Indian Journal of Palliative Care
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   Table of Contents - Current issue
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January-March 2020
Volume 26 | Issue 1
Page Nos. 1-153

Online since Tuesday, January 28, 2020

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EDITORIAL  

Need for palliative care education in India: Can online palliative care education bridge these needs? Highly accessed article p. 1
Naveen Salins
DOI:10.4103/IJPC.IJPC_7_20  
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ORIGINAL ARTICLES Top

A randomized placebo-controlled trial evaluating the analgesic effect of salmon calcitonin in refractory bone metastasis pain Highly accessed article p. 4
Parmanand N Jain, Aparna Chatterjee
DOI:10.4103/IJPC.IJPC_167_19  
Injection calcitonin is a natural hormone inhibiting osteoclastic bone resorption have been used as an analgesic to control bone metastasis pain or pain due to osteoporosis or fracture. This randomized double blind placebo controlled trial was undertaken to determine the role of injection Salmon Calcitonin therapy to control refractory pain caused due to bone metastasis arising from cancer breast, lung, prostate or kidney. All patients had received palliative radiotherapy and were suffering unsatisfactory pain relief on NSAIDs and tab morphine. Fourteen days inj. calcitonin or placebo injections were administered in 23 patients initially as high dose induction dose (800 IU per day SC) followed 200 IU subcutaneous (SC) once a day. Patients were assessed for pain intensity and quality of life on EORTC QLQ-30 questionnaire 6 hourly for 2 days and on 7th and 30th day. Any incidence of hypercalcemia, bone fracture, nerve root and bone marrow compression were also noted. This study found a significant reduction in pain after SC calcitonin injection therapy at 14 and 30 days' assessment. No patients in the study group required rescue analgesia after 18 hrs. There was a statistically significant difference in rescue analgesics required between the groups during two days hospitalization. Global health as well as physical and social wellbeing was better at 30 and 90 days in the study group as compared to control group, however it could not reach a statistical significance which may be attributed to the small sample size of the study.
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Quality of sleep in patients with cancer: A cross-sectional observational study p. 9
Ananth Pai, B Sivanandh, Karthik Udupa
DOI:10.4103/IJPC.IJPC_164_19  
Background: Insomnia and poor sleep quality are common problems in patients with cancer. It interferes with the coping ability, symptoms, and treatment outcomes. The Pittsburgh Sleep Quality Index (PSQI) is a reliable, valid instrument to assess the quality of sleep in patients with cancer. Patients and Methods: The study was conducted at the department of medical oncology of a tertiary cancer care center. Consecutive eligible participants were recruited and evaluated for sleep quality using PSQI questionnaire. The questionnaire was administered only once with the questions evaluating to the quality of sleep over the last 1 month. A PSQI total score of ≤5 was suggestive of good quality of sleep and a score of >5 was indicative of poor quality of sleep. Results: Ninety-two consecutive consenting cancer patients admitted for chemotherapy participated in the study. Thirty-one (33.7%) patients had early cancer and 35 (38%) patients had Stage IV metastatic disease. Thirty-six (39.1%) patients reported sleep of <6 h and 30 (32.6%) patients had impaired functioning during day due to sleepiness. Fifty-three (57.6%) patients had poor total PSQI score, of which 39 (73.5%) were female and 14 (26.5%) were male. The study showed no correlation of the PSQI scores with the stage of the disease, and the prior treatment received. Conclusions: The study showed that Indian cancer patients have short sleep duration and poor quality of sleep. A higher prevalence of sleep disturbances was seen among female cancer patients. PSQI questionnaire can be a cost-effective way of screening cancer patients for poor quality of sleep.
