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Pain management constitutes a pivotal aspect of palliative care. Certain instances of distressing pain are significantly relieved through interventional pain methodologies, demanding the expertise of pain specialists. Our perspective revolves around the integration of these 2 facets, envisaging a symbiotic relationship that could enhance patient outcomes. A prospective assessment was carried out within a collaborative clinic, uniting the realms of pain management and palliative medicine. Anonymized patient information was scrutinized to grasp the advantages of this amalgamation and identify strategies to address any inherent deficiencies. Furthermore, an illustrative case study was delineated, spotlighting the collaborative dynamics at a systemic level. During the period spanning from November 2020 to June 2021, a total of 43 patients received consultations at this collaborative clinic. Each patient was exposed to a comprehensive pain management regimen, with the most frequently conducted procedure being an intercostal nerve block, which was administered in 9.30% of cases. For the provision of effective pain relief within the palliative care context, the confluence of joint consultations from cancer pain specialists emerges as a requisite measure. This approach carries the promise of optimizing pain control and augmenting the quality of palliative care. [ABSTRACT FROM AUTHOR]

Income tax deductions aimed at alleviating the financial strain of catastrophic health expenses, prove inadequate in supporting cancer care in India. First, the stringent eligibility criteria for accessing this tax deduction restrict its availability to a narrow segment of the population. Typically, it is granted only to those who receive treatment at government-sanctioned medical facilities. Consequently, this deduction excludes a substantial number of patients, intensifying their financial woes. Moreover, the maximum deduction amount, despite sporadic revisions, falls short in the face of skyrocketing cancer treatment costs. The current structure of the income tax deduction does little to alleviate this burden, as the deduction often pales in comparison to the actual costs incurred. Rather than dissolution of this provision in the new tax regime, we propose a reform and reevaluation of the income tax deduction framework to ensure it genuinely fulfills its role in alleviating the financial strain of cancer care in India. [ABSTRACT FROM AUTHOR]

Byline: Anuja. Damani, Arunangshu. Ghoshal, Krithika. Rao, Pankaj. Singhai, Spandana. Rayala, Seema. Rao, K. Ganpathy, Nisha. Krishnadasan, Lt. Verginia (Retd. Army), Nandini. Vallath, Gayatri. Palat, Chitra. Venkateshwaran, Jenifer. S, Lulu. [...]

Byline: Anuja. Damani, Arunangshu. Ghoshal, Naveen. Salins, Sushma. Bhatnagar, Priti. Sanghavi, Vidya. Viswanath, Shrenik. Ostwal, Gauraiya. Chinchalkar, Nandini. Vallath Novel corona virus disease 2019 (COVID-19) is an ongoing pandemic that [...]

Byline: Arunangshu. Ghoshal The article entitled, 'Factors influencing the initiation of strong opioids in cancer patients on palliative care: An audit from a tertiary cancer center in India,' raises many [...]

Byline: Arunangshu. Ghoshal Palliative care (PC) offers support for patients and families from the diagnosis of an incurable disease through to death and the aftermath. Developing relevant quality indicators is [...]

Byline: Arunangshu. Ghoshal The article entitled 'Cancer pain, anxiety and depression in admitted patients in a tertiary care hospital - A prospective observational study' raises many important issues regarding the [...]

Byline: Rutula. Sonawane, Arunangshu. Ghoshal, Anuja. Damani, MaryAnn. Muckaden, Jayita. Deodhar Rates of malignant melanoma have been increasing in frequency. Studies have shown that up to 46% of patients with [...]

Byline: Anuja. Damani, Arunangshu. Ghoshal, Naveen. Salins, M. Muckaden, Jayita. Deodhar Introduction: Dyspnea is a subjective, multidimensional experience of breathing discomfort, commonly seen in patients with advanced cancer. This study [...]

Byline: Arunangshu. GhoshalThe article entitled 'Validity and Reliability of 11-face Faces Pain Scale in the Iranian Elderly Community with Chronic Pain' raises many important issues regarding measurement and implementation problems [...]

