Date of Award

Spring 2012

Document Type


Degree Name

Doctor of Philosophy (PhD)


Mathematics, Statistics and Computer Science

First Advisor

Ahamed, Sheikh I.

Second Advisor

Ahamed, Sheikh I.

Third Advisor

Merrill, Stephen J.


The goal of palliative care is to improve the quality of life of terminally ill patients through the management of pain and other symptoms. Though the term `palliative care' is well known in the developed world, it is relatively a new term in the developing world. According to WHO, each year 4.8 million people suffering from severe pain caused by cancer, fail to receive treatment due to lack of resources and other barriers.

In this thesis we have elaborated on the challenges faced by the rural breast cancer (BC) patients of Bangladesh and a solution for their palliative care treatment. Although breast cancer is commonly thought of as a disease of the developed world, the WHO statistics show that 69% of all BC deaths occur in developing countries. Unlike western countries where 89% of the women have a survival rate of more than 5 years, most BC patients in Bangladesh die because the majority of cases are diagnosed in late stages. These patients need palliative care which is almost absent in rural Bangladesh. These issues show the desperate need of a low cost palliative care system solution for the terminally ill patients of the developing world.

Based on detailed field studies, we have developed and deployed a mobile based remote symptom monitoring and management system named e-ESAS. Design of e-ESAS has evolved through continuous feedback from both the patients and doctors. e-ESAS is being used by 10 breast cancer patients to submit symptom values from their home for the last 10 months (Nov'11- Sep '12). Our results show how e-ESAS with motivational videos not only helped the patients to have a `dignified' life but also helped the doctors to achieve the goals of palliative care. Also the analyzed results are shown in 4 categories to appropriately measure the contribution of e-ESAS in improving the QoL.

This thesis also focuses on developing a mobile based pain intensity detection tool which is a first step in replacing the manual paper based scale for measuring pain. The tool also might play a big role in assessing the pain level of verbally impaired patients.