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Prescription pattern of drugs used for neuropathic pain and adherence to NeuPSIG guidelines in cancer p. 13
Vishal K Singh, Yashashri C Shetty, Naveen Salins, Parmanand Jain
DOI:10.4103/IJPC.IJPC_172_19  
Objective: The objective of the present research was to evaluate the prescription pattern of the drugs used in the pharmacological treatment of cancer-related neuropathic pain (CRNP) and to assess the adherence of the physicians to the Neuropathic Pain Special Interest Group (NeuPSIG) Guidelines. Materials and Methods: This was a cross-sectional, observational study where patients who presented to the pain and palliative care outpatient clinic of the tertiary care hospital with CRNP were prospectively recruited. Participants were screened for neuropathic pain using DN4 questionnaire. Demographic details, diagnosis, medication details, and adherence to NeuPSIG guidelines were assessed using a validated questionnaire. Results: Of 300 patients screened, 64% were male and 36% were female, with a mean age of 48.26 ± 13.05 years. The predominant symptoms found were pin-and-needle sensation (99%) followed by tingling sensation (98.66%). The most common diagnosis was head-and-neck cancers (37.3%) followed by bone cancers (17.3%) and lung cancers (15.3%). Among the first-line drugs recommended in NeuPSIG for CRNP, pregabalin (78.7%) was the most common drug prescribed followed by amitriptyline (67%). The most common co-prescribed drugs were acid suppressants drugs (50.7%). Tapentadol, which is not part of the NeuPSIG guidelines, was prescribed on 51 occasions for neuropathic pain. Underdosing was observed in 272 prescriptions. Only 12 prescriptions completely adhered, while 275 had partial, and 13 prescriptions had poor adherence to NeuPSIG guidelines. Conclusion: The most commonly used drugs in the treatment of CRNP were pregabalin and amitriptyline. Most physician partially or did not adhere to the NeuPSIG guideline in the management of CRNP.
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HealthCare-Related Quality of Life and Lived Existential Experiences among Young Adults Diagnosed with Cancer: A Mixed-Method Study p. 19
C Vasantha Kalyani, Suresh K Sharma, K Kusum, KJ Lijumol
DOI:10.4103/IJPC.IJPC_207_18  
Background: As cancer is a noncommunicable disease and it is a major global burden in terms of finances. It is also affecting quality of life of a person completely. Aim: The aim of the present study was to identify the effect of cancer on quality of life of an individual as a whole. Methods: The present study was triangulation study, and we examined 30 young adult cancer patients of age group 20–44 years who were admitted in different oncological units of our hospital in 2018. We included all their case datasheets for identifying clinical variables. Data collection tools used were the European organization for research and treatment for cancer quality of life questionnaire (version 3-Hindi). Qualitative data were collected using open-ended questionnaire regarding young adult cancer patient's experiences, feelings, and difficulties faced during cancer diagnosis and treatment. Results: Results concluded that young adult cancer patient's global health status score were average. Their physical function as well as social function score depicted that both were affected significantly, whereas cognitive functions were not affected anymore. Most commonly symptoms faced by young adult's cancer patients were pain, insomnia, fatigue, nausea, vomiting, and appetite loss. Financial burden was major burden faced by patient as well as caregiver during the diagnosis and treatment of cancer. From qualitative data of the study, it was concluded that when patient were first told about cancer diagnosis first, they feel sad. Their primary relatives were first informed about their diagnosis. Most of patient's cancer were diagnosed in first stage. Cancer had affected patient's personal as well as social life completely. Nobody helps them during the diagnosis and treatment of their disease. Majority of cancer treatment options were chemotherapy, radiation therapy, and surgery and majority of them were getting chemotherapy from AIIMS, Rishikesh. The most common difficulty the patient's faced during the diagnosis of cancer was financial. Patient's opinion for cancer and its treatment were that everybody who had any symptoms of cancer they should immediately come to hospital for treatment. When we asked them about effect of cancer as a whole their responses were disturbed family role, disturbed attachment with family and friends, disturbed social role, financial burden as well as disturbed education, respectively. Conclusion: From this study, we concluded that quality of life of young adult cancer patients were affected badly in terms of physical, social, symptomatically, and financially. It may also help to plan ahead by patients as well as health professionals to improve the patient's quality of life.
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A study on the motivations of Korean hospice volunteers p. 24
Young Ran Yeun
DOI:10.4103/IJPC.IJPC_136_19  
Aim: Volunteers play a key role in hospice and palliative service. This study was performed to investigate the motivations of Korean hospice volunteers and to identify the predictors that affect their service period. Materials and Methods: The accomplished questionnaire sheets of 93 subjects were included in the analysis. Inventory of Motivations for Hospice Palliative Care Volunteerism to measure the motivations of the hospice volunteers was used. The collected data were subjected to a statistical analysis of the mean and standard deviation, a t-test, and multinomial logistic regression analysis. Results: The motivation score of the hospice volunteers in South Korea is 75.57 ± 10.97, and the top three in the motivation list were altruism, civic responsibility, and self-promotion. Among the subdomains, altruism, 1–4-year working experience (B = 0.79, standard error (SE) = 0.26, P = 0.002, Exp (B) =0.45), and more than 10-year working experience (B = 1.00, SE = 0.30, P = 0.001, Exp (B) =0.36) had statistically significant influences. Conclusions: The finding of this study can be used as basic information for the recruitment and management of hospice volunteers in South Korea.
