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Introduction: Various techniques are available to treat and alleviate pain and other symptoms in liver metastasis (LM) or advanced hepatocellular carcinoma (HCC) patients. One of such technique is the external beam radiotherapy to whole liver. This study aimed to evaluate the feasibility, efficacy, tolerability and patient’s reaction to external beam radiotherapy (EBRT) in palliation of symptoms and quality of life (QoL) LM patients or HCC patients. Material and Method: A total of 50 patient of either liver metastasis or HCC were included and planned on single 8Gy/fraction to whole liver radiotherapy. Ultrasonographic guided marking of liver was done prior to treatment and pretreatment dexamethasone and antiemetic was given. Evaluation was done at 1 week and 1 month after the end of treatment. Results: After the whole liver radiotherapy, significant improvement was reported in the bilirubin level (68%), pain level (75.5%), and nausea (32%). Talking about the quality of life, the radiotherapy was reported to found potentially effective in enhancing the quality of life among the patients. Greatest percentage improvementwas reported for pain (75.6%), Global health status (39.6%), physical functioning (32.4%), rolefunctioning (36%), social functioning (36%) and appetite loss (30.6%). [ABSTRACT FROM AUTHOR]

Background: To achieve sustainable development goal 3.8, countries must prioritise the provision of palliative care. We aimed to estimate the prevalence of palliative care needs in India. Methods: A systematic literature search was conducted in databases of PubMed, Cochrane, Embase, Web of Science, and EBSCO Host. We included community-based studies published in English between inception and April 30, 2023. We excluded hospital-based studies that were conducted solely including diseased patients. Data were extracted independently, and a quality assessment was performed. To estimate the pooled prevalence and 95% confidence intervals (CI), we used the random-effects model. Heterogeneity was assessed using the Q statistic and I2 test. Subgroup analyses were conducted based on the study site, urban--rural distribution, gender, and age groups. Publication bias was evaluated using a funnel plot and Egger test. STATA software was used for data analysis. Results: Out of the 2632 articles identified, 8 cross-sectional studies were included. Using the random-effects model, the pooled estimate of palliative care needs was found to be 6.21/1000 population (95% CI: 2.42--11.64). The southern region showed a prevalence of 10.83/1000 compared to 2.24/1000 in the northern region. Urban areas had a prevalence of 3.34/1000, while rural areas had a prevalence of 7.69/1000. Among females, the prevalence was 9.64/1000, compared to 6.77/1000 among males. Notably, individuals aged over 60 years had a higher prevalence of palliative care needs, with a rate of 37.86/1000 population. Conclusion: This systematic review and meta-analysis highlight a substantial need for palliative care in India, with a prevalence of 6.21 individuals/1000 population. [ABSTRACT FROM AUTHOR]

Introduction: Palliative care (PC) has been classically synonymous with end-of-life care offered to patients with advanced incurable cancers with an aim to improve their quality-of-life (QoL). However, there is growing evidence to suggest that early integration of PC (EIPC) along with cancer-directed management improves patient-reported outcomes. In this study, we aim to evaluate the impact of EIPC on QoL of cervical cancer patients treated with curative intent. Material and Methods: Patients with locally advanced cervical cancer (stage IB2 to IIIB) having eastern cooperative oncology group (ECOG) performance score 0–2 were randomized into EIPC arm and standard of care arm of concurrent chemoradiation by a computer-generated table of random numbers. QoL was assessed by functional assessment of cancer therapy – general (FACT-G) questionnaire twice in both arms. The first assessment was done prior to starting treatment and second assessment at three months after treatment completion. The mean scores on physical, mental, emotional, social, and functional well-being subscales of FACT-G scale were calculated in both arms, and Wilcoxon test was used to evaluate differences in QoL scores within and in between the arms. This trial was registered with Clinical Trials Registry of India (CTRI) vide CTRI/2017/05/008704. Results: Fifty patients were enrolled in each arm. However, only 42 and 45 patients in EPIC and standard oncological care arm were evaluated in the final analysis. Comparing QoL scores between the two time points in each arm, the mean pre-treatment scores in EIPC arm was significantly higher than post-treatment scores in the domains of physical and emotional well-being, whereas social and functional well-being scores improved significantly after treatment as compared with that as baseline. However, when compared between two arms, the difference of mean scores pre- and post-treatment were almost similar for physical and functional well-being but statistically significant differences were found only in social and emotional well-being scales. Conclusions: Our study is a feasibility study done in an attempt to test the validity of EIPC in cervical cancers. The results are inspiring to conduct robust studies in the future to explore this new domain of integration of palliative services in curable cancers. [ABSTRACT FROM AUTHOR]

