Search

Background: Psychological factors have a key role in affecting the clinical outcome of a disease. Studies have found an alteration in the immune system and endocrine function in patients with psychological stress. Cancer patients often display these symptoms. This study aims to find out the prevalence and factors affecting the presence of preoperative depression, anxiety, and stress in cancer patients by using the Depression Anxiety Stress Scale-42 (DASS 42). Methods: Three hundred and sixty patients were included in the study who were posted for cancer surgery. They were required to answer a questionnaire where details were collected about the sociodemographic and economic background, type of cancer and treatment received, details about the presence of pain, and if the patient is on any analgesics. Data were analyzed using Stata version 16, and multivariate analysis was done using logistic regression. Results: The prevalence of depression, anxiety, and stress was found to be 16.11%, 32.5%, and 12.78%, respectively. Logistic regression analysis revealed that marital status and type of surgery proposed predicted depression; anxiety was significantly contributed by the type of surgery proposed and analgesic the patient is taking; whereas marital status, type of surgery proposed, and analgesic the patient is taking predicted stress. Conclusion: Married patients are more likely to suffer from depression and stress. Patients undergoing palliative surgery will be prone to all kinds of negative emotions including depression, anxiety, and stress. The type of analgesics, which the patent is taking as prescribed based on the World Health Organization (WHO) ladder for cancer pain also significantly influences anxiety and stress. [ABSTRACT FROM AUTHOR]

Byline: Sourav. Burman, Rakesh. Garg, Sushma. Bhatnagar, Seema. Mishra, Vinod. Kumar, Sachidanand. Bharati, Nishkarsh. Gupta Introduction: Awareness of end-of-life care (EOLC) has been at grass root level in our country. [...]

Background and Aims: Intubation in head and neck carcinoma (HNC) is difficult due to many reasons. Various guidelines recommend strategies for airway management in such anticipated difficult airway cases. However, literature is limited on airway management planning as per the level of difficulty based on airway assessment in these patients. EL-Ganzouri risk index (EGRI) has been proposed to aid in making airway management plan in HNC cases by some authors. This retrospective study was conducted to look at the data related to the pre-anesthetic airway assessment and the airway management plan executed by the anesthesiologists in 1000 patients of HNC in the previous nearly four years in order to determine how the choices made conformed to EGRI scores. Material and Methods: Records of all the patients with oral cancer posted for surgery over four years from January 2014 to December 2017 were retrospectively analyzed for preoperative airway assessment using El Ganzouri risk index assessment (EGRI), the intraoperative technique for nasotracheal intubation, airway management plan, and any intraoperative complications. Results: The risk of predicted airway difficulty was low (EGRI <4) in 38 patients and was high in the rest. The EGRI score was higher in the FOB group [4-9] as compared to DL [2-3] and VL [1-6]. The patients with EGRI >7 were intubated awake and those with EGRI <7 were intubated under general anesthesia (79.8%). Overall, the technique of choice for intubation was fibreoptic bronchoscopy (54%) followed by video laryngoscopy (42.6%). Conclusion: The airway management plan used in a tertiary care cancer center conformed to the approach suggested by the multivariate El Ganzouri risk index (EGRI). EGRI appears to be a useful means to ascertain the appropriate strategies for intubation in head and neck cancer patients. [ABSTRACT FROM AUTHOR]

Background and Aims: Anesthetic management for brachytherapy require repeated exposure to anesthesia in elderly patients with comorbidities. The varying locations provide an anesthesiologist with further challenges. Material and Methods: We studied retrospectively anesthesia type, details of anesthetic techniques and complications that occurred in patients having received anesthesia for brachytherapy in our institute in the last 6 years. Categorical variables were described as frequency and percentage, and continuous variables described as median and interquartile range. For continuous variables, mean values compared using two sample t tests for independent samples. Results: The majority of patients were females who received brachytherapy for carcinoma cervix. A higher percentage of carcinoma breast and male genitourinary malignancies had comorbidities. Predominant side effects included 22 (1.85%) had hypotension, 19 (1.59%) had difficulty in putting spinal, 13 (1.09%) patients had tachycardia and 11 (0.92%) had headache in the postoperative period. Conclusion: Neuraxial block as anesthetic technique in pelvic brachytherapy using fentanyl as additive helped reduce the dose of local anesthetic and avoided the complications of high spinal. The choice of anesthesia can vary depending on the duration and site of brachytherapy keeping in consideration the patient's factors. [ABSTRACT FROM AUTHOR]