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Disclosure deficit experienced by people living with HIV/AIDS in Alice and Its environs in Eastern Cape Province,South Africa: Perceptions of selected stakeholders p. 28
Simon Murote Kang'ethe
DOI:10.4103/IJPC.IJPC_137_19  
Aim: This article investigated the underpinnings of low HIV disclosure among people living with HIV/AIDS (PLWHA) in Alice town and its environs in South Africa. Methods: This article adopted qualitative methodologies of interviews and focus groups involving 38 selected stakeholders to tap their insights and perceptions on the position of disclosure rate in Alice town and its environs. Results: The findings indicated that disclosure rate was confounded by state of immense stigma; state of conflict faced by the PLWHA from their kins and community; PLWHA fearing job victimization; and lack of adequate psychosocial supportConclusions: The article recommends that the disclosure process takes place amid an environment of equilibrium between the PLWHA's intrinsic and extrinsic motivation, as well as when environment promises adequate psychosocial support. Moreover, the role of the members of social service profession is critical in advocating and preparing PLWHA for disclosure, as well as putting a conducive environment to allow disclosure.
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Translation, cultural, and age-related adaptation and psychometric properties of Persian version of “Quality of Dying and Death” in nurses working in neonatal intensive care units p. 34
Mahsa Moslemi, Lida Nikfarid, Manijeh Nourian, Maliheh Nasiri, Ferershteh Rezayi
DOI:10.4103/IJPC.IJPC_119_19  
Background: Death and dying care is an area with less attention in nursing. This even is evidenced as more challenging in some populations such as neonates. Neonatal intensive care unit (NICU) nurses should be aware of the quality of care they provide for dying neonates and their families to find the areas which need attention. Objective: The aim of this study was to assess the psychometric features of the Quality of Dying and Death (QODD) questionnaire in NICU nurses in Tehran, the capital city of Iran. Methods: This methodological study was conducted in 2017. For this purpose, using census method, 130 NICU nurses working in selected hospitals participated. After the backward–forward translation, based on the method proposed by the International Test Commission, the psychometric properties of the Persian QODD were examined through the assessment of the face, content and construct validity, internal consistency, and stability. Results: Final Persian QODD's content and face validity were accepted through a qualitative method. In the confirmatory factor analysis, the original version of QODD was not confirmed. Subsequently, an exploratory factor analysis was carried out in which phrases were included in three dimensions (symptom control, preparation for death of neonate, and professional attention) that explained 75% of the variance. Cronbach's alpha values ranged from 0.82 to 0.88 for these three dimensions. The intraclass correlation coefficient (ICC) was ICC = 0.94 between two tests performed with a 2-week interval on twenty eligible nurses. Conclusions: The Persian version of QODD has acceptable psychometric properties in nurses working with the neonatal population and can be used to investigate the NICU nurses' opinion on the QODD provided in NICU patients.
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COMMENTARY Top

Adapting and using the quality of dying and death questionnaire p. 39
Arunangshu Ghoshal
DOI:10.4103/IJPC.IJPC_170_19  
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ORIGINAL ARTICLES Top

Assessment of distress among patients and primary caregivers: Findings from a chemotherapy outpatient unit p. 42
Anantharaman Rajeshwari, Rajagopal Revathi, Narayanan Prasad, Normen Michelle
DOI:10.4103/IJPC.IJPC_163_19  
Background: Chemotherapy is one of the treatment modalities for cancer. The side effects of treatment, at times, can affect the emotional well-being of patients and their caregivers, thereby leading to distress. This paper aims at screening and identifying levels of distress among patients undergoing chemotherapy and their caregivers. Subjects and Methods: A cross-sectional study design was used. Patients (n = 102) undergoing chemotherapy in the outpatient daycare unit and their caregivers (n = 101) were screened for distress using the National Comprehensive Cancer Network distress thermometer and the problem checklist. Data were analyzed using descriptive and inferential statistics. Results: Patients (53.4%) and their caregivers (22.2%) reported experiencing moderate-to-severe levels of distress. Patients reported significant distress in the areas of physical (P = 0.000) and emotional problems, whereas caregivers reported distress in the areas of family (P = 0.000) and emotional problems. There was no significant difference in emotional problems (P ≥ 0.05) between the patients and their caregivers. There was a positive correlation between physical and emotional problems (r = 0.760, P = 0.000). Majority of patients (85.2%) and caregivers (80.1%) showed interest to avail psycho-oncology services. Conclusions: Distress is prevalent among patients with cancer undergoing chemotherapy and their caregivers. Clinical implications highlight the need to identify and address caregiver distress during routine distress screening for patients using specific psychosocial interventions. Future research warrants the use of administering specific assessments to identify severe psychological issues, such as depression and anxiety for patients reporting severe levels of distress on the screening tool.
