Indian Journal of Palliative Care
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   2015| May-August  | Volume 21 | Issue 2  
    Online since May 6, 2015

 
 
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ORIGINAL ARTICLES
Effective factors in providing holistic care: A qualitative study
Vahid Zamanzadeh, Madineh Jasemi, Leila Valizadeh, Brian Keogh, Fariba Taleghani
May-August 2015, 21(2):214-224
DOI:10.4103/0973-1075.156506  PMID:26009677
Background: Holistic care is a comprehensive model of caring. Previous studies have shown that most nurses do not apply this method. Examining the effective factors in nurses' provision of holistic care can help with enhancing it. Studying these factors from the point of view of nurses will generate real and meaningful concepts and can help to extend this method of caring. Materials and Methods: A qualitative study was used to identify effective factors in holistic care provision. Data gathered by interviewing 14 nurses from university hospitals in Iran were analyzed with a conventional qualitative content analysis method and by using MAXQDA (professional software for qualitative and mixed methods data analysis) software. Results: Analysis of data revealed three main themes as effective factors in providing holistic care: The structure of educational system, professional environment, and personality traits. Conclusion: Establishing appropriate educational, management systems, and promoting religiousness and encouragement will induce nurses to provide holistic care and ultimately improve the quality of their caring.
  11,481 193 -
REVIEW ARTICLES
Evidence-based clinical practice guidelines for interventional pain management in cancer pain
Sushma Bhatnagar, Maynak Gupta
May-August 2015, 21(2):137-147
DOI:10.4103/0973-1075.156466  PMID:26009665
Intractable cancer pain not amenable to standard oral or parenteral analgesics is a horrifying truth in 10-15% of patients. Interventional pain management techniques are an indispensable arsenal in pain physician's armamentarium for severe, intractable pain and can be broadly classified into neuroablative and neuromodulation techniques. An array of neurolytic techniques (chemical, thermal, or surgical) can be employed for ablation of individual nerve fibers, plexuses, or intrathecalneurolysis in patients with resistant pain and short life-expectancy. Neuraxial administration of drugs and spinal cord stimulation to modulate or alter the pain perception constitutes the most frequently employed neuromodulation techniques. Lately, there is a rising call for early introduction of interventional techniques in carefully selected patients simultaneously or even before starting strong opioids. After decades of empirical use, it is the need of the hour to head towards professionalism and standardization in order to secure credibility of specialization and those practicing it. Even though the interventional management has found a definite place in cancer pain, there is a dearth of evidence-based practice guidelines for interventional therapies in cancer pain. This may be because of paucity of good quality randomized controlled trials (RCTs) evaluating their safety and efficacy in cancer pain. Laying standardized guidelines based on existing and emerging evidence will act as a foundation step towards strengthening, credentialing, and dissemination of the specialty of interventional cancer pain management. This will also ensure an improved decision-making and quality of life (QoL) of the suffering patients.
  5,979 453 -
ORIGINAL ARTICLES
Caring for dying patients: Attitude of nursing students and effects of education
Mojtaba Jafari, Hossein Rafiei, Asra Nassehi, Farzaneh Soleimani, Mansuor Arab, Mohammad Reza Noormohammadi
May-August 2015, 21(2):192-197
DOI:10.4103/0973-1075.156497  PMID:26009673
Background: Education about caring for dying patients could be effective in changing nursing students' attitude toward caring for dying patients. Aim: The aim of the present study was to examine the nursing students' attitude toward caring for dying patients and effects of education on their attitude. Materials and Methods: The present study enjoys a quasi-experimental method with using one-group pre-test/post-test design conducted in Bam in southeast of Iran. The attitude of nursing students was measured using Frommelt Attitude Toward Care of the Dying (FATCOD) scale before and after an educational intervention. Data were analyzed using non-parametric tests in Statistical Package for the Social Sciences (SPSS) 18 software. Results: Of 32 students, 30 participated in this study (response rate of 94%). Only 20% of the students reported previous experience of dying patients in their clinical courses. Students showed moderately negative to neutral attitudes toward caring for dying patients. Education has improved students' attitude significantly (mean score of FATCOD before study were 3.5 ± 0.43 and after intervention were 4.7 ± 0.33) ( P < 0.001). Conclusion: Educational programs about death and caring for dying patients should be added to undergraduate nursing curricula. Further research recommended examining nursing students' knowledge about caring for dying patients and the effect of education on their knowledge.