Byline: Arunangshu. Ghoshal, Pradnya. Talawadekar, Anil. Palleri, Joan. Marston, MaryAnn. Muckaden Background: The 'Children's Palliative Care Project' was initiated in October 2010 in the Indian state of Maharashtra with a [...]

Although medical mistrust (MM) may be an impediment to public health interventions, no MM scale has been validated across countries and the assessment of MM has not been explored using item response theory, which allows generalisation beyond the sampled data. We aimed to determine the dimensionality of a brief MM measure across four countries through Mokken analysis and Graded Response Modelling. Analysis of 1468 participants from UK (n = 1179), Ireland (n = 191), India (n = 49) and Malaysia (n = 49) demonstrated that MM items formed a hierarchical, unidimensional measure, which is very informative about high levels of MM. Possible item reduction and scoring changes were also demonstrated. This study demonstrates that this brief MM measure is suitable for international studies as it is unidimensional across countries, cross cultural, and shows that minor adjustments will not impact on the assessment of MM when using these items. [ABSTRACT FROM AUTHOR]

Objectives: Adolescents with cancer experience several psychosocial concerns. Cancer among adolescents contributes to one-fifth of cancers in India. Most of the published empirical literature on adolescents' views about their cancer experience is from high-income countries. The objectives of the study were to explore the experiences of adolescents with cancer in India. Materials and Methods: Twenty-eight adolescents were purposively recruited and participated in prospectively conducted qualitative interviews conducted at the Tata Memorial Hospital, Mumbai, between 2013 and 2015. Interview data were transcribed and analysed using Braun and Clarke' s reflexive thematic analysis. Results: Two themes and several subthemes were generated during the analysis. The transition to the new reality of illness was traumatic. It embodied fear about the unknown, disease and symptoms. The experience was isolating and disfigurement further led to peer separation. Inadequate information made the adolescents anxious and worried, and children and parents experienced moments of severe distress. The love and support received from parents, siblings and extended family facilitated positive coping. Peer support was reassuring and enabled them to have a normalising experience. Discovering their inner strength, acceptance of the situation and faith in God made them resilient and hopeful. Conclusion: Adolescents with cancer experience significant emotional concerns, which are often unexplored and unaddressed. An adolescent-specific communication framework and psychosocial programme contextual to the Indian setting may be developed based on the study findings. [ABSTRACT FROM AUTHOR]

Objectives: Patients needing palliative care prefer to be cared for in the comfort of their homes. Although private home health-care services are entering the health-care ecosystem in India, for the majority it is still institution-based. Here, we describe a model of home-based palliative care developed by the Tata Memorial Hospital, a government tertiary care cancer hospital. Materials and Methods: Data on patient demographics, services provided and outcomes were collected prospectively for patients for the year November 2013 - October 2019. In the 1st year, local general physicians were trained in palliative care principles, bereavement services and out of hours telephone support were provided. In the 2nd year, data from 1st year were analysed and discussed among the study investigators to introduce changes. In the 3rd year, the updated patient assessment forms were implemented in practice. In the 4th year, the symptom management protocol was implemented. In the 5th and 6th year, updated process of patient assessment data and symptom management protocol was implemented as a complete model of care. Results: During the 6 years, 250 patients were recruited, all suffering from advanced cancer. Home care led to good symptom control, improvement of quality of life for patients and increased satisfaction of caregivers during the care process and into bereavement. Conclusion: A home-based model of care spared patients from unnecessary hospital visits and was successful in providing client centred care. A multidisciplinary team composition allowed for holistic care and can serve as a model for building palliative care capacity in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

Byline: Arunangshu. Ghoshal, Shamali. Poojary, Anuja. Damani, Naveen. Salins, Jayita. Deodhar, Maryann. Muckaden Emergencies in palliative care need to be defined by the potential distress that a clinical issue raises [...]