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Assessment of quality of life among end-stage renal disease patients undergoing maintenance hemodialysis p. 47
Ashima Ravindran, Anjali Sunny, Rajesh Penganazhi Kunnath, Binoo Divakaran
DOI:10.4103/IJPC.IJPC_141_19  
Background: Renal failure is a chronic disease that can seriously affect quality of life (QOL). Health-Related QOL represents the physical, psychological, and social domains of health that are influenced by a person's experience, beliefs, expectations, and perceptions. The aim of this study is to explore QOL of Stage 5 chronic kidney disease (CKD) patients on maintenance hemodialysis (MHD) in South India. Materials and Methods: This was a cross-sectional observational study conducted among patients with CKD undergoing MHD at 11 major centers in South India. Demographic data were collected using a predesigned questionnaire. QOL index was measured using the 26-item WHOQOL-BREF questionnaire, and statistical analysis was carried out using the SPSS version 24 (Academy of Medical Sciences, Kannur, Kerala, India). Results: Five hundred and three patients undergoing MHD were enrolled, and the following QOL scores were recorded: social relationship (51.65 ± 21.03), environmental (46.91 ± 19.29), psychological (41.07 ± 20.30), and physical health (40.17 ± 17.05). QOL of patients declined with aging in all four domains. Being male, younger, educated, and unmarried appeared to have a favorable effect on several aspects of patients' QOL. Conclusion: The evaluation of QOL in CKD patients undergoing hemodialysis showed that it was relatively compromised. Because the patients had a chronic, progressive irreversible disease, the most affected was physical domain. Age, education, employment, and marital status were found to affect one or more domains of QOL. Age and education are significant independent variables; as the age increases, QOL decreases, and higher the education better the QOL.
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Quality of life, anxiety, and depression in the head-and-neck cancer patients, undergoing intensity-modulated radiotherapy treatment p. 54
Maria Nikoloudi, Ioannis Lymvaios, Anna Zygogianni, Efi Parpa, Dimitra-Aspasia Strikou, Eleni Tsilika, Vassilios Kouloulias, Kyriaki Mystakidou
DOI:10.4103/IJPC.IJPC_168_19  
Aims: The aim of this study is to investigate and compare distress and quality-of-life parameters among head-and-neck cancer patients who underwent intensity-modulated radiotherapy (IMRT). Subjects and Methods: The patients' sample consists of 55 individuals under IMRT treatment. Three questionnaires (Quality of Life Questionnaire [QLQ]-C30 and QLQ-H and N35) of the European Organization for the Research and Treatment of Cancer and the Greek Hospital Anxiety and Depression Scales were used. Results: Functioning and symptoms scales measured a week before the scheduled treatment worsen significantly until the end of the treatment and at the 3-month follow-up, tend to revert to their pretreatment values. Conclusions: Our results showed that all parameters (functioning scales, symptoms scales, and G-HAD subscales) worsen from the start to the end treatment and tend to revert to their pretreatment values after a 3-month period.
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Lived experience of spouses of persons with motor neuron disease: Preliminary findings through interpretative phenomenological analysis p. 60
Manjusha G Warrier, Arun Sadasivan, Kiran Polavarapu, Veeramani Preethish Kumar, Niranjan Prakash Mahajan, Chevula Pradeep Chandra Reddy, Seena Vengalil, Saraswati Nashi, Atchayaram Nalini, Priya Treesa Thomas
DOI:10.4103/IJPC.IJPC_123_19  
Introduction: Motor neuron disease (MND) is a progressive neuromuscular disorder that can have significant and debilitating impact on the affected patient and families. Spouses are the primary carers for persons with MND in India, and the life of the person with MND and their spouse is never the same after the diagnosis. Aim: The objective was to explore the lived experience of spouses of persons diagnosed with MND. Methods: A qualitative exploratory study with three-point interviews was conducted with spouse caregivers of two persons diagnosed with MND who were receiving treatment from a national tertiary referral care center for neurological disorders. All the patients were diagnosed as definite MND according to the modified El Escorial criteria. With the spouses, in-depth interviews were conducted at their home, lasting on an average of 1 hour using a semi-structured interview guide (prompts). Interpretative phenomenological analysis was used to derive themes from the interviews. Results: The major themes emerged from the analysis were meaning of MND which contained the subthemes of delay in diagnosis and deterioration, psychological response across illness trajectory, relationship with the subthemes of changing roles in being acarer, marital relationship, to be seen as doingright,“ and communication; adaptation with the subthemes of coping strategies and support system and life without the loved one. Conclusion: The changes in the lives of spouses and in strategies for caring the partner with deterioration of symptoms in the illness trajectory are explained in this study. The palliative approach in the management of MND has to take into account, the experiences and needs of carers since care happens at home.