  5,195 199 -
Nurses' knowledge and education about oral care of cancer patients undergoing chemotherapy and radiation therapy
Radhika R Pai, Ravikiran Ongole
May-August 2015, 21(2):225-230
DOI:10.4103/0973-1075.156507  PMID:26009678
Context: Oral health awareness and oral care are crucial aspects of oncology nursing practice. However very few studies concentrate on the oral care of cancer patients undergoing cancer treatment and nursing practice in the Indian subcontinent. Most of the published studies have been conducted in the Western and European countries. Aim: This study aimed to determine the nurses' knowledge and education about oral care in cancer patient undergoing chemotherapy and radiation therapy. Setting and design: A cross sectional descriptive survey was conducted among 158 staff nurses working in oncology related areas from 4 different hospitals of Dakshina Kannada district and Udupi district of Karnataka state, India. Statistical Analysis: descriptive and inferential statistics was used by using SPSS 16 version. Results: Majority 81 (51.3%) of the staff nurses had poor knowledge of oral care in cancer patients whereas 87 (55.1%) reported that knowledge acquired through basic education in oral care is not sufficient. Most of the staff nurses 115 (72.8%) did not receive basic education in oral care of cancer patients. There was significant association between knowledge and variables such as designation (.005), years of work experience (.040) and years of experience in cancer wards (.000) at 0.05 levels. Conclusion: Lack of knowledge suggest the need to develop and implement continuing nursing education programs on oral care specifically for patients receiving cancer treatments, for improving knowledge of staff nurses' in order to render comprehensive care to the patients. This study also recommends the importance of inclusion of cancer patient specific oral care in the curriculum which can enhance competency of the qualified nurses in cancer wards.
  3,850 165 -
Effects of an integrated yoga program on self-reported depression scores in breast cancer patients undergoing conventional treatment: A randomized controlled trial
Raghavendra Mohan Rao, Nagarathna Raghuram, HR Nagendra, MR Usharani, KS Gopinath, Ravi B Diwakar, Shekar Patil, Ramesh S Bilimagga, Nalini Rao
May-August 2015, 21(2):174-181
DOI:10.4103/0973-1075.156486  PMID:26009671
Aim: To compare the effects of yoga program with supportive therapy on self-reported symptoms of depression in breast cancer patients undergoing conventional treatment. Patients and Methods: Ninety-eight breast cancer patients with stage II and III disease from a cancer center were randomly assigned to receive yoga (n = 45) and supportive therapy (n = 53) over a 24-week period during which they underwent surgery followed by adjuvant radiotherapy (RT) or chemotherapy (CT) or both. The study stoppage criteria was progressive disease rendering the patient bedridden or any physical musculoskeletal injury resulting from intervention or less than 60% attendance to yoga intervention. Subjects underwent yoga intervention for 60 min daily with control group undergoing supportive therapy during their hospital visits. Beck's Depression Inventory (BDI) and symptom checklist were assessed at baseline, after surgery, before, during, and after RT and six cycles of CT. We used analysis of covariance (intent-to-treat) to study the effects of intervention on depression scores and Pearson correlation analyses to evaluate the bivariate relationships. Results: A total of 69 participants contributed data to the current analysis (yoga, n = 33, and controls, n = 36). There was 29% attrition in this study. The results suggest an overall decrease in self-reported depression with time in both the groups. There was a significant decrease in depression scores in the yoga group as compared to controls following surgery, RT, and CT (P < 0.01). There was a positive correlation (P < 0.001) between depression scores with symptom severity and distress during surgery, RT, and CT. Conclusion: The results suggest possible antidepressant effects with yoga intervention in breast cancer patients undergoing conventional treatment.
  3,587 128 -
The relationship between body esteem and hope and mental health in breast cancer patients after mastectomy
Mohammad Heidari, Mansureh Ghodusi
May-August 2015, 21(2):198-202
DOI:10.4103/0973-1075.156500  PMID:26009674
Background: Breast cancer and its treatment, including mastectomy, can cause feelings of mutilation, depreciation in the value of the body, reduction in attractiveness, and lead to mental disorders and hopelessness. Objective: The present study aimed to determine the relationship between appreciating the body, hope and mental health in women with breast cancer after mastectomy. Materials and Methods: This study was a descriptive study of 100 breast cancer patients who had undergone mastectomy and referred to the Sayed Al-Shohada Medical Center in Isfahan, Iran. The subjects were selected by convenient sampling. Data gathering tools were the Body Esteem Scale (BES), Herth Hope Index (HHI), and Symptom Checklist 25 (SCL-25) mental health questionnaire. Data analysis was performed using SPSS software. Results: Most of the patients had low body esteem. There was a significant direct linear relationship between body esteem and hope and mental health. This relationship was stronger between valuing the body and hope. Conclusion: Body esteem has a significant linear relationship with hope and mental health.