Byline: Anuja. Damani, Arunangshu. Ghoshal, Manjiri. Dighe, Sunil. Dhiliwal, Maryann. Muckaden Context: Patients with chronic life-limiting conditions on palliative care (PC) prefer to be treated at home. Medical care by [...]

Byline: Anuja. Damani, Arunangshu. Ghoshal, Naveen. Salins, Jayita. Deodhar, MaryAnn. Muckaden Context: Dyspnea is a subjective, multidimensional experience of breathing discomfort, commonly seen in patients with advanced cancer. To find [...]

Byline: Arunangshu. Ghoshal, Anuja. Damani, Naveen. Salins, Jayita. Deodhar, M. Muckaden Only a few studies have assessed the economic outcomes of palliative care in India. The major areas of interest [...]

Byline: Arunangshu. Ghoshal The label 'translational research' (TR) has become ever more popular in the biomedical domain in recent years. It is usually presented as an attempt to bridge a [...]

Objectives: To describe the key initiatives that were successful in planning and implementing hospital- and community-based Paediatric Palliative Care (PPC) services designed for a resource-limited setting in Maharashtra, India, in collaboration with DfID. Materials and Methods: The CPC project was a 5-year service development project (April 2010--March 2015) conducted in Maharashtra, India, developed in collaboration with the Department for International Development (DFID), Hospice UK, International Children's Palliative Care Network (ICPCN), Indian Association of Palliative Care (IAPC) and Tata Memorial Centre, to advocate and care for the needs of children and families with life-limiting illnesses in a non-cancer setting. It was implemented through raising awareness and sensitising hospital administrators and staff about PPC, providing education and training on PPC, team building, and data collection to understand the need for PPC. Results: The total number of children enrolled in the CPC project was 866, 525 (60.6%) were male with a mean age of 9.3 years. Major symptom across sites was mild pain, and serial Quality of Life measurement (through PedsQL questionnaire) showed improvement in social, psychological and school performance. Advocacy with the Ministry of Health helped in procurement of NDPS licenses in district hospitals, and led to access to palliative care for children at policy level. Conclusion: The model of PPC service development can be replicated in other resource-limited settings to include children with life-limiting conditions. The development of pilot programmes can generate interest among local physicians to become trained in PPC and can be used to advocate for the palliative care needs of children. [ABSTRACT FROM AUTHOR]

Objectives: Malignant fungating breast cancers are a definite challenge to treatment due to limited knowledge and prevailing distressing symptoms. Various treatment protocols with regard to radiotherapy (RT) and chemotherapy have been reported in the literature but the knowledge of proper integration of these regimes with effective palliative care nursing care, particularly in resource poor settings, is not well understood. Hence, this study was undertaken to assess the change in the degree of comfort achieved before and after treatment of these fungating breast cancer wounds along with issues regarding compliance to such treatment in a peripheral rural medical college hospital. Materials and Methods: A total of 20 patients were selected from the medical records files of the RT department of North Bengal Medical College and Hospital who were registered and treated during the period 1 June 2019-31 July 2021. Palliative care nursing of malodour, bleeding, maggots, pain and assessment of psychological parameters was done based on the 11-point revised Edmonton Symptom Assessment Scale at the beginning and at each subsequent follow-up visits. Patients were also individualised for receiving palliative RT, chemotherapy, surgery and hormone therapy based on their clinicodemographic profiles. Informed consent was taken from all patients and every treatment was in accordance with the ethical permissions as sought from the Institutional Ethics Committee. Statistical analysis was done based on descriptive statistics and SPSS version 22. Results: Median follow-up was 13 months. Overall, there was a significant improvement in comfort and well-being as assessed by paired t-test before and after treatment (paired t-test = 16.548; P = 0.000). However, there was no significant correlation with palliative radiation dose and schedule as per spearman's correlation coefficient. The mean radiation dose was BED 48.56 Gy3 (EQD2 = 29.3 Gy3) and the median number of fractions used was 10. Almost 50% of patients were noncompliant to treatment and this might be attributed to the prevailing COVID-19 pandemic situation. There was maximum relief with regard to bleeding control (100%), malodour dissipation (76.9%) and control of maggots infestation (71%) and these results were also found to be strongly associated with treatment as per analysis done by Chi-square test of difference of proportions. Conclusion: Effective comfort can be achieved with proper judicious combination of palliative care nursing and other oncological treatment such as radiation, chemotherapy and surgery. [ABSTRACT FROM AUTHOR]

