Indian Journal of Palliative Care
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   2014| May-August  | Volume 20 | Issue 2  
    Online since May 16, 2014

 
 
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ORIGINAL ARTICLES
Preference of the place of death among people of Pune
Priyadarshini Kulkarni, Pradeep Kulkarni, Vrushali Anavkar, Ravindra Ghooi
May-August 2014, 20(2):101-106
DOI:10.4103/0973-1075.132620  PMID:25125864
Aim: Provision of end-of-life care requires that we have adequate information about the preferred place of death in the population. Since no such study is reported in India, this study was taken up in and around Pune, a large cosmopolitan city. Setting and Design: A questionnaire was designed in three parts and distributed among the people above the age of 18 in and around Pune. Materials and Methods: The questionnaire had three parts the first being a consent form, followed by one for collection of personal information and lastly questions specific to the subject matter. Filled forms were screened for inconsistencies, gaps of information and errors. Results: The population survey was mixed, both urban and rural, men and women, educated and uneducated, young and old. Despite this heterogeneity, the results were consistent to the point that most of the people surveyed preferred home as the place of death. This preference cuts across all barriers, the only difference being that women had a stronger preference for home death compared to men. Conclusions: Helping people to die at their preferred place is a part of end-of-life care. Majority of people surveyed by us, prefer to die at home, where they are relatively more comfortable. Public and governmental policies should be directed toward facilitating home deaths.
  1 2,519 152
CASE REPORTS
The multidisciplinary team in palliative care: A case reflection
Liza Bowen
May-August 2014, 20(2):142-145
DOI:10.4103/0973-1075.132637  PMID:25125872
This essay is a reflection on the multidisciplinary team in palliative care, from the perspective of a final year MBBS student from the UK spending one month with an Indian pain and palliative care team at Institute Rotary Cancer Hospital (IRCH), AIIMS, New Delhi.
  - 7,137 170
Role of a dentist in comprehensive management of a comatose patient with post traumatic head injury and neuropathological chewing
Sunanda Sharma, Aditi Nanda, Dheeraj Koli, Sapna Daksh, Mahesh Verma
May-August 2014, 20(2):146-152
DOI:10.4103/0973-1075.132639  PMID:25125873
Injury of the head and neck region can result in substantial morbidity. Comprehensive management of such patients requires team work of several specialties, including dentists. A young female patient with extensive loss of cranium and associated pathological chewing was referred to the dental department. The lost cranium was replaced by a custom-made, hand-fabricated cranioplast. Trauma due to pathological mastication was reduced by usage of a custom-made mouthguard. Favorable results were seen in the appearance of the patient and after insertion of the mouthguard as evidenced in good healing response.The intricate role of a dental specialist in the team to manage a patient with post traumatic head injury has been highlighted. The take away message is to make the surgical fraternity aware of the scope of dentistry in the comprehensive management of patients requiring special care.
  - 2,945 105
Management of total cancer pain: A case of young adult
Aanchal Satija, Suraj Pal Singh, Komal Kashyap, Sushma Bhatnagar
May-August 2014, 20(2):153-156
DOI:10.4103/0973-1075.132651  PMID:25125874
Pain due to cancer is one of the most distressing symptoms experienced by the patients at some or the other time during the course of treatment or disease progression. The multidimensional nature of cancer pain is characterized by various dimensions including physical, social, psychological, and spiritual; which together constitute the term "total pain". Young cancer patients illustrate their unique psychological and developmental needs. This case report highlights the concept of "total cancer pain" in a young adult and demonstrates his distinctive social, spiritual, and psychological sufferings. The report emphasizes that addressing all these concerns is considerably significant in order to provide optimal pain relief to the patient. In the present scenario, it has been done by a skillful multiprofessional team communicating effectively with both the patient and the carer.