  3,143 120 -
Treating palliative care patients with pain with the body tambura: A prospective case study at St. Joseph's hospice for dying destitute in Dindigul South India
Cordula Dietrich, M Teut, Kakuko Lopoyetum Samwel, S Narayanasamy, T Rathapillil, G Thathews
May-August 2015, 21(2):236-241
DOI:10.4103/0973-1075.156509  PMID:26009680
Background: The Body Tambura is a recently invented stringed instrument that is used for receptive music therapy designed to be placed and attached on the human body. The aim of this study was to record perceived effects of a treatment with the Body Tambura on palliative care patients with special reference to pain. Materials and Methods: A prospective case study was carried out with patients of St. Joseph's Hospice for Dying Destitute in Dindigul/South India. Patients were treated with a treatment after baseline assessment and also on the next day. Outcomes were measured quantitatively by using a numeric rating scale (0-10, 10 maximum intensity of pain felt) at baseline, directly after treatment, and the day after the treatment to determine the intensity of the pain. Results: Ten patients (five women and five men) participated in the study. The majority described the therapy as a pleasant experience. The pain intensity at baseline was reduced from 8.3 ± standard deviation (SD) 1.16 to 4.6 ± 1.52 at day 1 and from 4.6 ± 2.07 to 2.4 ± 1.58 at day 2. Conclusion: A clinically relevant pain reduction was described as short time outcome; the therapy was received and perceived well. Forthcoming research should include a control group, randomization, a larger number of participants, and a longer period of treatment.
  2,908 75 -
Burden and outcomes of pressure ulcers in cancer patients receiving the Kerala model of home based palliative care in India: Results from a prospective observational study
Biji M Sankaran, Santam Chakraborty, Vijay M Patil, Sindhu N Raghavan, Shibimol Thomas, Subhradev Sen
May-August 2015, 21(2):152-157
DOI:10.4103/0973-1075.156469  PMID:26009667
Aim: To report the prevalence and outcomes of pressure ulcers (PU) seen in a cohort of cancer patients requiring home-based palliative care. Materials and Methods: All patients referred for home care were eligible for this prospective observational study, provided they were living within a distance of 35 km from the institute and gave informed consent. During each visit, caregivers were trained and educated for providing nursing care for the patient. Dressing material for PU care was provided to all patients free of cost and care methods were demonstrated. Factors influencing the occurrence and healing of PUs were analyzed using logistic regression. Duration for healing of PU was calculated using the Kaplan Meier method. P < 0.05 are taken as significant. Results: Twenty-one of 108 (19.4%) enrolled patients had PU at the start of homecare services. None of the patients developed new PU during the course of home care. Complete healing of PU was seen in 9 (42.9%) patients. The median duration for healing of PU was found to be 56 days. Median expenditure incurred in patients with PU was Rs. 2323.40 with a median daily expenditure of Rs. 77.56. Conclusions: The present model of homecare service delivery was found to be effective in the prevention and management of PUs. The high prevalence of PU in this cohort indicates a need for greater awareness for this complication. Clinical Trial Registry Number: CTRI/2014/03/004477
  2,684 130 -
The correlation between perceived social support and illness uncertainty in people with human immunodeficiency virus/acquired immune deficiency syndrome in Iran
Moosa Sajjadi, Maryam Rassouli, Narges Bahri, Fatemeh Mohammadipoor
May-August 2015, 21(2):231-235
DOI:10.4103/0973-1075.156508  PMID:26009679
Background: Illness uncertainty is a source of a chronic and pervasive psychological stress for people living with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) (PLWH), and largely affects their quality of life and the ability to cope with the disease. Based on the uncertainty in illness theory, the social support is one of the illness uncertainty antecedents, and influences the level of uncertainty perceived by patients. Aim: To examine uncertainty in PLWH and its correlation with social support in Iran. Materials and Methods: This cross-sectional correlational study was conducted with 80 PLWH presenting to AIDS Research Center, Tehran, Iran in 2013. The data collected using illness uncertainty and social support inventories were analyzed through Pearson's correlation coefficient, Spearman's correlation coefficient, and regression analysis. Results: The results showed a high level of illness uncertainty in PLWH and a negative significant correlation between perceived social support and illness uncertainty ( P = 0.01, r = -0.29). Conclusion: Uncertainty is a serious aspect of illness experience in Iranian PLWH. Providing adequate, structured information to patients as well as opportunities to discuss their concerns with other PLWH and receive emotional support from their health care providers may be worthwhile.