Byline: Jayita. Deodhar, Vanita. Noronha, Mary. Muckaden, Shrikant. Atreya, Amit. Joshi, Sandeep. Tandon, Arunangshu. Ghoshal, Naveen. Salins, Vijay. Patil, Kumar. Prabhash Purpose: Early palliative care is beneficial in advanced lung [...]

Byline: Arunangshu. Ghoshal, Naveen. Salins, Jayita. Deodhar, Anuja. Damani, Mary. Muckaden Purpose: Fatigue is one of the most common symptoms seen in patients with advanced cancer. It is known to [...]

Introduction: The concept of total pain encompasses a person's physical, psychological, social, spiritual, and practical struggles. Effective pain and symptom management are the core elements of palliative care which aims at reducing suffering and improving quality of life (QOL) throughout the course of illness and need to be addressed with multidisciplinary coordinated approach in a timely manner. It may be challenging for palliative care providers to address all these distressing issues during short out-patient consultations. Hence, Respite Palliative Care Unit (RPCU) is an appropriate place to provide holistic patient care. Case Description: A 59-year-old widow, from Muslim community, was following up with Palliative Medicine out-patient department for management of progressively increasing chest pain with frequent exacerbations. She remained unsatisfied with the pain management and reported moderate to severe intensity of pain despite maximal pain management using multimodal approaches. We planned to systematically explore and address the issues leading to uncontrolled pain and distress. The patient was admitted to RPCU for holistic pain management and continuity of care. We explored and addressed the complex psycho-socio-spiritual aspects contributing to the total pain experience to achieve better symptom control and improve her overall well-being. Conclusion: This case report emphasizes the role of RPCU in effective and holistic management of psychosocial, spiritual issues, difficult communication, and advanced care planning. This model of palliative care can be a valuable addition to various health-care set-ups in the developing countries for improvement of patient care. [ABSTRACT FROM AUTHOR]

Objectives: The Lancet Commission on Global Access to Palliative Care and Pain Relief reported significant levels of health-related suffering globally, with the highest incidence in the low- and middle-income countries. The report describes suffering as health-related when it is associated with illness or injury of any kind and suffering as serious when it cannot be relieved without professional intervention and when it compromises physical, social, spiritual, and/or emotional functioning. This paper describes the preliminary development phase of a tool for screening Serious Health-related Suffering (SHS) at individual patient level, suitable to the healthcare settings in India. The study was conducted by the National Cancer Grid-India, with support from the Indian Association of Palliative Care. Materials and Methods: Domain identification and item generation were conducted according to the recommendations for tool development by the American Psychological Association and World Health Organisation quality of life instrument. The consensus for domain questions and associated items was achieved using Delphi, nominal group technique, expert review, and polling. Results: The Phase-1 study for developing the screening tool for SHS contextualised to resource-limited settings generated a bilevel questionnaire. The initial level assesses and scores the physical, emotional, social, spiritual, and financial domains of health-related suffering. The next level assesses seriousness, through functional limitation and patient's preference. Conclusion: The generation of domains, items, and screening questions for health-related suffering and its seriousness completes the preliminary phase of developing the SHS screening tool applicable to a resource-limited healthcare setting. Field testing of the tool is being conducted as Phase-2 of this study, to validate it in clinical settings. [ABSTRACT FROM AUTHOR]

Byline: Anuja. Damani, Naveen. Salins, Arunangshu. Ghoshal, MaryAnn. Muckaden Introduction: There is a gradual increasing trend in childhood cancers in India and pediatric palliative care in India is an emerging [...]