  - 3,247 173
Primary peritoneal serous carcinoma: A rare case and palliative approach
Viral M Bhanvadia, Jignesh K Parmar, Yogendra G Madan, Shamim S Sheikh
May-August 2014, 20(2):157-159
DOI:10.4103/0973-1075.132653  PMID:25125875
Primary peritoneal serous carcinoma (PPSC) is a rare primary malignancy that diffusely involves the peritoneum, indistinguishable clinically and histopathologically from primary serous ovarian carcinoma. The origin of PPSC has not been well characterized. Here we present a case of PPSC diagnosed in ultrasonography-guided fine needle aspiration cytology (FNAC) in a 76- old female presenting with ascites, abdominal pain, distension and constipation. PPSC is an unusual tumour but cytomorphology is distinctive enough to diagnose preoperatively. In the case report hereby described PPSC is an inoperable malignancy, hence chemotherapy and palliative care are the only offered treatment.
  - 4,888 142
EDITORIAL
Time for change: Integrating palliative medicine to mainstream medicine
Naveen Salins
May-August 2014, 20(2):97-98
DOI:10.4103/0973-1075.132618  PMID:25125862
  - 1,971 190
EDITORIAL COMMENTARY
End-of-life care for patients afflicted with incurable malignancy and end-stage renal disease
Dipankar Bhowmik, Amit Kumar
May-August 2014, 20(2):99-100
DOI:10.4103/0973-1075.132619  PMID:25125863
  - 2,041 139
LETTER TO EDITOR
Nicotine replacement therapy for palliation of nicotine abstinence syndrome- Is it worth?
Preetinder Singh
May-August 2014, 20(2):166-166
DOI:10.4103/0973-1075.132655  PMID:25125877
  - 1,696 85
ORIGINAL ARTICLES
Poor health related quality of life among patients of sickle cell disease
Vijay M. Bhagat, Shubhangi R. Baviskar, Abhay B. Mudey, Ramchandra C. Goyal
May-August 2014, 20(2):107-111
DOI:10.4103/0973-1075.132622  PMID:25125865
Background: Sickle cell disease (SCD) is characterized by chronic hemolytic anemia and vascular occlusion, causing recurrent painful episodes, neuro-cognitive deficits, organ failures and death in early adulthood. Besides the medical consequences, most of the families with a child of SCD have to cope with financial and social crisis. Quality of life (QOL) is a broad multidimensional concept that usually includes subjective evaluations of both positive and negative aspects of life. Other than health; emotional well being, social dysfunction, chronic pain and fatigability are also important aspects of overall quality of life that add to the complexity of its measurement. Aim: The present case control study was designed to determine the health related quality of life (HRQoL) in patients of sickle cell disease and to compare it with patients of other chronic non-communicable diseases. Setting and Design: Case control study conducted at tertiary health care facility of Central India. Material and Methods: The present study conducted to measure HRQoL among patients of SCD and patients of other chronic non-communicable diseases. A translated and pretested version of WHO SF-36 questionnaire was used to measure HRQoL. Results: We observed that there was significantly lower HRQoL among SCD patients. Conclusion: Besides merely pharmacotherapy, restoration of overall quality of life should be the mainstay of management of patients with SCD.
  - 3,067 179
Palliative approach in advanced pelvic osteosarcoma: a single centre experience of a rare disease
Ritesh Kumar, Rakesh Kapoor, Divya Khosla, Narendra Kumar, Pramod Kumar Singh, Mahendra Kumar, SC Sharma
May-August 2014, 20(2):112-115
DOI:10.4103/0973-1075.132624  PMID:25125866
Background: Pelvic osteosarcoma is a rare and aggressive malignant neoplasm with poor outcomes. It represents only 5% of all osteosarcomas. The authors present our institute's experience in management and outcomes of five successive patients of pelvic osteosarcoma. Materials and Methods: We retrospectively reviewed five patients of pelvis osteosarcoma treated in our institute from September 2008 to December 2010. Clinical characteristics and treatment (CCT) modality in form of surgery and chemotherapy were noted. Statistical analysis was done with regards to progression-free survival (PFS) using Kaplan-Meier survival analysis. Results: The median age of the patients was 16.0 years. The median duration of symptoms was 9 months. One patient had lung metastases at presentation. All patients received systemic chemotherapy. One patient underwent surgery in the form of limb sparing approach. Three patients had partial response to treatment, one had complete response, and one had progressive disease. Median duration of PFS was 7 months only. Conclusions: Pelvic osteosarcomas are rare neoplasms with aggressive growth patterns. Survival results are poor in view of advanced stage of presentation and difficult surgical approaches. The combined modality approach is needed to improve the results.