  2,698 115 -
REVIEW ARTICLES
Utility and potential of bedside ultrasound in palliative care
Ekta Dhamija, Sanjay Thulkar, Sushma Bhatnagar
May-August 2015, 21(2):132-136
DOI:10.4103/0973-1075.156465  PMID:26009664
Bedside ultrasound is an important tool in modern palliative care practice. It can be utilized for rapid diagnostic evaluation or as an image guidance to perform invasive therapeutic procedures. With advent of portable ultrasound machines, it can also be used in community or home care settings, apart from palliative care wards. Major applications of bedside ultrasound include drainage of malignant pleural effusions and ascites, nerve blocks, venous access, evaluation of urinary obstruction, deep vein thrombosis and abscesses. Bedside ultrasound leads to better clinical decision-making as well as more accurate and faster invasive therapeutic procedures. It also enhances patient comfort and reduces cost burden. However, use of bedside ultrasound is still not widespread among palliative care givers, owing to initial cost, lack of basic training in ultrasound and apprehensions about its use. A team approach involving radiologists is important to develop integration of bedside ultrasound in palliative care.
  2,673 136 -
ORIGINAL ARTICLES
Impact of medical intervention on stress and quality of life in patients with cancer
Vijay Prasad Barre, Gadiraju Padmaja, Ravi Kumar Saxena, Suvashisa Rana
May-August 2015, 21(2):203-208
DOI:10.4103/0973-1075.156503  PMID:26009675
Context: Many studies have explored stress and quality of life in (QOL) patients with cancer, under several phases of disease and treatment. However, the impact of medical intervention on psychological parameters, such as stress and quality of life focusing on psychological intervention has been sparsely studied. Aims: The main aim of the study was to examine the impact of medical intervention on the level of stress and quality of life of patients with lung, breast, and head and neck cancers. Settings and Design: The study was carried out in hospital settings by following a one-group pre-test-post-test pre-experimental design. Statistical analysis used: The quantitative data were analysed by means of descriptive statistics, paired t-tests, Cohen's d, and bar graphs accordingly. Results: The effect of medical intervention was medium in case of reduction of overall stress in participants. So far as the components are concerned, the effect was high in case of psychosomatic complaints, medium in case of fear and information deficit, and low in case of everyday life restrictions. The effect of medical intervention in respect of the quality of life was found to be high in case of symptom scale (pain) and additional symptoms (constipation); medium in case of functional scale (emotional functioning, cognitive functioning) and symptoms scale (nausea, vomiting). In additional symptoms scale the effect of medical intervention was found to be medium in dyspnoea and appetite loss. Conclusions: The findings revealed that though the medical intervention reduced stress and improved the quality of life, it was not instrumental in bringing down the stress to minimal level and enhancing the quality of life to optimum level. Therefore, the findings point to the need of inclusion of psychological intervention along with the medical intervention for minimizing stress and optimizing the quality of life of patients with cancer.
  2,582 110 -
The prevalence of severe pain, its etiopathological characteristics and treatment profile of patients referred to a tertiary cancer care pain clinic
PN Jain, Kaveri Pai, Aparna S Chatterjee
May-August 2015, 21(2):148-151
DOI:10.4103/0973-1075.156467  PMID:26009666
Pain is the most feared symptom in cancer. About 52-77% patients suffer pain despite World Health Organization (WHO) recommendations. Out of total, one-third patients suffer moderate to severe pain. This study was undertaken to determine the prevalence, etiopathogenesis and characteristics of severe pain and treatment response among pain clinic referrals in a busy tertiary care cancer center. This study found a high prevalence (31.5%) of severe pain. A total of 251 patients who had complete pain data were analyzed for etiopathological characteristics and treatment response. Head and neck cancer contributed the highest prevalence among all regions. Oncologists prescribed non-steroidal anti-inflammatory drugs (NSAIDs) or paracetamol with or without mild opioids to 14% patients and pain clinic physicians prescribed opioids and overall 63.7% patients had a better response after pain clinic referral, even then, morphine was not prescribed to many deserving patients. Doctors need pain education about opioids to remove any fear of prescribing opioids in presence of severe pain.
