Indian Journal of Palliative Care
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   2013| May-August  | Volume 19 | Issue 2  
    Online since August 21, 2013

 
 
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ORIGINAL ARTICLES
Perceptions and attitudes towards organ donation among people seeking healthcare in tertiary care centers of coastal south India
Prasanna Mithra, Prithvishree Ravindra, B Unnikrishnan, T Rekha, Tanuj Kanchan, Nithin Kumar, Mohan Papanna, Vaman Kulkarni, Ramesh Holla, K Divyavaraprasad
May-August 2013, 19(2):83-87
DOI:10.4103/0973-1075.116701  PMID:24049347
Background: Organ transplantation is the most preferred treatment modality for end-stage organ diseases. The need for the transplants is higher than the availability. Prerequisites for the success of transplantation program include awareness and positive attitudes. Aim: To assess the perceptions and attitudes of the people seeking health care in tertiary care centers towards organ donation in Mangalore, India. Settings and Design: This cross-sectional study included 863 people seeking general healthcare as outpatients. Materials and Methods: Face to face interviews were carried out using pretested tools which included the socio demographic data. Data was analyzed using Statistical Package for Social Sciences version 11.5. Results: Overall, 59.6% participants showed the willingness to donate organs. Females (64.1%) and participants from upper socio economic status (62.7%) had higher willingness rates for organ donations. Hindus (63.6%) and Christians (63.3%) had higher willingness rates for organ donations than Muslims (38.2%). Also, 23.7% participants showed willingness to donate eyes and 33.6% wished to donate any organ after death. Most of the participants (67%) were aware that money should not be accepted for donating organs, and 58.1% were aware that it is an offence to accept any benefit for organ donations. Forty percent participants had perceived risks associated with organ donation. Regarding donor cards, 42.3% of the participants knew about it and 3.7% already possessed it. Conclusion: It is apparent from the study that though there was high level of awareness about organ donation, a high proportion of the participants did not have positive attitudes towards organ donation.
  4,343 205 -
CASE REPORTS
Pericardial-peritoneal window: A novel palliative treatment for malignant and recurrent cardiac tamponade
Ashwin Anand Kallianpur, Shivpreet Singh Samra, Vinod Nimbran, Rakesh Gupta, Cherian Akkarappatty, Nidhi Gupta, Gaurav Gupta
May-August 2013, 19(2):116-118
DOI:10.4103/0973-1075.116710  PMID:24049355
Transdiaphragmatic approach to the pericardium through a subxiphoid incision is a safe, rapid, and effective way to obtain drainage of the pericardium fluid in patient of disseminated malignancy with recurrent cardiac tamponade. No drainage tubes are needed; pericardial fluid is absorbed by the peritoneum; there is no need for double lumen tubes for single lung ventilation and the subxiphoid incisions are small and almost painless.
  4,095 87 -
ORIGINAL ARTICLES
Hypofractionated palliative radiotherapy in locally advanced inoperable head and neck cancer: CMC vellore experience
Saikat Das, Solly Thomas, Suparna Kanti Pal, Rajesh Isiah, Subhashini John
May-August 2013, 19(2):93-98
DOI:10.4103/0973-1075.116709  PMID:24049349
Background: A novel, short duration, palliative radiotherapy schedule for inoperable head and neck cancer was evaluated in terms of palliation of cancer-related symptoms and acute toxicities. Materials and Methods: Thirty-six patients with inoperable head and neck cancer were included in the study (2010-2012). All patients received 40 Gy in 10 fractions (equivalent dose: 49.8 Gy in conventional fractionation) with 2 fractions per week. Treatment-related toxicity was assessed using Radiation Therapy Oncology Group criteria. Functional Assessment of Cancer Therapy (Head and Neck, FACT H and N) quality of life (QOL) tool was administered before starting and at the completion of radiotherapy. Mean value before and after treatment was compared (paired t-test, P = 0.05, two-tailed for significance). Results: Thirty-three patients (male: 29, female: 4, mean age: 57.8 ± 9.7 years) were included in the analysis (three patients discontinued treatment due to socioeconomic reasons). All patients had advanced inoperable head and neck cancers (27% IVA, 61% IVB, 9% IVC, TNM stage and 3% recurrent disease). Distressing pain at primary site (42%), dysphagia (18%), neck swelling (30%), and hoarseness (10%) were common presentations. Incidence of grade III mucositis and dermatitis and pain was 18%, 3%, and 24%, respectively. Planned radiotherapy without any interruptions was completed by 73% patients. QOL assessment showed improvement in social well-being (17.4 vs. 20.01, P = 0.03), but no significant change was observed in head and neck specific score (25.1 vs. 25.0, P = NS) after treatment. Reduction of pain was observed in 88% patients and 60% patients had improvement of performance status. Median overall survival of the cohort was 7 months. Conclusions: The study shows that this short duration palliative radiotherapy schedule is a clinically viable option for advanced inoperable head and neck cancer to achieve significant palliation of the main presenting symptoms like pain, dysphagia, and throat pain.
