Tributes for Dr. Robert Twycross

January 29, 1941—October 22, 2024

The death of foundational palliative care practitioner Dr. Robert Twycross sparked many tributes from those whose lives he touched. Here are some of them sent to IAHPC.

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A commanding figure, an exceptional educator, and a champion of the care of the seriously ill and dying is how we should remember Robert Twycross.

I first met Robert in the 1975 at a one-day cancer pain meeting in Florence, Italy, organized by Dr. John Bonica and Dr. Vittorio Ventafridda. In that meeting, Dr. Raymond Houde, who was an expert in the clinical pharmacology of morphine, presented data on the relative potency of oral and parenteral morphine. I presented data on a prevalence survey of cancer pain. Ray Houde based his assessment on his clinical analgesic studies and Robert based his perspective on his bedside clinical experience. They argued fiercely about the oral to parenteral ratios and both held to their own perspectives. Dr. Vittorio Ventafridda later invited Robert and me to a meeting in Italy where we thrashed out a “method for cancer pain relief“ that eventually became, in 1986, the first World Health Organization monograph on “Cancer Pain Relief.“ 

In writing this monograph with Robert and Vittorio, I witnessed Robert’s brilliant determination to keep it simple and accessible, and his visionary way of teaching principles of pharmacology in general and straightforward terms. He was the master of making the complex simple, and served a critical role in describing assessment and treatment methods for pain and symptom relief in understandable terms. In the week we spent together editing the text, Robert was the consummate clinician educator and a challenging force to reckon with as we argued about phrases, words, concepts, and conclusions. He is recognized nationally and internationally for his studies on the use of oral morphine in the treatment of cancer pain as well as his expansive educational efforts in teaching the principles and practice of palliative care. He thrived on working in low-resource countries to help them develop palliative care programs, and he is revered for this work by those who have had the opportunity to learn and be mentored by him. He was a true pioneer and an exceptional role model. We mourn his passing and celebrate his accomplishments in advancing palliative care worldwide. 

—Dr. Kathleen Foley,  Attending Neurologist, Pain & Palliative Care Service, Memorial Sloan-Kettering Cancer Center, New York, New York, USA; and Professor of Neurology, Neuroscience, and Clinical Pharmacology, Weill Medical College, Cornell University, Ithaca, New York, USA

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On behalf of the Ghana Palliative Care Association (GPCA), we express our heartfelt condolences to the IAHPC and the global palliative care community on the loss of Dr. Robert Twycross. His passing on October 22, 2024, marks the departure of a pioneer whose work shaped palliative care worldwide.

From his early research with Dame Cicely Saunders to his pivotal role in refining cancer pain management and contributing to the WHO Cancer Pain Analgesic Ladder, Dr. Twycross transformed clinical practice and policy. His teachings, the Palliative Care Formulary, and his efforts to build networks and capacity, particularly in low- and middle-income countries, have profoundly influenced our work in Ghana.

We celebrate his legacy of collaboration, knowledge-sharing, and advocacy, which will continue to inspire us. GPCA stands committed to advancing the compassionate care he championed and working toward a world free from health-related suffering.

—Winifred Otoo, Accra, Ghana

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[Excerpted from a tribute in the South Asian Journal of Geriatric Medicine, Surgery, Palliative Care & Hospice] 

As I sit down to reflect on the footprint Dr. Robert Twycross has had left on my life and career, I find myself overwhelmed with gratitude and a sense of loss.

Dr. Twycross was not just a pioneer in palliative medicine: he was a ray of hope and compassion for countless individuals, inspiring both healthcare professionals and patients alike... His passion for patient-centered care ignited a fire in my soul, pushing me to consider a path that would allow me to advocate for those in need... [H]e planted the seeds of palliative care in my heart, emphasizing the importance of dignity, comfort, and humanity for patients facing the end of life. His words resonated deeply within me, awakening a sense of purpose I had never felt before.

He had a gift for making everyone around him feel valued and understood... His warmth and empathy inculcated an environment of trust, open dialogue and teamwork among all members of the healthcare team.

Standing alongside Dr. Twycross, witnessing his joy and pride as we opened our doors [of Aastha Hospice, Lucknow] to the community, I realized the true impact of his work. His dedication to palliative care was not just a professional pursuit; it was an expression of love for humanity.

As we mourn the loss of Dr. Twycross, we also celebrate his extraordinary journey and the countless lives he touched. He leaves behind a legacy of kindness, wisdom, and dedication to those in need... Your legacy will forever inspire us to serve with the same passion and dedication you embodied throughout your remarkable life.

—Dr. Abhishek Shukla, Executive Editor, 
South Asian Journal of Geriatric Medicine, Surgery, Palliative Care & Hospice

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The following was an introduction, written in German, to IAHPC's 2021 newsletter interview with Dr. Twycross.

The palliative world mourns the loss of Dr. Robert Twycross. He was a pioneer of the hospice movement and helped to establish palliative care as a recognized field of modern medicine in the 1970s. Among many other things, he made a significant contribution to the IAHPC List of Essential Medicines, which became the basis for the World Health Organization's list.

Dr. Twycross graduated from Oxford University Medical School in 1965, then worked at St. Christopher's Hospice in London under Dame Cicely Saunders from 1971. His research there into the effectiveness of the “Brompton cocktail” led to the spread of a rational approach to the treatment of cancer pain. This later became the basis of the WHO staging scheme for cancer pain therapy.

A founding member of many prestigious professional societies, he taught in more than 50 countries and held numerous high-ranking academic titles around the world. From 1988 to 2005, Dr. Twycross was Director of the World Health Organization's Collaborating Centre for Palliative Care.

Dr. Twycross co-founded the Palliative Care Formulary and authored numerous articles and chapters on palliative care. He also published several books, including the highly successful and well-established “Introducing Palliative Care.”

His life's work has had a lasting influence on the development and recognition of palliative care as an important aspect of modern medicine.

—Dr. Thomas Sitte, Board Chair, German Palliative Foundation

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I remember Robert Twycross with great pleasure. He was a great teacher for all of us: Vittorio Ventafridda, Derek Doyle, Geoffrey Hanks and others. Rest in peace Robert, you have put the talents you were given to good use.

—Carla Ida Ripamonti,  Director of Supportive Care, Cancer Unit of the IRCCS Foundation, National Cancer Institute of Milano, Italy

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I met Dr. Twycross in Oxford in 1981 and I appreciate him greatly for all his wonderful teachings, especially the attention he gave his patients and their families. As an honorary member of Paliativos sin Fronteras, he helped us a lot. He was an outstanding doctor and his example will guide our lives.  May God bless his family. We were blessed with his presence and his teachings. With special affection and gratefulness.  

—Wilson Astudillo, Paliativos sin Fronteras

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What a great loss to the palliative care fraternity. May his gentle Soul rest in eternal peace. 

—Jerreh K. Drammeh, Gambia National Palliative Care Association 

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So sad. We have lost an asset that can never be replaced. Rest in peace Dr Robert. 

—Honest Twinomujuni, Uganda

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