Indian Journal of Palliative Care
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   2008| July-December  | Volume 14 | Issue 2  
    Online since February 11, 2009

 
 
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ORIGINAL ARTICLES
Attitudes towards euthanasia and physician-assisted suicide among Pakistani and Indian doctors: A survey
Syed Qamar Abbas, Zafar Abbas, Stanley Macaden
July-December 2008, 14(2):71-74
DOI:10.4103/0973-1075.45448  
Aim: This study attempts to assess the attitude of Pakistani and Indian doctors to euthanasia and physician-assisted suicide. Methods: We used a questionnaire survey that included one case history of a patient with cancer and another of one suffering from motor neurone disease (MND). Results: Fifty-two of 100 doctors from Pakistan returned the completed questionnaires. Eight of the 52 (15.3%) doctors agreed with the concept of euthanasia being an acceptable option for the patient with MND. Six of the 52 (11.5%) supported a similar approach for the cancer patient. From India, 60/100 doctors returned the completed questionnaires. Sixteen of the 60 (26.6%) doctors supported euthanasia as an option for the patient with MND whereas 15 (25%) supported a similar option for the cancer patient. Conclusion: We conclude that only a minority of the doctors support euthanasia. This group belongs to a younger age group. In Pakistan, they were more likely to be males. The religion of the doctors did not appear to be a determining factor.
  7,615 331 8
Mind over matter: A qualitative examination of the coping resources used by women with cancer
Margaret A Schneider, Paula C Fletcher, Hannah Snider
July-December 2008, 14(2):56-70
DOI:10.4103/0973-1075.45447  
Aim: This exploratory study investigates the coping resources used by six women diagnosed with cancer. Objective: The purpose of this study was to provide these women with the opportunity to discuss their cancer experiences along with the specific coping methods they found to be helpful throughout their journey. Methods: The participants, ranging in age from 25 to 63, completed a background questionnaire, followed by either a semi-structured interview (n=3) or an interview via written response (n=3). Results: Several key coping methods were described as being helpful to these women, and these methods fell into three major categories: intrapersonal, interpersonal, and extrapersonal coping resources. Although each of these resource categories had a direct influence on overall well-being itself, the interpersonal and extrapersonal resources also influenced the intrapersonal category, offering an alternate means by which they could influence overall well-being. These findings highlight the many coping resources used by these women when navigating their cancer journey.
  3,321 287 2
Palliative care in advanced cancer patients in a tertiary care hospital in Uttarakhand
Manisha Bisht, SS Bist, DC Dhasmana, Sunil Saini
July-December 2008, 14(2):75-79
DOI:10.4103/0973-1075.45449  
Aim: Advanced cancer, irrespective of the site of the cancer, is characterized by a number of associated symptoms that impair the quality of life of patients. The management of these symptoms guides palliative care. The present study aims to describe the symptoms and appropriate palliation provided in patients with advanced cancer in a tertiary care hospital in Uttarakhand. Methods: This was an observational study. A total of 100 patients with advanced cancer were included in the study. The data obtained from the patients included symptoms reported by the patients, currently prescribed treatments and the site of cancer. Results: The average number of symptoms reported per patient was 5.33 0.67 (mean SE). The most common symptoms were pain, weakness/fatigue, anorexia, insomnia, nausea/vomiting, dyspnea, constipation and cough. Polypharmacy was frequent. Patients consumed approximately 8.7 0.38 (mean SE) drugs on average during the 2-month period of follow-up. Conclusion: The result gives insight into the varied symptomatology of patients with advanced cancer. Polypharmacy was quite common in patients with advanced cancer, predisposing them to complicated drug interactions and adverse drug reactions.
  2,965 219 3
Evaluation of a combination of low-dose ketamine and low-dose midazolam in terminal dyspnea-attenuation of "double-effect"
Abhijit Kanti Dam
July-December 2008, 14(2):97-101
DOI:10.4103/0973-1075.45453  
Aim: Of all symptoms in palliative medicine those concerning respiration are most excruciating and difficult to treat. Reticence about the use of morphine for palliation of dyspnea is common, especially in nonmalignant diseases, as there is a fear of causing respiratory depression, particularly where Chronic Obstructive Pulmonary Disease (COPD) exists. This factor is also compounded by the lack of availability of morphine in parts of developing countries. Ketamine has excellent anesthetic and analgesic effects in addition to being easily available. It produces bronchodilatation and does not produce respiratory or cardiovascular depression. The author seeks to evaluate the role of low-dose (0.2 mg/kg) ketamine and midazolam (0.02 mg/kg) in the attenuation of terminal dyspnea. Methods: Sixteen patients with terminal dyspnea, admitted to the Critical Care Unit (CCU) with cancer and other noncancer diagnoses were recruited. The subjective component of dyspnea was assessed using the Graphic Rating Scale (GRS), which has values from 0 - 10, 10 being maximum dyspnea. Each patient received a low-dose of ketamine and midazolam for relief of dyspnea. All the patients received low-flow (2 L/min.) oxygen therapy via nasal cannula. Immediately after admission, all the patients were reassured and nursed in a decubitus position of their choice. The GRS was recorded at the point of admission, 10 minutes after starting oxygen therapy, and ten minutes after administration of low-dose ketamine and midazolam. Hemodynamic parameters were also recorded at these three points. Result: All the patients who enrolled in our study had significant dyspnea at admission, as was evident from the GRS scores of 8.250 (SD 0.91), respiratory rate of 28.56 (SD 5.0), mean arterial blood pressure (MABP) of 102.7 (SD 14.63), pulse rate of 115.62 (SD 23.3), and SpO2 of 92.43 (SD 2.38). All the patients benefited from the combination of ketamine and midazolam, as evidenced by the statistically significant ( P < 0.01) improvement in all monitored parameters. Conclusion: The author concludes that a combination of low-dose ketamine and midazolam can be safely used in the palliation of terminal dyspnea, with excellent results. The duration of action of this combination in providing symptomatic relief is however short-lived, being 36.7 minutes on an average (SD 5.23), thus necessitating intermittent IV top-ups. No adverse reports were obtained in the study.