Background and Aims: Endoscopic insertion of self-expandable metallic stent (SEMS) is now accepted as first line modality of treatment for palliation in un-resectable extra-hepatic biliary obstructive jaundice. This study was done to assess the clinical efficacy and duration of patency of endoscopically inserted metallic stent in un-resectable malignant biliary obstruction. Materials and Methods: Between 2015 to 2017, 101 patients who underwent ERCP and SEMS placement for palliation of malignant biliary obstruction were included prospectively. Main outcome measures were technical success, clinical success, mean duration of SEMS patency, clinical efficacy,rate of biliary re-intervention and survival of patients. Results: Overall technical success and clinical success was achieved in 93% and 82.2% respectively. Mean duration of SEMS patency was 109 days. Analysis in subgroup of patients classified according to site of obstruction (Hilar -68, Distal CBD-33) showed that median duration of stent patency was significantly better in distal biliary stricture (135 days vs 95 days), whereas re-intervention rates were higher in higher biliary stricture than distal stricture (41% Vs 6%). Seven patients with hilar biliary stricture suffered post-SEMS insertion cholangitis. Conclusion: SEMS placement is feasible palliative method for un-resectable malignant biliary obstruction with acceptable technical and clinical success. The duration of SEMS patency and clinical efficacy is significantly better in distal biliary stricture whereas re-intervention rate is higher in hilar biliary stricture. [ABSTRACT FROM AUTHOR]

Context: In India, a considerable proportion of patients with head and neck cancer present with locoregionally advanced disease. Symptom palliation becomes a major objective in these cases when they could not be considered for a curative approach. Aims: The aim of this study is to assess the role of palliative radiotherapy for symptom control in patients with locally advanced head and neck cancer. Settings and Design: This was a retrospective study. Subjects and Methods: Between July 2015 and June 2016, 98 patients with stage IV head and neck cancer were treated with palliative radiotherapy 25 Gray (Gy)/4 fractions (fr)/1 fraction (6.25 Gy)/week. Presenting symptoms were noted. The primary end point was relief of symptoms in the 4th week after radiotherapy. Percentage symptom relief was quantified by the patient using a rupee scale. Treatment response was noted using the WHO criteria. Acute toxicity was graded as per the Radiation Therapy Oncology Group (RTOG) criteria. Results: The most common presenting symptom was pain. At 4 weeks after radiotherapy completion, all patients had >50% pain relief. Dysphagia was improved in 82% of patients. Respiratory distress was improved in all the symptomatic patients. Tumor complete response (CR) was seen in 2 patients, partial response in 89, stable disease in 3, and progressive disease in 4. RTOG Grade 2 and 3 acute skin and mucosal toxicities were seen in 29% and 27% cases, respectively. No patient had Grade 4 adverse effect. Conclusions: Hypofractionated radiation could provide effective symptom palliation in advanced head and neck cancers. The weekly schedule was well tolerated and found convenient by the patients. [ABSTRACT FROM AUTHOR]