  - 2,622 88
Quality of life in cancer patients undergoing chemotherapy in a tertiary care center in Malwa region of Punjab
Harminder Singh, Kamalpreet Kaur, Raja Paramjeet Singh Banipal, Shaminder Singh, Ritu Bala
May-August 2014, 20(2):116-122
DOI:10.4103/0973-1075.132627  PMID:25125867
Objective: The objective of this prospective, non-interventional, 4-month observational study was to analyze and compare patient-reported quality of life (QOL) and their physical/psychosocial symptom burden during their respective chemotherapy sessions. Materials and Methods: A prospective and descriptive study was carried out jointly by Pharmacology and Oncology Departments of a tertiary care center in Malwa region of Punjab. The data collection was performed by administering validated questionnaire/response after taking informed consent. Results: A total of 131 cancer patients were recruited with the mean age of 49.05 ± 14.35 (SD (standard deviation)) years. As per the QOL scoring of Global Health Status (GHS) and four items of symptom scale, that is, insomnia, pain, appetite loss, and constipation, and financial difficulties attained a significance difference. GHS significantly improved in group three as compared to group one, indicating that the patient's overall health/QOL improved as the chemotherapy session progressed. Conclusion: Although QOL scoring system did not show significant improvement in all areas (except insomnia, pain, appetite loss, constipation, and financial difficulties) with reference to their respective chemotherapy cycles, but a judicious diagnosis with an appropriate treatment including chemotherapy may lessen the negative perception of cancer as a deadly and fatal disease in our rural population.
  - 4,311 231
Adaptation of a quality of life questionnaire for Iranian patients with esophageal cancer
Mojgan Forootan, Morteza Tabatabaeefar, Nakisa Maghsoodi, Maryam Ardeshiri, Mahdi Fatemi, Hormat Rahimzadeh
May-August 2014, 20(2):123-127
DOI:10.4103/0973-1075.132629  PMID:25125868
Introduction: Evaluation of quality of life is very important in cancer patients. Esophagus-specific quality of life questionnaire (QLQ-OES18) is a disease-specific questionnaire for assessing quality of life in esophageal cancer (EC). So we aimed to translate and evaluate the reliability and validity of the QLQ-OES18 when applied to Iranian patients. Materials and Methods: This study was designed as cross-sectional study on 62 newly confirmed EC in two referral hospital in Tehran, Iran. Reliability of the subscales was evaluated by intraclass correlation coefficients. Pearson's correlations of an item with its own scale and other scales were calculated to assess convergent and discriminant validity. Clinical validity was also evaluated by known-group comparisons. Results: Cronbach's alpha was higher than 0.7 in most subscales. All subscales met the standards of convergent and discriminant validity. Also QLQ-OES18 had discriminatory power for differentiation between patient's groups with different clinical status. Conclusion: Our results provide evidences that Persian version of QLQ-OES18 is a valid and reliable questionnaire when applied to a sample of Iranian patients with EC and is recommended for use in clinical research.
  - 2,211 123
Fear of cancer recurrence and its predictive factors among Iranian cancer patients
Alireza Mohajjel Aghdam, Azad Rahmani, Zahra Kochaki Nejad, Caleb Ferguson, Asghar Mohammadpoorasl, Zohreh Sanaat
May-August 2014, 20(2):128-133
DOI:10.4103/0973-1075.132632  PMID:25125869
Context: Fear of cancer recurrence (FOCR) is one of the most important psychological problems among cancer patients. In extensive review of related literature there were no articles on FOCR among Iranian cancer patients. Aim: The aim of present study was to investigation FOCR and its predictive factors among Iranian cancer patients. Materials and Methods: In this descriptive-correlational study 129 cancer patients participated. For data collection, the demographic checklist and short form of fear of progression questionnaire was used. Logistic regression was used to determine predictive factors of FOCR. Result: Mean score of FOCR among participants was 44.8 and about 50% of them had high level of FOCR. The most important worries of participants were about their family and the future of their children and their lesser worries were about the physical symptoms and fear of physical damage because of cancer treatments. Also, women, breast cancer patient, and patients with lower level of education have more FOCR. Discussion: There is immediate need for supportive care program designed for Iranian cancer patients aimed at decreasing their FOCR. Especially, breast cancer patients and the patient with low educational level need more attention.
