Luczak10 provides a description of palliative care developments in Bulgaria which begins with the work of two oncologists from the National Cancer Institute in Sofia in the early 1990s. This led to the translation into Bulgarian of a small number of key texts as well as the publication of articles on palliative care and pain relief in the Bulgarian Medical Journal. In 1992 a home care service was begun in Sofia. In 1993 Antoanetta Gancheva organised Bulgaria's first palliative care course for doctors and nurses, with contributions from Robert Twycross, Jennifer Barraclough (both UK) and Vittorio Ventafridda (Italy). Later a special supplement of the Bulgarian medical journal Oncology appeared with articles on palliative care topics.11 Some Bulgarian doctors have also travelled abroad for training in palliative care.
The country has 12 oncological dispensaries and a national oncology centre in Sofia. Some of these have become centres for modest development in palliative care; for example since 1992 the Sofia national oncology centre has had a home care team caring for around 1500 patients per year. Likewise Sofia (since 1996) and Plovdiv (since 1997) have had specialist psychological and social work support for patients with cancer. There is a growing network of NGOs and hospices in several cities and towns.
The Poznan Declaration of 1997 was translated into Bulgarian and disseminated to the regional cancer centres by a national task force for hospice/palliative care in Bulgaria. However, politicians are reported to have no concept of palliative care, whilst the public know little about it and health care personnel are just beginning to learn.12
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