Objectives: The availability of routine care for patients with cancer during the coronavirus disease 2019 (COVID-19) pandemic has become challenging, and the use of telemedicine can be promising in this area. The objective of the study is to evaluate the feasibility of telemedicine-based palliative interventions in cancer patients. Materials and Methods: This retrospective study was conducted in a tertiary care centre with 547 follow-up patients who used palliative medicine teleconsultation services. The following data were retrieved from the records: Patient's reason for the call, the main barriers to a hospital visit, the assistance given to them by the physician on the call and the patients' satisfaction with the service on a 4-point scale. The data were analysed using percentages for categorical variables and mean/standard deviation for quantitative variables. Results: Out of the 547 patients, 462 (84.46%) utilised voice calling service, and the major reason for not visiting the hospital were cited to be fear of contracting COVID-19 (37.3%), inability to attend due to health constraints (7.13%) and issues with transportation (48.8%). The majority of the calls (63.62%) calls were regarding uncontrolled symptoms of the primary diseases. A total of 402 (73.49%) patients were very satisfied, and a total of 399 (72.94%) decided to continue to use this medium in the future as well. Conclusion: Telemedicine is a good modality for the assessment of chronic pain and providing symptomatic supportive care in patients with cancer in the COIVD-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Opioid-induced constipation (OIC) causes a significant worsening of quality of life (QOL). The patient assessment of constipation QOL questionnaire (PAC-QOL) is a validated scale in English language to assess the QOL in patients with chronic constipation and guide the management by measuring response to a targeted therapy. Objective: The objective of the study was to evaluate the validity and reliability of PAC-QOL questionnaire after translation in Hindi language for Indian cancer patients with OIC. Materials and Methods: This was a prospective observational cross-sectional study. Three hundred and thirteen adult cancer patients receiving opioid treatment for pain and experiencing self-reported symptoms of constipation were evaluated. The severity of constipation was assessed at baseline and at an interval of at least 2 weeks by the physician using constipation scoring system (CSS) and self-reported Hindi version of PAC-QOL questionnaire. Results: The data obtained from 313 patients were taken for analysis. The internal consistency of the tool was established with the favorable value of Cronbach's alfa coefficient (i.e., >0.70) obtained for all four subgroups and overall score. The intraclass correlation coefficient value of >0.70 also established good correlation between overall and subgroups scores of Hindi version of PAC-QOL, obtained at 1st and 2nd visit. It was observed from the result that a significant correlation existed between the overall and subgroups scores of Hindi version of PAC-QOL and CSS, thus establishing concurrent validity. Conclusion: It was concluded from the study results that Hindi version of PAC-QOL is both reliable and valid to assess the QOL in patients with OIC. [ABSTRACT FROM AUTHOR]

Aim: Informal caregivers of cancer patients have extensive burdens. They are susceptible for deterioration of their quality of life (QOL). We aimed to assess caregiver burden and QOL of family caregivers of cancer patients receiving chemotherapy admitted in the ward/intensive care unit/high-dependency unit. Materials and Methods: This prospective observational study including 178 caregivers was carried out in a tertiary care hospital. The assessment of caregiving burden was done using the Zarit Burden Interview and its impact on QOL using the WHO BREF QOL questionnaire. Results: The mean age and mean Zarit Burden score of caregivers were 38.98 ± 10.53 and 30.697 ± 8.96, respectively. Of the total, 70.22% of caregivers reported mild-to-moderate burden and 21.38% reported moderate-to-severe burden. On assessment of QOL WHO BREF, the mean general score was 5.79 ± 1.84, physical health score was 49.65 ± 16.07, psychological health 51.85 ± 20.43, social relations 59.38 ± 21.43, and environmental 58.73 ± 17.51. The QOL scores were slightly better in mild-to-moderate burden compared to moderate-to-severe burden but not statistically significant except for social relations (P = 0.053). We did not find any difference in burden scores or QOL between male and female caregivers. Conclusion: Mild-to-moderate burden was seen in 70.22% of caregivers and 21.38% had moderate-to-severe burden. [ABSTRACT FROM AUTHOR]