Background: Majority of patients of lung cancer present with locally advanced or metastatic disease, where systemic therapy is the treatment of choice. Many of these patients have local symptoms due to thoracic disease, wherein radiotherapy is proven to be an effective modality for alleviation of symptoms. However, the optimal dose of radiotherapy for adequate palliation remains debatable. The purpose of this retrospective study was to assess the efficacy of two different schedules of thoracic radiotherapy (TRT) with respect to symptom palliation.Materials and Methods: A total of 100 consecutively treated patients with stages III-IV lung cancer treated with two different fractionation regimens of palliative TRT, either protracted course 20 Gy/5# over 1 week or short course of 17 Gy/2# over 8 days were assessed for symptom relief and survival. Impact of patient, tumor and treatment-related factors on response and overall survival (OS) was done by univariate analysis using log-rank test.Results: Median age of the entire cohort was 60 years, majority being males, smokers with low Eastern Cooperative Oncology Group performance status (performance score ≥2). Predominant symptoms were chest pain (68) followed by cough (21) and dyspnea (15). Palliative TRT was offered as either protracted course 20 Gy/5# over 1 week or short course of 17 Gy/2# over 8 days in 21 and 79 patients respectively. Median duration of symptom relief was 2 months, no differences in OS at 1 year with either regimen.Conclusions: TRT is an effective means of palliation having similar symptom relief and outcomes with weekly (17 Gy/2# over 8 days) or protracted radiotherapy regimens (20 Gy/5#over 1 week). Short TRT schedules are convenient and economical for patients as well as resource sparing for high volume centers. [ABSTRACT FROM AUTHOR]

Background: Home-based palliative services form the cornerstone of Kerala's palliative program. However, two issues need research: (a) whether family-homes can be considered as the locus of ageing and dying for marginal populations who experience deprivation and poverty and (b) whether the present delivery structure meets the needs of elderly population. These issues are examined in the context of two rural areas. The study explores end-of-life characteristics of the elderly - their sociodemographic status and living patterns, morbidity profile, and functional status. It also looks into the accessibility and utilization of palliative services and respondents' satisfaction with different components of the services. Materials and Methods: A descriptive cross-sectional survey design is used. Data were collected based on the interviews of sixty service users sampled randomly from a roster of palliative care services. Semi-structured interviews were substantiated by personal field observations. Results: The study has found people living under extreme financial distress with inadequate shelter and poor social security provisions. The health profile is characterized by high level of functional dependence. Many dependent widowed women were living alone without appropriate care and shelter. The palliative program as perceived by the respondents is characterized by few doctor visitations and poor frequency. Conclusion: The study concludes that home-based palliation in its present form does not promote good end-of-life care. It lacks an integrated approach with good service-mix. It raises serious questions on family-home as the locus of ageing and dying for marginal populations, and suggests need for restructuring of the palliative program. [ABSTRACT FROM AUTHOR]

Introduction: Poor socioeconomic status and illiteracy attribute to the advanced presentation of head and neck cancer (HNC) patients in India and are candidates for palliation in our setup. We set up a palliative cancer care clinic (PCCC), and an audit of initial 153 HNC patients is presented. Aims and Objectives: To assess the impact of palliative cancer care services. Methodology: Data of advanced HNC patients suited for palliation were collected to document demography, symptomatology, cancer treatment, and supportive care. Results: One hundred and fifty-three patients were seen during January 2013 to March 2015 in the PCCC. Seventy-two (47%) referral cases were due to disease progression and 81 (53%) due to "de novo" advanced cases. Median follow-up forthis group was 5.3 months. Ninety (59%) cases needed some degree of assistance for their normal activities. Sixty-seven (44%) patients belonged to poor socioeconomic status and 65 (43%) were educated up to equivalent of high school. One hundred and thirty-five (88%) patients had an adequate family support. Pain was the most common presenting symptom in 134 (87%) cases with adequate relief in 112 (84%) patients with another 13 (09%) could not be assessed. Overall median duration of symptoms was 6 months. Cancer-directed therapy was used in 143 (93%) patients. Near the end of life in 47 (73%) out of 63 documented cases, caregivers were psychologically prepared for the inevitable. Conclusion: The role of palliative care team in alleviating physical, psychosocial, and emotional issues of patient and family members was significant. PCCC seems to be a feasible working model in our setup. [ABSTRACT FROM AUTHOR]