  - 3,174 167
Does pain behavior influence assessment of pain severity?
Geetha Desai, Santosh K Chaturvedi, Lalitha Krishnaswamy
May-August 2014, 20(2):134-136
DOI:10.4103/0973-1075.132634  PMID:25125870
Context: Nurses are involved in assessment of pain in most clinical settings. Pain continues to be underestimated and undertreated. Materials and Methods: This study assessed the rating of pain severity by nurses who observed the two case scenarios using role plays. The data were computed and frequency distribution was derived. Results: Majority of the nurses underrated the pain and based their ratings on various factors. Conclusions: It is important to increase the awareness among nurses about comprehensive assessment of pain for better management.
  - 2,252 104
Palliative care for patients with malignancy and end-stage renal failure on peritoneal dialysis
Lv Jing, Xue Wu-Jun, Tan Feng
May-August 2014, 20(2):137-141
DOI:10.4103/0973-1075.132636  PMID:25125871
Background: Many patients on peritoneal dialysis experience a poor quality of life because of a high burden of comorbid conditions. Dialysists must pay more attention to reducing a patient's pain and suffering, both physical and psychological and improve the quality of life for the patients as much as possible. A consensus regarding eligibility for palliative care and the delivery of these inventions does not currently exist. Objective: The present study aimed to describe the implementation of palliative care for end-stage renal failure patients on peritoneal dialysis. Design: A report on three cases. Materials and Methods: This study included three outpatients on peritoneal dialysis who received palliative care and died between January 2008 and June 2010. Measurements: The patients' comorbidities, nutritional status, and functional status were evaluated using the Charlson comorbidity score, subjective global assessment, and Karnofsky Performance Score index, respectively. The Hamilton depression and Hamilton anxiety scales were also employed. The patients' clinical manifestations and treatments were reviewed. Results: Each patient displayed 11-16 symptoms. The Charlson comorbidity scores were from 11 to 13, the subjective global assessment indicated that two patients were class assigned to "C" and one to class "B", and the mean Karnofsky index was <40. Among these patients, all experienced depression and two experienced anxiety, Low doses of hypertonic glucose solutions, skin care, psychological services, and tranquillizers were intermittently used to alleviate symptoms, after making the decision to terminate dialysis. The patients died 5 days to 2 months after dialysis withdrawal. Conclusion: The considerable burden associated with comorbid conditions, malnutrition, poor functional status, and serious psychological problems are predictors of poor patient prognoses. Withdrawal of dialysis, palliative care, and psychological interventions can reduce patient distress and improve the quality of life before death, with the care provided.
  - 2,611 127
PRACTITIONER SECTION
Use of opioids and sedatives at End-of-Life
Shin Wei Sim, Shirlynn Ho, Radha Krishna Lalit Kumar
May-August 2014, 20(2):160-165
DOI:10.4103/0973-1075.132654  PMID:25125876
Despite their proven efficacy and safety, opioid and sedative use for palliation in patients afflicted with cancer in Singapore have been shown to be a fraction of that in other countries. This paper explores the various psychosocial and system-related factors that appear to propagate this conservative approach to care in what is largely a western-influenced care practice. A search for publications relating to sedative and opioid usage in Asia was performed on PubMed, Google, Google Scholar, World Health Organization, and Singapore's government agency websites using search terms such as "opioids," "sedatives," "palliation," "end-of-life-care," "pain management," "palliative care," "cancer pain," "Asia," "Singapore," and "morphine." Findings were classified into three broad groups - system-related, physician-related, and patient-related factors. A cautious medico-legal climate, shortage of physicians trained in palliative care, and lack of instruments for symptom assessment of patients at the end of life contribute to system-related barriers. Physician-related barriers include delayed access to palliative care due to late referrals, knowledge deficits in non-palliative medicine physicians, and sub-optimal care provided by palliative physicians. Patients' under-reporting of symptoms and fear of addiction, tolerance, and side effects of opioids and sedatives may lead to conservative opioid use in palliative care as well. System-related, physician-related, and patient-related factors play crucial roles in steering the management of palliative patients. Addressing and increasing the awareness of these factors may help ensure patients receive adequate relief and control of distressing symptoms.
  - 3,890 284
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