  3,504 185 -
CASE REPORTS
Tracheobronchomalacia post-pneumonectomy: A late complication
Ashima Datey, Avinash Chaskar, Latha Sarma
May-August 2013, 19(2):107-109
DOI:10.4103/0973-1075.116713  PMID:24049352
An 83-year-old male presented with dyspnoea and stridor. He had undergone pneumonectomy 40 years ago. CT scan revealed gross shift of mediastinum (post-pneumonectomy syndrome) with tortuous trachea kinked at the thoracic inlet. Fibre optic bronchoscopy showed a near total expiratory closure of trachea, right main bronchus, and segmental bronchi confirming tracheobronchomalacia. He was managed with long length, low tracheostomy in view of his poor general condition of permitting more invasive procedures. He showed adequate clinical improvement and was discharged home. Tracheobronchomalacia in post-pneumonectomy syndrome requires emergent management. Its occurrence after 40 years is very rare and may be easily missed. It can be diagnosed with dynamic CT and FOB. Although invasive management with stenting or surgical methods is routinely advised, conservative care can be effective in selected cases.
  3,483 71 -
ORIGINAL ARTICLES
Spiritual concerns in Hindu cancer patients undergoing palliative care: A qualitative study
Srinagesh Simha, Simon Noble, Santosh K Chaturvedi
May-August 2013, 19(2):99-105
DOI:10.4103/0973-1075.116716  PMID:24049350
Aims: Spiritual concerns are being identified as important components of palliative care. The aim of this study was to explore the nature of spiritual concerns in cancer patients undergoing palliative care in a hospice in India. Materials and Methods: The methodology used was a qualitative method: Interpretive phenomenological analysis. A semi-structured interview guide was used to collect data, based on Indian and western literature reports. Certain aspects like karma and pooja, relevant to Hindus, were included. Theme saturation was achieved on interviewing 10 participants. Results: The seven most common spiritual concerns reported were benefit of pooja, faith in God, concern about the future, concept of rebirth, acceptance of one's situation, belief in karma, and the question "Why me?" No participant expressed four of the concerns studied: Loneliness, need of seeking forgiveness from others, not being remembered later, and religious struggle. Conclusions: This study confirms that there are spiritual concerns reported by patients receiving palliative care. The qualitative descriptions give a good idea about these experiences, and how patients deal with them. The study indicates the need for adequate attention to spiritual aspects during palliative care.
  3,262 165 -
IMAGES IN PALLIATIVE MEDICINE
Type 2 (impending) carotid blow out syndrome
Naveen Salins, Lohithashva S Omkarappa
May-August 2013, 19(2):119-119
DOI:10.4103/0973-1075.116708  PMID:24049356
  3,229 77 -
ORIGINAL ARTICLES
Distress screening using distress thermometer in head and neck cancer patients undergoing radiotherapy and evaluation of causal factors predicting occurrence of distress
Shirley Lewis, Naveen Salins, Amrit Kadam, Raghavendra Rao
May-August 2013, 19(2):88-92
DOI:10.4103/0973-1075.116703  PMID:24049348
Introduction: Distress is commonly seen in head and neck cancer patients undergoing radiotherapy. Causal factors of distress are multifactorial; which encompasses physical, psychological, spiritual, and existential factors with complex interrelationship among the factors. Materials and Methods: Thirty patients undergoing head and neck radiotherapy were included in the study. Patients were screened for pain scores, distress scores, physical and psychological symptoms, and spiritual and emotional distress. Results: Significant increasing trend seen for pain score, distress score, and total number of symptoms during 2 nd week, 4 th week, and on completion of radiotherapy treatment (all P's < 0.001) compared to pretreatment. Those who had chemotherapy (CT) along with radiation had significantly greater pain score (t = 5.54, P = 0.03) and distress score (t = 3.9, P = 0.05) at 2 weeks into radiotherapy compared to those who did not receive CT. There was significantly higher grade of skin toxicity in those with spiritual distress (Somers' d = 0.36, P = 0.02) and higher grade of mucositis in those with existential distress (d = 0.34, P = 0.02) at 4 weeks into radiotherapy. Conclusion: Positive correlation between distress score and pain score and occurrence of physical symptoms. Increasing trend seen for pain score, distress score, and total number of symptoms during 2 nd week, 4 th week, and completion of radiotherapy treatment compared to pretreatment. Increase in distress score in those with existential and spiritual distress.