To study the natural course of disease in patients of advanced squamous cell carcinoma of head and neck (SCCHN) admitted in a rural tertiary hospital and to formulate an acceptable protocol of management and their prognosis. A 5-year retrospective analysis of patients of advanced SCCHN attended in the department of Radiotherapy and admitted at department of ENT at B. S. Medical College, Bankura, West Bengal were analyzed for the present study. B. S. Medical College, Bankura at West Bengal, which is a rural medical college and act as tertiary referral, center for three district of West Bengal namely Midnapur, Purulia, Bankura, part of Burdwan and adjoining area of Jharkhand state. We investigated 100 patients in our hospital who presented with advanced and in-operable stage of SCCHN. Biopsy proved cases of SCCHN in stage III, stage IVA and stage IVB which is surgically unresectable and without any past history of radiotherapy and chemotherapy were included in this study. Eighty-nine men and 11 female with advanced SCCHN were included in this study. Their median age was 48 years (36–78 years) with a median weight of 44 kg and median Karnofsky score 70. Different types of palliative surgical intervention like Ryles’ tube insertion (16%), feeding jejunostomy (11%), tracheostomy (60%) and arterial ligation (2%) was done to relieve the symptoms. Forty-three patients received chemoradiation and 22 patients received only radiotherapy. Best supportive care was provided to 35 patients. Twenty-nine percent of patients had partial response in terms of disease control and none had complete response. Symptomatic relief of respiratory obstruction, dysphagia and pain constitute the mainstay of treatment in the present study. A short course of radiotherapy is found to be effective in control of symptoms and helps to improve the quality-of-life. Complete response to therapy in advanced head and neck squamous cell carcinoma with a poor nutritional status is very difficult to achieve. [ABSTRACT FROM AUTHOR]

Squamous cell carcinoma of head and neck (SCCHN) is one of the commonest cancers seen in India, constituting up to 25% of their overall cancer burden. Advanced SCCHN is a bad disease with a poor prognosis and patients usually die of uncontrolled loco-regional disease. Curative intent management of loco-regionally advanced SCCHN has become more evidence-based with active clinical research in the form of large prospective randomized controlled trials and meta-analyses. However, little has been written about palliative radiotherapy (PRT) in head and neck cancers. It is widely recognized that PRT provides effective palliation and improved quality-of-life in advanced incurable malignancies. It is in this context that this study proposes to review the existing literature on palliative radiotherapy in advanced incurable SCCHN to help formulate consensus guidelines and recommendations. [ABSTRACT FROM AUTHOR]

Study Objective: To show the feasibility, technique, and results of laparoscopic anterior exenteration in selected patients., Design: A retrospective cohort study., Setting: Galaxy Care Laparoscopy Institute, Pune, India., Patients: Seventy-four of 85 patients who underwent laparoscopic anterior exenteration for stage IVA carcinoma of the cervix from January 2005 to January 2015 were analyzed; the median follow-up was 30 months. Contrast-enhanced computed tomographic imaging of the abdomen and pelvis was performed for all patients., Interventions: The same surgeon and team performed all the operations for uniformity in 10 operative steps., Measurements and Main Results: The mean operative time was 180 minutes, and the mean blood loss was 160 mL. The mean hospital stay was 6 days. The average number of lymph nodes removed was 21.4. Surgical margins were negative in all patients. Forty-two patients had positive lymph nodes. Chemoradiation was given to those with positive lymph nodes. Perioperative complications occurred in 15 (20.27%) patients including deep vein thrombosis, urinary tract infection, ureterosigmoid leak (n = 2/74), and so on. Positron emission tomographic imaging and computed tomographic scanning were performed at 6 months after surgery and 6 months after adjuvant therapy in those with positive lymph nodes. There was no immediate postoperative mortality. The overall survival rate at 5 years was 25%., Conclusion: Laparoscopic anterior exenteration is feasible in cases of advanced carcinoma of the cervix. Results have shown that in selected patients this procedure is associated with good long-term survival., (Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.)