  2,381 155 -
Preserving self-concept in the burn survivors: A qualitative study
Vahid Zamanzadeh, Llila Valizadeh, Mojgan Lotfi, Feridoon Salehi
May-August 2015, 21(2):182-191
DOI:10.4103/0973-1075.156492  PMID:26009672
Background: Burn injury is a devastating experience affecting all aspects of a person's essence, including his/her identity and perception. These patients require complex cognitive efforts to redefine their identity to deal with difficult condition after burn injury and preserve self-concept. The experience of life after burn injury is generally a solitary one, closely related to the patients' cultural and religious context. Therefore, this study was conducted aiming at investigating burn patients' experiences regarding how to preserve self-concept in life after burn injury in Iran. Materials and Methods: This qualitative study was carried out using qualitative content analysis and in-depth unstructured interviews with 17 surviving burn subjects. Results: During the qualitative content analysis process, the concept of "locating" as the essence of the participants' experience was extracted as follows: (A) self-exploration (exploring the changes in one's life), (B) others' exploration (exploring the changes in the life of family members and the relationship between self and others), (C) position evaluation (self-position analysis), and (D) self-concept preservation. Conclusion: The present study has developed new understandings of mental experiences of burn patients' self-concept by describing the concept of "self-locating." It helps us in classifying and understanding the concepts described in comprehensive theories developed in this area. They do this by focusing on what burn patients experience for choosing self-preservation strategies and having a meaningful life. The finding can be used as a conceptual framework for palliative care program in Iran.
  2,420 99 -
Attitudes and knowledge of Iranian nurses about hospice care
Saber Azami-Aghdash, Hossein Jabbari, Fariba Bakhshian, Leila Shafaei, Soheyla Shafaei, Kasra Kolahdouzan, Mohammad Mohseni
May-August 2015, 21(2):209-213
DOI:10.4103/0973-1075.156505  PMID:26009676
Context: Due to expansion of chronic diseases and increase of health care costs, there is a need for planning and delivering hospice care for patients in their final stages of life in Iran. The aim of the present study is to investigate the knowledge and attitudes of nurses about delivering hospice care for End of Life (EOL) patients. Materials and Methods: This cross-sectional study was conducted in 2012 with a sample size of 200 nurses that were selected by convenient (available) sampling. The data collection instrument was a self-administered questionnaire whose validity was approved by experts' opinions and its reliability was approved by test-retest method. Results : Among all participants of this study, 87% were female. The mean age of nurses was 32.00 ± 6.72. From all respondents 62% stated that they have no knowledge about hospice care and 80% declared that need for hospice care is increasing. Most of the participants felt that, appropriate services are not presented to patients in the final stages of their lives. About 80% believed that hospice care leads to reduction of health care costs, improvement of physical, mental and social health of patients and finally improvement of the quality of health care services. There was a significant relationship between age, employment history and level of education of nurses and their attitude and knowledge about how this service is provided. Conclusion : In view of the increase in chronic illnesses and the costs of caring, the need for provision of hospice care is felt more and more every day. However the awareness level of nurses about these services is low. Therefore the need for including these issues in nursing curriculum and holding scientific courses and seminars in this field is needed.