  2,803 182 -
Palliative care in advanced gynecological cancers: Institute of palliative medicine experience
Sushmita Pathy, Saveena G Raheja, S Rakhi
July-December 2008, 14(2):86-89
DOI:10.4103/0973-1075.45451  
Aim: To study the epidemiological profile, clinical symptoms and referral patterns of patients with gynecological malignancy. To evaluate pain symptoms, response to treatment and factors affecting management in patients with advanced gynecological malignancies. Methods: A retrospective analysis was performed of the gynecological malignancy cases registered at the Pain and Palliative Care Clinic, Calicut, over a 12-month period between January 2006 and December 2006.Patient characteristics, symptoms and response to treatment were evaluated in detail. Results: A total of 1813 patients registered, of which 64 had gynecological malignancies. Most of the cases were referred from the Oncology Department of the Calicut Medical College. Fifty-five percent of the patients were unaware of their diagnosis. Psychosocial issues and anxiety were observed in 48%. Insomnia was seen in 52% of the cases. Pain was the most common and most distressing symptom. Adequate pain relief was achieved in only 32% of the patients. Conclusions: The number of gynecological malignancy cases attending the Pain and Palliative Care Clinic is small. Pain is the most common and distressing symptom, with only 32% of the patients achieving adequate pain relief. Poor drug compliance, incomplete assessment of pain and the lack of awareness of morphine therapy were identified as the most common causes for poor pain control.
  2,376 212 -
Quality of life assessment with different radiotherapy schedules in palliative management of advanced carcinoma esophagus: A prospective randomized study
Shaveta Mehta, Suresh C Sharma, Rakesh Kapoor, Rakesh Kochhar, Vipin Mehta
July-December 2008, 14(2):90-96
DOI:10.4103/0973-1075.45452  
Aim: To investigate the quality of life (QOL) of patients with advanced carcinoma esophagus treated with different palliative radiation schedules. Methods: Sixty-two consecutive patients with inoperable, non-metastatic carcinoma of the esophagus were randomly allocated to Arm-A (external radiotherapy 30 Gy/10 fractions + brachytherapy 12 Gy/two sessions), Arm-B (external radiotherapy 30 Gy /10 fractions) and Arm-C (external radiotherapy 20Gy /five fractions). The QOL was assessed using the European Organization for Research and Treatment of Cancer questionnaire at presentation, after treatment and at 3 months follow-up. Results: The mean QOL score improved, in arm-A from 38 to 52 after treatment and 56 at 3 months, in arm-B from 30 to 44 after treatment and 55 at 3 months and in arm-C from 24 to 40 after treatment but decreased to 37 at 3 months. Improvement in dysphagia scores at the first follow-up was 46.1% in arm-A, 25.0% in arm-B and 22.6% in arm-C. The difference was maintained at 3 months, with maximum improvement in arm-A (57.6%). No significant differences were found between the three arms with regard to complications and additional procedures needed for relief of dysphagia. Conclusion: In comparison with external radiotherapy alone, external radiotherapy with intraluminal brachytherapy has shown a trend toward better QOL and consistent dysphagia relief without significant difference in adverse effects.
  2,172 153 -
A survey of the domiciliary situation of urban and rural patients of a palliative care unit in south India
Ramu Kandasamy, Reena George, Neha Egbert, Jenifer Jeba
July-December 2008, 14(2):80-85
DOI:10.4103/0973-1075.45450  
Aim: A demographic study was conducted to understand the social status of the urban and rural patients attending a palliative care unit in South India. Methods: Fifty rural and 50 urban patients attending the palliative care outpatient clinic of the Christian Medical College and Hospital, South India were prospectively surveyed using a structured interview and home visits. Parameters studied included age, gender, marital status, education, occupation, religion, caste, housing, economic status, diagnosis, distance to the nearest health resource personnel and hospitals. Results: Occupation, religion, caste, housing, electricity, toilet and accessibility to health care were found to be significantly different between urban and rural patients. Seventy percent of the patients were below 60 years of age. The majority were unskilled laborers or housewives. One-third had never been to school and only 3% had been educated beyond high school. Half the patients slept on the floor, 50% of the dwellings had only one or two rooms and did not have toilets or running water. Ninety-five percent had electricity. The economic status of the patients correlated significantly with age, occupation and facilities in the house such as number of rooms, availability of beds, toilets and water supply. Women and older patients were significantly less likely to have completed school education. Women were less likely to be the main decision-makers and more likely to be the main caregivers. Conclusion: Economic status was a strong predictor of the various facilities available to the patient. A significant proportion of this population lived in deprived circumstances. A knowledge and understanding of the social conditions of the palliative care patients helps provide better-tailored care.
  2,103 138 -
EDITORIAL
From the desk of the editor
Jacob Alexander
July-December 2008, 14(2):55-55
DOI:10.4103/0973-1075.45446  
  1,720 213 -
CASE REPORT
Disease process providing a path for palliation
Abhijit Kanti Dam
July-December 2008, 14(2):102-103
DOI:10.4103/0973-1075.45454  
The author describes a novel approach of insertion of a feeding tube though a malignant fistulous tract in the buccal mucosa with excellent palliation.
  1,570 142 -
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