hire a full-time nurse to act as a ‘relative’ and receive palliative care services from government hospitals.

 

A quick search shows that Pathum Thani Hospital has a palliative care service guideline, which strongly implies that they offer such services. This kind of care often involves a network of government-run primary care units (known as โรงพยาบาลส่งเสริมสุขภาพตำบล, formerly called สถานีอนามัย — you can ask any Thai person you know about them) that provide home visits. These services almost always include morphine tablets, with dosages adjusted to effectively control pain and discomfort. Most of these services also provide a slow-injection device for subcutaneous morphine administration when oral medication is no longer possible. However, they are legally not allowed to administer a lethal dose.

 

Another quick search shows that Thammasat University Hospital runs a hospice service under the name Thammasat Thammarak Hospice and Palliative Care Center, located in Pathum Thani as well. Their contact number is 095-464-9783. You might consider reaching out to them.

 

May you find peace and comfort during this stage of life.

[Magictoad]

23 hours ago, connda said:

Nope.  Nor are there any hospices. They don't exist here. And palliative care in hospitals is in the stone-ages, or non-existent. They'll hand you a bottle of Tylenol and wish you good luck. And the palliative care you can obtain will probably be inadequate if you can get it as Thai doctors have two problems.  1) They feel that the pain you experience is your karma and your own fault, and 2) they feel that if they give you adequate amounts of painkillers you'll become an "addict" (heaven forbid).  And they aren't going to give you morphine to take home. It's extremely difficult to obtain except in hospitals and then only under certain conditions. And don't plan to be put on a machine to self-administer morphine based on your pain levels.  They'll ration morphine and they won't care how much pain you are experiencing.   They use to have fentanyl patches, but I'm pretty sure those were discontinued.  See reasons 1 and 2 above.

You're better off staying in your home country.  This is no place to die if you're in pain.  Where do you think wealthy Thais go to die if they have cancer?  They don't stay here.  Check Soapy Massage tycoon and politician Chuwit Kamolvisit.  He left to go die in the UK.  You can't get adequate palliative care here, and you won't get it at all for home use. 

Wishing you the best.  🙏

The above information is WRONG. I am 72 YO with terminal cancer and have researched the subject of palliative care. As I wrote in another post you have many choice which include single person home care at your own residence or a Care home that supplies medical support. Get sufficient Morphine or Fentanyl  to finish yourself  off when the time/ pain/ dignity dictates it. The nursing home that I researched was 30 km out of Pattaya and about 65K  baht a month.

[connda]

4 hours ago, Sheryl said:

our pharmacy is breaking the law, big time.  (not for the tramadol. But for the rest). And so are you, in buying these over the counter.

I told him the same thing.  Get caught, it's jail time.  You need a valid prescription from a doctor.  There have been enough stories on AN about foreigners getting busted for possession of tranquilizers like Xanax. It's a trip to a clinic to stay legal.

[xtrnuno41]

On 5/16/2025 at 11:59 AM, PoorSucker said:

But where do you live?

There was a post today with a palliative nurse that worked in Europe for 10 years, looking for work (not her but husband)

 

[roquefort]

8 hours ago, soalbundy said:

I don't think this is entirely true, I know of two instances where doctors did regular home visits for terminally ill patients here in Surin province, one for a French guy and the other was a Thai man with cancer, in this case morphine was given to his daughter and she was taught how to ad minister it to her father on a regular basis, he died at home pain free after 5 months of care from his daughter. I believe the government hospital in Surin city has start a palliative department.

Correct. Srinakarind hospital in Khon Kaen also has a palliative care department. They will liaise with the local Amphur hospital to provide at-home pain relief by administration of morphine.