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Factors influencing the initiation of strong opioids in cancer patients on palliative care: An audit from a tertiary cancer center in India p. 66
Ankita Gupta, Bhushan Parmar, Minni Hurria Arora, Raviteja Miriyala, Neeru Anand, Sushmita Ghoshal
DOI:10.4103/IJPC.IJPC_89_19  
Aim: This audit was done to analyze the factors influencing the use of strong opioids in cancer patients receiving comprehensive palliative care from a tertiary institute. Materials and Methods: Case records of patients registered for palliative care at our center in 3 months were retrospectively reviewed and followed up throughout the course of their illness. Demographic factors, prior treatments, social support system, analgesic use at registration, and use of radiation and adjuvant analgesics were recorded. Strong opioid use and their time of initiation were evaluated, and multivariate analysis was used to identify the factors correlating with the above. Results: After registration, strong opioids were initiated in 16% of the patients. It was observed that patients younger than 55 years and those with visceral metastases and history of use of weak opioids at the time of registration had a higher probability of being started on strong opioids. Factors associated with a significantly longer strong opioid-free interval were having spouse as primary caregiver, presence of skeletal metastases, use of palliative radiotherapy, and low socioeconomic status. Conclusion: It is certain that the use of strong opioids for adequate analgesia is a necessity for palliative-care patients. However, optimal utilization of adjunctive analgesic modalities, coupled with good supportive care, can minimize the requirement and duration of strong opioid use, especially in developing countries with limited access to specialist palliative care.
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COMMENTARY Top

Judicious usage of who step III opioids in palliative care in India p. 70
Arunangshu Ghoshal
DOI:10.4103/IJPC.IJPC_158_19  
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ORIGINAL ARTICLES Top

How cancer supportive and palliative care is developed: Comparing the policy-making process in three countries from three continents p. 72
Mahtab Alikhani, Soudabeh Vatankhah, Hasan Abolghasem Gorji, Hamid Ravaghi
DOI:10.4103/IJPC.IJPC_55_19  
Background: Supportive and palliative care worldwide is recognized as one of the six main cancer control bases and plays an important role in managing the complications of cancer. Limited studies have been published in the field of this policy analysis in the world. Aim: This study aimed to analysis the policy-making process of supportive and palliative cancer care in three countries. Methodology: This qualitative study is a part of a comparative study. The data were collected through reviewing scientific and administrative documents, the World Health Organization website and reports, government websites, and other authoritative websites. Searches were done through texts in English and valid databases, in the period between 2000 and 2018. To investigate the policy process, heuristic stages model is implemented consisting of the four stages: agenda setting, policy formulation, policy implementation, and policy evaluation. Results: The findings of the study were categorized based on the conceptual model used in four areas related to the policy process, including agenda setting, policy formulation, policy implementation, and evaluation of cancer palliative care policies. Conclusion: Several factors are involved in how cancer palliative care policy is included in policy-makers' agenda, understanding a necessity, raising public awareness, and acceptance as a result of sensing the physical and nonphysical care outcomes. The stages of development, implementation, and evaluation of palliative care in countries regardless of existing differences are a function of the health system and context of each country.
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An autopsy of palliative health hazards associated with the contemporary traditional male circumcision rite: The case of 2016 Alice study p. 80
Aphiwe Mpateni, Simon Murote Kang'ethe
DOI:10.4103/IJPC.IJPC_177_19  
Aim: This article examined the health hazards associated with the contemporary traditional circumcision rite in Alice, Eastern Cape, South Africa. Methods: The study from which this article was extracted was explorative, descriptive, and employed a qualitative method. The study took use of one-on-one interviews, with the use of interview guide as an instrument to ease focus group discussions and interviews. Data were then analyzed thematically. Results: The findings brought the following factors; hospitalization of initiates; contraction of diseases; amputation of manhood organs; and maltreatment leading to health hazards. Conclusions: This article then recommended that, government, cultural custodians, and parents are requested to work hand in hand to curb all these health hazards associated with the contemporary rite.