  2,389 110 -
Continuing professional development for volunteers working in palliative care in a tertiary care cancer institute in India: A cross-sectional observational study of educational needs
Jayita Kedar Deodhar, Mary Ann Muckaden
May-August 2015, 21(2):158-163
DOI:10.4103/0973-1075.156475  PMID:26009668
Context: Training programs for volunteers prior to their working in palliative care are well-established in India. However, few studies report on continuing professional development programs for this group. Aims: To conduct a preliminary assessment of educational needs of volunteers working in palliative care for developing a structured formal continuing professional development program for this group. Settings and Design: Cross-sectional observational study conducted in the Department of Palliative Medicine of a tertiary care cancer institute in India. Materials and Methods: Participant volunteers completed a questionnaire, noting previous training, years of experience, and a comprehensive list of topics for inclusion in this program, rated in order of importance according to them. Statistical Analysis Used: Descriptive statistics for overall data and Chi-square tests for categorical variables for group comparisons were applied using Statistical Package for Social Sciences version 18. Results: Fourteen out of 17 volunteers completed the questionnaire, seven having 5-10-years experience in working in palliative care. A need for continuing professional development program was felt by all participants. Communication skills, more for children and elderly specific issues were given highest priority. Spiritual-existential aspects and self-care were rated lower in importance than psychological, physical, and social aspects in palliative care. More experienced volunteers (>5 years of experience) felt the need for self-care as a topic in the program than those with less (<5-years experience) ( P < 0.05). Conclusions: Understanding palliative care volunteers' educational needs is essential for developing a structured formal continuing professional development program and should include self-care as a significant component.
  2,174 97 -
Analysis of patterns of palliative radiotherapy in north west India: A regional cancer center experience
Akhil Kapoor, Mukesh Kumar Singhal, Narender Kumar, Ashok Kalwar, Puneet Kumar Bagri, Satya Narayan, Raj Kumar Nirban, Harvindra Singh Kumar
May-August 2015, 21(2):168-173
DOI:10.4103/0973-1075.156482  PMID:26009670
Background: Palliative radiotherapy (PRT) is the eventual requirement in 30-50% of all cancer patients. PRT is primarily aimed to relieve pain and prevent/treat collapse or fracture in case of bone metastasis, to reduce edema in patients with cranial metastasis, and to control distressing symptoms of rapid primary growth. An audit of PRT planned in a busy cancer center can help in the characterization of the requirements of the patients and the formulation of institutional policies. Materials and Methods: In total, 516 patients who received PRT in our regional cancer center from January 2012 to December 2012 and whose complete records were available for analysis were selected for this retrospective study. Medical records and radiotherapy files were analyzed to obtain data such as sociodemographic parameters, prescription of PRT, and follow up. Descriptive statistics were evaluated in terms of frequencies and percentages to allow comparisons. Results: Of the 516 patients, 73% patients were male; the median age of the patients receiving PRT was 62 years (range 13-83 years). About 48% ( n = 248) patients received PRT at the primary site while rest (52%) were given PRT at the metastatic site. The most common indication of PRT was pain (56.8% cases), followed by cytostatic PRT (19.8%) and raised ICT (12.4%). The median dose prescribed was 30 Gy (range 8-36 Gy) delivered in 1-12 fractions over the duration of 1-18 days. The overall response rate was about 43% at 2 weeks of completion of PRT; the median follow-up of the patients was 154 days (range 9-256 days). The long-term symptom relief at median follow up was 8%. Conclusions: Good clinical judgment and expertise is required in prescribing correct fractionation schedule to achieve effective symptom palliation with lowest possible cost and inconvenience to the patients and relatives. Hypofractionated radiotherapy is a feasible treatment option in patients with advanced incurable disease to achieve effective palliation.
  2,169 85 -
Audiometric patterns in ototoxicity after radiotherapy and chemotherapy in patients of head and neck cancers
Monika Shamrao Malgonde, PS Nagpure, Manoj Kumar
May-August 2015, 21(2):164-167
DOI:10.4103/0973-1075.156479  PMID:26009669
Introduction: Inspite of various strategies adopted to protect the sensitive structures during organ preservation strategies, radiation damage can occur from the pharyngotympanic tube to the brain stem auditory pathway causing hearing loss. The purpose of this study is to evaluate the audiometric abnormalities and characterize them among the patients of head and neck cancers who have undergone radiotherapy (RT) and chemoradiation therapy (CT+RT). Materials and Methods: Sixty-six histopathologically proven head and neck cancer patients receiving RT and 34 patients receiving concomitant CT + RT underwent evaluation for audiometric abnormalities from 1 st September 2010 to 31 st August 2012. Results: Hearing losses were predominately of sensorineural type and mild. Patients who received concomitant CT+RT experienced greater sensorineural hearing loss compared with patients treated with RT alone. A paired sample t-test was conducted to compare the hearing losses before therapy and 6 and 12 months after therapy and was found to be significant ( P < 0.05). It was found that hearing loss was persistent. Significant difference was found in the proportion of hearing loss after RT and RT+CT ( P < 0.05) after 1 month. In addition, mixed hearing loss occurred due to damage to the middle ear contents and can be improved if intervened appropriately.