Byline: Arunangshu. Ghoshal, Naveen. Salins, Anuja. Damani, Jayita. Deodhar, MaryAnn. Muckaden Purpose: To audit referral practices of pediatric oncologists referred to specialist pediatric palliative care services. Patients and Methods: Retrospective [...]

Byline: Anuja. Damani, Arunangshu. Ghoshal, Naveen. Salins, Jayita. Deodhar, Mary. Muckaden Hemichorea hemiballismus (HCHB) is a rare and debilitating presentation of hyperglycemia and subcortical stroke. Early identification, proper assessment and [...]

Byline: Arunangshu. Ghoshal, Anuja. Damani, Naveen. Salins, Jayita. Deodhar, Mary. Muckaden Levofloxacin is a commonly prescribed antibiotic for managing chest and urinary tract infections in a palliative care setting. Incidence [...]

Objectives: Access to early palliative care (EPC) for all patients with metastatic lung cancer is yet to be achieved in spite of recommendations. This quality improvement (QI) project was initialized to improve the rates of such referrals from the thoracic oncology clinic for all new outpatients in a premier cancer center in India. Materials and Methods: Change in the proportion of patients receiving referrals for EPC during and after intervention (April-May 2018), compared to baseline (January-March 2018) were explored. Interventions included understanding of the process flow, identification of key drivers, and root cause analysis which identified the gaps as lack of documentation for EPC. Teaching and encouraging staff at the clinic to incorporate referrals into all initial visits for patients with metastatic lung cancer were incorporated. Results: The bundle of QI interventions increased referrals from an average of 50% to 75%, mean difference = 12.64 (standard deviation = 10.13) (95% confidence interval = 22.01-3.29), P = 0.016 (two-tailed) on paired sample test. Conclusion: Improved referral rates for EPC in a multidisciplinary cancer clinic is possible with a QI project. This project also identifies the importance of data documentation and patient information processes that can be targeted for improvement. [ABSTRACT FROM AUTHOR]

PURPOSE: To understand the preferences and attitudes of patients and family caregivers on disclosure of cancer diagnosis and prognosis in an Indian setting. METHODS: Overall, 250 adult patients with cancer and 250 family caregivers attending the outpatients of a tertiary cancer hospital for the first time were recruited purposively. The mean ages of patients and caregivers were 49.9 years (range, 23-80 years) and 37.9 years (range, 19-67 years), respectively. Separately, they completed prevalidated, close-ended preference questions and were interviewed for open-ended attitude questions. RESULTS: A total of 250 adult patients (response rate, 47.17% overall, 73.2% in men, and 26.8% in women) and 250 family caregivers (response rate, 40.65% overall, 84.0% in men, and 16.0% in women) participated. Significant differences were observed in the preference to full disclosure of the name of illness between patients (81.2%) and caregivers (34.0%) and with the expected length of survival between patients (72.8%) and caregivers (8.8%; P <.001). The patients felt that knowing a diagnosis and prognosis may help them be prepared, plan additional treatment, anticipate complications, and plan for future and family. The caregivers felt that patients knowing a diagnosis and prognosis may negatively affect the future course of illness and cause patients to experience stress, depression, loss of hope, and confidence. CONCLUSION: Patients with cancer preferred full disclosure of their diagnoses and prognoses, whereas the family caregivers preferred nondisclosure of the same to their patients. This novel information obtained through a large study with varied participants from different parts of the country will help formulate communication strategies for cancer care. [ABSTRACT FROM AUTHOR]