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Emotional bond: The nature of relationship in palliative care for cancer patients p. 86
Mir Hossein Aghaei, Zohreh Vanaki, Eesa Mohammadi
DOI:10.4103/IJPC.IJPC_181_19  
Aim: Relationship between care providers and cancer patients is one of the main elements in providing healthcare to these patients. Understanding the characteristics and the nature of the relationship is a basis for further organization of palliative care and will enhance the performance of care providers. The purpose of this study was to investigate the nature of the relationship in palliative care for cancer patients. Methods: In this qualitative study, 16 participants with rich experiences in the field of cancer patient's palliative care were selected by purposive sampling. A semi-structured face-to-face interview was conducted with each of the participants. After data collection, all interviews were transcribed and reviewed, and then primary codes, sub-categories, and categories were extracted. Results: Data analysis emerged three categories; being alongside the patient, establishing and maintaining cordiality relationship, and mutual understanding with the patient. Moreover, an emotional bonding was the main theme that defined the nature of relationship between the care provider team and cancer patients in a palliative care approach. Conclusion: Effective relationship based on emotional bonding is the foundation of palliative care in cancer patients. Considering the structures and palliative care settings in health systems, it is possible to provide training programs regarding the strategies related to establishing emotional bond for effective delivery of palliative care.
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REVIEW ARTICLES Top

The effect of complementary and alternative medicines on quality of life in patients with breast cancer: A systematic review p. 95
Nahid Dehghan Nayeri, Fatemeh Bakhshi, Afifeh Khosravi, Zahra Najafi
DOI:10.4103/IJPC.IJPC_183_19  
Background: Breast cancer disease and its classic treatment lead to decrease in patients' quality of life (QOL). This systematic review aimed to compare the effectiveness of complementary and alternative medicines (CAMs) categories on the QOL of women with breast cancer. Methods: English clinical trials from PubMed, Emabase, Scupos, and Google Scholar databases were searched electronically by the end of 2018 with the Cochrane Collaboration protocol. Two researchers independently extracted data such as participants' characteristics, CAM methods, QOL assessment tools. CAMs were classified into three categories of dietary supplements, herbal medicine, and mind-body techniques. Results: During the initial search, 1186 articles were found. After reviewing titles, abstracts, and full texts based on inclusion and exclusion criteria, 28 clinical trials were included in the systematic review, 18 of which was randomized controlled trial (RCT). Participants included women with breast cancer who were undergoing the first three phases of breast cancer or postcancer rehabilitation. Among CAM interventions, one article used a dietary supplement, and the other 27 articles included a variety of mind-body techniques. Twenty-seven studies showed improved QOL (P > 0.05). Conclusion: The findings may indicate the potential benefits of CAMs, especially mind-body techniques on QOL in breast cancer patients. Further RCTs or long-term follow-up studies are recommended. Moreover, the use of similar QOL assessment tools allows for more meta-analysis and generalizability of results, especially for the development of clinical guidelines.
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Pedometer-based exercise interventions for patients with breast cancer receiving chemotherapy – A systematic review p. 105
Stephen Rajan Samuel, Aagna R Gandhi, K Vijaya Kumar, P U Prakash Saxena
DOI:10.4103/IJPC.IJPC_175_19  
Background: Exercises such as walking are prescribed for the patients with breast cancer receiving chemotherapy, but only a few studies include pedometers in conjunction with the routine exercises prescribed. Thus, the aim was to find if the adherence and performance of exercise is improved or has no impact if coupled with the physical activity monitors. Methods: A systematic search using the keywords was conducted in PubMed Central, CINAHL, Embase, Cochrane Library, and Scopus. The search revealed 275 articles, of which 3 randomized controlled trials were selected for qualitative analysis based on the inclusion and exclusion criteria for the review. Results: The three studies retrieved by the systematic review have used different protocols of pedometer-based walking on patients with breast cancer undergoing chemotherapy and studied the following outcome measures: fatigue, body composition, quality of life, and psychological factors. Conclusion: The evidence obtained from the review suggests that pedometer-based walking programs have a positive impact on cancer-related fatigue and overall quality of life of patients with breast cancer receiving chemotherapy.