  2,137 104 -
CASE REPORTS
Metronomic chemotherapy in anaplastic thyroid carcinoma: A potentially feasible alternative to therapeutic nihilism
Swaroop Revannasiddaiah, Irappa Madabhavi, Anita Bodh, Priyanka Thakur, Mukesh Sharma
May-August 2015, 21(2):245-249
DOI:10.4103/0973-1075.156511  PMID:26009682
Anaplastic thyroid carcinoma (ATC) is one of the most aggressive malignancies and prognostic outlook remains very dismal. Treatment most often is palliative in intent attempting to relieve the patients from local compressive symptoms in the neck. Radical surgery, radiotherapy (RT), and chemotherapy have not been tested in large prospective trials, and current evidence from retrospective series and small trials indicate only marginal survival benefits. Given the poor prognostic and therapeutic outlook, patients must be encouraged to be actively involved in the decision making process. We report the case of an elderly patient who had no response to palliative RT, and was treated with oral metronomic chemotherapy. The response to oral metronomic chemotherapy was dramatic, and the patient has enjoyed complete freedom from symptoms as well as radiologically exhibits a complete regression. Thus, we document the first ever use of a simple, cost-effective, and convenient oral metronomic chemotherapeutic regimen delivering a remarkable response in an elderly patient with ATC.
  2,091 97 -
REPORT
Indian association of palliative care conference: February 13-15 th 2015, Hyderabad
Michael Minton
May-August 2015, 21(2):129-131
DOI:10.4103/0973-1075.156463  PMID:26009663
  2,049 116 -
EDITORIAL
Live forever, for the moment
Naveen Sulakshan Salins
May-August 2015, 21(2):127-128
DOI:10.4103/0973-1075.156461  PMID:26009662
  1,961 131 -
PERSONAL REFLECTION
Palliative home care: A designer's perspective
Tigmanshu Bhatnagar
May-August 2015, 21(2):250-252
DOI:10.4103/0973-1075.156512  PMID:26009683
The purpose for this observational research was to understand how Can Support provides palliative care at home and analyze its strengths and weaknesses in various socioeconomic scenarios for future development. In the period of 2 weeks, patients and their caregivers were silently observed in their natural surroundings during home care visits in order to listen their problems, identify the pattern of questions for the home care team, their natural way of storytelling, organizational techniques for medicines and medical reports, care givers lives, patient journey, etc. Such observations have enabled the understanding of the phenomena of home palliative care and have led to the identification of certain influential variables of the practice.
  1,895 126 -
CASE REPORTS
Metastatic adenocarcinoma of prostate in a 28-year-old male: The outcome is poor in young patients?
Renu Madan, Lavleen Singh, Kunhi Parambath Haresh, Goura Kishore Rath
May-August 2015, 21(2):242-244
DOI:10.4103/0973-1075.156510  PMID:26009681
Prostate cancer is common in older patients. Rarity in younger population limits the study of natural history and prognosis in this population. Most of the published data has reported poor outcome in younger patients with metastatic prostate cancer. Here, we report a case of prostate cancer in 28-year-old male who presented with bone metastasis. After bilateral inguinal orchidectomy, he was started on anti-androgen therapy and received palliative radiotherapy for bone metastasis. There was only a slight decrease in prostate-specific antigen (PSA) level and pelvic disease post treatment. Subsequently, he was started on opioid analgesics (by World Health Organization, WHO, step ladder) in view of persistent pain. The index case is being presented for its rarity and probable poor outcome in young patients and to stress on the fact that the possibility of primary prostatic adenocarcinoma should be investigated in a male presenting with bone metastasis irrespective of the age.
  1,918 89 -
LETTERS TO EDITOR
Caregivers' perspective on home-based care of operated neurosurgery patients discharged from PGIMER, Chandigarh, India
Vishal Kumar, Amarjeet Singh, Manoj K Tewari, Sukhpal Kaur
May-August 2015, 21(2):253-254
DOI:10.4103/0973-1075.156513  PMID:26009684
  1,559 78 -
Nicotine replacement therapy for the palliation of nicotine abstinence syndrome: Boon more than bane
Roshan Bhad, Nandita Hazari
May-August 2015, 21(2):254-255
DOI:10.4103/0973-1075.156514  PMID:26009685
  1,516 69 -
Online since 1st October '05
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