  3,031 140 3
CASE REPORTS
Persistent hiccups in cancer patient: A presentation of syndrome of inappropriate antidiuretic hormone induced hyponatremia
Alka Goyal, Syed Mehmood, Seema Mishra, Sushma Bhatnagar
May-August 2013, 19(2):110-112
DOI:10.4103/0973-1075.116712  PMID:24049353
Hyponatremia is quite common in cancer patients, but the presentation as persistent hiccups is not common. Literature over hiccups development due to hyponatremia is quite scant. Hiccups are of various types, persistent hiccups are those that last more than 48 h and remains less than 1 month. Hiccups lasting more than 24 h require investigation for an underlying organic etiology, with hyponatremia included in the differential diagnosis. This paper discusses a carcinoma lip patient presented with the persistent hiccups and unconsciousness post-operatively. The patient was initially responded with trials of both metoclopramide and Ryle's tube insertion, but eventually, his hiccups resolved only after treatment of hyponatremia. Patient's clinical course and investigations suggest an etiology of syndrome of inappropriate antidiuretic hormone (SIADH) secretion behind the hyponatremia. Study suggested that SIADH linked hyponatremia should be considered in the differential diagnosis of cancer patients with refractory hiccups.
  2,955 101 -
Gall bladder carcinoma presenting with spinal metastasis: A rare phenomenon
Mohit K Joshi, Richa Joshi, Manish Chadha, Shan E Alam, Hemant Varshneya, Sunil Kumar
May-August 2013, 19(2):113-115
DOI:10.4103/0973-1075.116711  PMID:24049354
Skeletal metastasis as a primary presentation of gall bladder carcinoma is rare. A 50-year-old lady presented with neck pain and weakness in her right upper limb of 3 months duration. Clinical and imaging work-up suggested locally advanced gall bladder carcinoma with metastasis to cervical vertebra and sternum. Only one case till date has been reported where the patient presented with neurological symptoms due to pathological fracture secondary to metastasis from an occult gall bladder carcinoma. Although rare, an occult gall bladder cancer may present with neurological symptoms due to pathological fracture of spine secondary to metastasis. We present a brief review of literature of patients who presented with skeletal metastases in clinically silent gall bladder malignancy. Palliative care issues in advanced gall bladder carcinoma have also been discussed.
  2,628 82 1
EDITORIAL
Who is really afraid of death?
Sushma Bhatnagar
May-August 2013, 19(2):81-82
DOI:10.4103/0973-1075.116700  PMID:24049346
  2,042 169 -
LETTERS TO EDITOR
Guided/graded motor imagery for cancer pain: Exploring the mind-brain inter-relationship
Senthil Paramasivam Kumar, Anup Kumar, Kamalaksha Shenoy, Mariella D'Souza, Vijaya K Kumar
May-August 2013, 19(2):125-126
DOI:10.4103/0973-1075.116704  PMID:24049359
  2,043 99 -
PRACTITIONER SECTION
Curative to palliative care-transition and communication issues: Surgeons perspective
SV Suryanarayana Deo, T Thejus
May-August 2013, 19(2):120-123
DOI:10.4103/0973-1075.116706  PMID:24049357
Transition of a cancer patient from curative to palliative stage is one of the most difficult and challenging phases of cancer care both from patient and physician point of view. Most of the time the treating surgeons are expected to facilitate this transition but due to a number of reasons surgeons often fail to fulfill this crucial responsibility. This article highlights the various issues involved in the transition phase from a surgeons perspective.
  1,958 94 1
LETTERS TO EDITOR
Evidence-based practice in chronic pain: A multidimensional biopsychosocial paradigm is the "need of the hour" in palliative care
Senthil Paramasivam Kumar, Anup Kumar
May-August 2013, 19(2):126-127
DOI:10.4103/0973-1075.116705  PMID:24049360
  1,851 105 -
Effective palliative care in head and neck cancer: Need of the hour
Preetinder Singh, Ramandeep Saluja
May-August 2013, 19(2):124-124
DOI:10.4103/0973-1075.116702  PMID:24049358
  1,767 99 -
COMMENTARY
Commentary
Deepak Gupta
May-August 2013, 19(2):105-106
  1,313 58 -
Online since 1st October '05
Published by Wolters Kluwer - Medknow