Context: Frequency of passive decisional control preferences (DCPs) has been variably reported but is generally higher among patients living in developing countries.Objectives: This prospective cross-sectional study aimed to determine the frequency of passive DCP among patients with advanced cancer in a tertiary cancer center in India and to identify its association with their sociodemographic and clinical characteristics.Methods: Patients with advanced cancer referred to palliative care (between March and August 2016) underwent assessment of DCP using validated tools including Control Preference Scale, Satisfaction with Decision Scale, and understanding of illness questionnaire. Information regarding patient characteristics including age, gender, education, marital status, employment, Karnofsky Performance Status Scale (KPS), cancer stage and type, and religion were also collected. Descriptive statistics and logistic regression analyses were performed.Results: Median age 48 years, Karnofsky 90, and 55.3% were men. Shared, active (patient prefers to make decision by his or her own), and passive DCP were 20.7%, 26.7%, and 52.7%, respectively (n = 150). A total of 51.3% were satisfied by the way the actual decisions were made. Passive DCP did not vary across regions. Multivariate analysis shows that the active DCP was significantly associated with better KPS (exp B 1.07 [1.01-1.15], P = .03).Conclusions: There are significant differences in DCP with KPS. Patients report a high level of satisfaction with their treatment decision-making process, though they have a poor understanding of their prognosis and goals of care and understand their treatment to be of curative intent. Individualized understanding of DCP and focus on illness understanding may be important for quality care and patient satisfaction outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the association between commonly measured serum biomarkers of inflammation and penile and testicular cancer risk in the Swedish Apolipoprotein-related MORtality RISk (AMORIS) study. Materials and methods: A total of 205,717 subjects had baseline measurements of C-reactive protein, albumin, and haptoglobin. The association between quartiles and dichotomised values of inflammatory markers and penile and testicular cancer risk were analysed by using multivariate Cox proportional hazard models. Results: A total of 125 men were diagnosed with testicular cancer and 50 with penile cancer during a mean follow-up of 20.3 years. No statistically significant trends were seen between serum inflammatory markers and risk of penile cancer, but higher albumin levels increased the risk of testicular cancer [HR for albumin (g/L): 1.10 (95% CI: 1.03-1.18)]. However, this trend was not observed when using medical cut-offs of albumin. Conclusions: In the present study, we did not find support for an association between commonly used markers of inflammation and risk of testicular or penile cancer. The role of inflammation may be more complicated and require assessment of more specialised measurements of inflammation in future studies. [ABSTRACT FROM AUTHOR]

BackgroundFatigue is one of the most common symptoms found in patients with advanced cancer. There is interplay between fatigue and other symptoms. AimTo examine the factors associated with fatigue in patients with advanced cancer and the impact of symptom control on improvement in fatigue. DesignProspective observational study. Patients were assessed for symptom burden using the Edmonton Symptom Assessment Scale (ESAS). All the study patients received standard palliative care. They were followed up 15–30 days after the first consult. Analysis of the results was performed using descriptive statistics, correlation, multiple linear regressions and logistic regression of fatigue with other variables. CTRI registration number REF/2014/02/006537. Setting/participantsPalliative Care clinic of a tertiary cancer care hospital, from January to June 2014. Patients had advanced cancer, were registered with the clinic, had ECOG ≤ 3, and ESAS fatigue score ≥ 1. Results500 subjects enrolled at baseline. 402 completed the planned follow-up (median age, 52 years; 51.6% male). Significant improvement in the fatigue score was observed (p < 0.001) at follow-up. Haemoglobin, albumin levels, type of cancer, sites of metastasis, ECOG score, body weight, all items on ESAS scale (except drowsiness) were found to be significantly associated with fatigue at baseline (p < 0.05). The logistic regression model showed that improvement in haemoglobin and albumin levels and in severity of pain and dyspnoea, significantly improved fatigue scores at follow up. ConclusionsFatigue improved with the standard palliative care delivered at our specialty Palliative Care clinic. Certain clinical, biochemical factors and symptoms were associated with fatigue severity at baseline, improvement of which lead to lesser fatigue at follow up. [ABSTRACT FROM AUTHOR]