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Oral microbiological evidence among palliative patients: An integrated systematic review Highly accessed article p. 110
Jagjit Singh Dhaliwal, Zaidah Rizidah Murang, Divya Thirumalai Rajam Ramasamy, Munikumar Ramasamy Venkatasalu
DOI:10.4103/IJPC.IJPC_178_19  
Life-limiting diseases such as cancers and its related treatments often compromise normal oral microbial flora and predispose a palliative patient to diverse oral infections. Knowledge on microbial flora in the oral cavity of patients with life-limiting diseases is essential to develop treatment options for clinical practitioners. This review aimed to systematically synthesize the published evidence on the oral microbiology of palliative patients. An integrative review was undertaken with defined search strategy from five databases with manual search through key journals and reference list. Studies included were published during the year 2000–2017 focusing on microbiological evidence associated with oral conditions among palliative patients. Candida presence was reported in the oral cavity of terminally ill patients in seven of nine articles, with Candida albicans being the predominant species. The majority of the included studies used oral swabs as a technique for isolation of the organism. This review is first to systematically synthesize the published evidence on the oral microbial flora of palliative patients, taking into account the techniques for identification of the microbiota. Larger multicenter studies may help in developing standardized clinical guidelines for the oral care of these patients.
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Rural elderly and access to palliative care: A public health perspective p. 116
Abhijeet Vasant Jadhav
DOI:10.4103/IJPC.IJPC_162_19  
In near future, the elderly population will increase to a high proportion. This will increase the burden of Age-Related Diseases (ARDs) to a significant level. Most of the ARDs need palliative care (PC) for a fairly long duration. Some statistical extrapolations are discussed to help in identifying this future burden. The existing PC centers are limited in numbers, situated mainly in urban areas, and mostly attached to cancer hospitals. Socioeconomic vulnerabilities of the elderly, especially in rural areas, are high, and access to health is also not optimal. In the coming decades, the number of needy people, as well as the demand for PC, will increase. Existing numbers indicate that exponential increment in quantum and quality of PC services is required to deal with the imminent burden. Specific suggestions are made to use existing public health programs to cater to the rural elderly.
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Beyond numbers – Recent understanding of emotional needs of persons diagnosed with cancer 2007–2018 p. 120
Annie Alexander, K Sreenath, R Srinivasa Murthy
DOI:10.4103/IJPC.IJPC_86_19  
Epidemiology is a vital tool of public health. The usefulness of epidemiology is not only about numbers of persons' ill in the community but also to understand the associations, the presentation, identification of new syndromes, to map the historical trends, and calculate morbid risk. The emotional impact of the diagnosis of cancer is well-recognized. Indian cancer research relating to the psychosocial aspects has been largely limited to counting the numbers with psychiatric syndromes. The review covers 12 years of the Indian research in psycho-oncology to understand the different aspects of epidemiology. During the review period, there are growing number of epidemiological studies (29); psychiatric morbidity ranges from 41.7% to 46%; and prevalence rate ranges from 4.4% to 97.8% for anxiety and 1.2%–89.9% for depression; majority of the studies have used one-stage screening for assessment, which is not the ideal method of identifying mental disorders. The severity of the disorders is presented only in nine studies. Quality of life is the most common associated dimension of the studies. There is the absence of studies of posttraumatic growth, resilience, and spirituality. This review calls for greater rigor in the planning of studies of emotional impact, especially the use of two-stage method, longitudinal studies, studies of different types of cancer and in different stages, include additional measures such as disease burden, coping, resilience, spirituality, and the family/social factors to understand the emotional aspects of living with cancer. There is a need for describing the emotional aspects of living with cancer (lived-in experiences) beyond the clinical syndromes.
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Cannabinoids as an alternative option for conventional analgesics in cancer pain management: A pharmacogenomics perspective p. 129
Anmi Jose, Levin Thomas, Gayathri Baburaj, Murali Munisamy, Mahadev Rao
DOI:10.4103/IJPC.IJPC_155_19  
The global cancer burden is significantly increasing at an alarming rate affecting patients, relatives, communities, and health-care system. Cancer patients require adequate pain relief and palliative care throughout the life course, especially in terminal illness. Although opioid treatment is successful in majority of patients, around 40% do not achieve enough analgesia or are prone to serious side effects and toxicity. The treatment of medical conditions with cannabis and cannabinoid compounds is constantly expanding. This review organizes the current knowledge in the context of SNPs associated with opioids and nonopioids and its clinical consequences in pain management and pharmacogenetic targets of cannabinoids, for use in clinical practice.
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CASE REPORTS Top

Lumbar erector spine plane block for pain management in postherpetic neuralgia in a patient with chronic lymphocytic leukemia p. 134
Abhishek Kumar, Tuhin Mistry, Nishkarsh Gupta, Vinod Kumar, Sushma Bhatnagar
DOI:10.4103/IJPC.IJPC_134_19  
Postherpetic neuralgia (PHN) refers to the chronic neuropathic pain that persists beyond the initial varicella-zoster rash. Patients with chronic lymphocytic leukemia (CLL) are susceptible to infections because of decreased immunity. Various treatment strategies including pharmacological, nonpharmacological, and interventional techniques have been described in the literature. We report the successful management of PHN with lumbar erector spinae plane block in a patient of CLL.
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Prolonged intravenous line access in a terminally ill patient, consequences and suggestions p. 137
Nishant Sahay, Rajnish Kumar
DOI:10.4103/IJPC.IJPC_138_19  
Prolonged and neglected use of an intravenous (IV) line could be limb- and life-threatening. In many terminally sick cancer patients of rural India, pain management is a major concern. It is a very common practice by local practitioners to give IV fluids and pain medications in such patients. Where IV access is difficult, a secure venous cannula is kept in situ for long periods to administer pain medicines and fluids. This article tries to highlight the dangers a neglected IV line poses to limb and life and tries to stress on the importance of a subcutaneous route for pain medication administration in terminally ill palliative patients.
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Ultrasound-guided glossopharyngeal nerve block at pharyngeal wall level in a patient with carcinoma tongue p. 140
Prashant Sirohiya, Vinod Kumar, Pratishtha Yadav, Sachidanand Jee Bharti
DOI:10.4103/IJPC.IJPC_132_19  
Glossopharyngeal nerve (GPN) block is used for pain management in patients' head and neck malignancy. The GPN is a mixed nerve containing both motor and sensory fibers. The usual approaches for GPN blocks are usually topical, intraoral, or peristyloid. Topical anesthesia may be difficult in patients with limited mouth opening or when there is inflammation in the area of interest. Intraoral and peristyloid approaches have risk of inadvertent neurovascular injection. The intraoral technique may lead to long-lasting oropharyngeal discomfort. Hence, GPN block is done at the pharyngeal wall level for pain relief.
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Unfolding role of erector spinae plane block for the management of chronic cancer pain in the palliative care unit p. 142
Prashant Sirohiya, Pratishtha Yadav, Sachidanand Jee Bharati, Bhatnagar Sushma
DOI:10.4103/IJPC.IJPC_188_19  
Pain adversely affects the quality of life in cancer patients. Although conventional oral analgesics and co-analgesics manage 80%–90% of pain, interventional pain management techniques may be useful in the management of cancer pain refractory to opioid analgesia or in patients unable to tolerate systemic opioids. Herein, we report three cases depicting the successful role of erector spinae plane block in our palliative care unit for the management of different chronic cancer pain.
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LETTERS TO EDITOR Top

Early intervention for the management of chronic pain in a patient with recurrent schwannoma foot p. 145
Prashant Sirohiya, Tuhin Mistry, Sapna Singla, Sushma Bhatnagar
DOI:10.4103/IJPC.IJPC_133_19  
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Rising violence against doctors: Can competency-based medical education through its competencies in palliative care offer a solution? p. 146
Sherin Susan Paul, PT Thampi
DOI:10.4103/IJPC.IJPC_131_19  
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Cebranopadol: A first-in-class nociceptin receptor agonist for managing chronic pain p. 147
Abhijit S Nair, Shyam Prasad Mantha, Sai Kaushik Pulipaka, Basanth Kumar Rayani
DOI:10.4103/IJPC.IJPC_117_19  
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Propensity score matching with retrospective and observational data in palliative care p. 149
Abhijit S Nair, Sandeep Diwan
DOI:10.4103/IJPC.IJPC_100_19  
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Quality of life with cancer: Role of physicians for a better well-being p. 150
Ravinder Singh Aujla, Ritika Agarwal
DOI:10.4103/IJPC.IJPC_143_19  
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Commentary to the article entitled “Cancer pain, anxiety and depression in admitted patients in a tertiary care hospital –A prospective observational study” p. 152
Arunangshu Ghoshal
DOI:10.4103/IJPC.IJPC_96_19  
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