Introduction: During the current COVID-19 crisis, striking a balance between adequate pain relief in advanced malignancy patients and avoiding hospitals due to fear of contracting the infection has been the biggest challenge for patients as well as palliative care physicians. This study explored the trends in opioid dispensing for cancer pain before and during the lockdown. Methods: The trends were calculated based on an analysis of quantity of all opioids dispensed. March 24, 2020, was considered as a cutoff for analyzing before and during lockdown period dispensing trends. No information regarding individual patients was retrieved in the current study. Results: There was a decrease in total morphine, tramadol, and fentanyl patch dispensing parallel to decrease in total number of patients visiting the outpatient department. However, there was a statistically significant increase in per capita opioid dispensing during the lockdown period. There was also an increase in the proportion of cancer pain patients that were dispensed morphine during the lockdown. Conclusion: Despite the lockdown, the palliative care team at Institute Rotary Cancer Hospital has continued to provide adequate pain relief to patients that could manage to reach the center. Policy-makers need to be cognizant of the pain relief needs of cancer patients in times when accessing hospitals is becoming increasingly difficult. Cancer-related pain and mortality could well be the next pandemic once the current COVID-19 begins to reduce. [ABSTRACT FROM AUTHOR]

Background and Aims: With the COVID-19 pandemic, lockdown, and fear from contagion, the advantages of telemedicine are clearly outweighing the setbacks by minimizing the need for individuals to visit health-care facilities. Our study aims to assess how palliative medicine physicians could follow up on cancer patients and barriers they faced, discuss their results, and evaluate their treatment response with the help of telemedicine. Materials and Methods: We conducted a prospective analysis of the smartphone-based telemedicine service at our palliative care (PC) unit from March 25, 2020, to May 13, 2020. We recorded the patient's reason for call, main barriers to a hospital visit, and the assistance given to them by the physician on call. Each caller was asked to measure his/her satisfaction with the service on a 4-point scale. Results: Out of 314 patients, 143 (45.54%) belonged to Delhi and 171 (54.46%) belonged to other states. 157 patients sought help for symptom management; 86 patients needed to restock their opioid medications. Seventy-one patients required information regarding their oncological treatments requiring consultation from other departments. Titration of oral opioids and medication prescription (n = 129), contact details of other PC units at their native state for opioid procurement (n = 55), and attachment to our community-based PC service (n = 22) were main modes of management. Fifty-six patients were very satisfied and 152 patients were satisfied with the service. Conclusion: Telemedicine is the future of health-care delivery systems. In PC, we deal with immunocompromised debilitated cancer patients and telemedicine is immensely helpful for us to provide holistic integrated care to these patients who are unable to visit hospitals regularly. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 pandemic has shaken the health-care infrastructure worldwide and has led to enormous challenges for cancer patients. They are suffering on various fronts during this pandemic, especially the often overlooked ones such as logistic and socioeconomic. Through the case series, we have highlighted the various components of these challenges the cancer patients are facing and tried to emphasize that the health-care setups and government along with nongovernmental organizations have to come on the forefront to help the patients mitigate these challenges. [ABSTRACT FROM AUTHOR]

World is facing a pandemic recently due to the outbreak of COVID-19 infection. Cancer has been identified as one of the major comorbidities which cause more severe disease due to COVID-19 infection. Moreover, there are several resource limitations and restrictions to avail the standard oncological health facilities due to robust measures taken for infection control. In this situation, palliative care in cancer patients deserves special attention. Their symptom management, psychological, social, cultural needs tremendously increase during the epidemic. Thus, we need to recognize the unique palliative care needs of cancer patients during pandemic and formulate the plan to maintain continuity of services. Triaging systems are essential tools for proper resource allocation during a pandemic. Therefore, we suggest triaging tools for emergency in hospital palliative care services: community-based palliative care and end of life care for cancer patients. Incorporation of newer technologies and identifying the potential resources are the other key components of the preparedness strategy. [ABSTRACT FROM AUTHOR]

Caregivers of cancer patients in the COVID-19 pandemics have been faced with new complexities and challenges related to their patient's care. It has added tremendous stress to the previous multiple caregiving roles. We present the journey of a caregiver of cancer survivor who had played multiple care giving roles for the past 10 years. With the added challenge of the pandemic the caregiver faced severe psychological distress concerning his caregiving role. This was addressed to a large extend with counseling and empathy. Communication is an important measure to relieve the distress and address the complexities faced by caregivers. [ABSTRACT FROM AUTHOR]

Palliative surgery forms an important pillar of palliative treatment to provide holistic care to cancer patients in the form of providing relief from pain, local control of disease, hemorrhage, and for the purpose of rehabilitation. During the COVID-19 pandemic, we report the successful management of two cases of colorectal cancer which came under the category of high priority and underwent palliative surgery to provide relief from pain. [ABSTRACT FROM AUTHOR]

Introduction: The phantom limb pain (PLP) and phantom limb sensation (PLS) are very common among amputated cancer patients, and they lead to considerable morbidity. In spite of this, there is a lack of epidemiological data of this phenomenon among the Asian population. This study was done to provide the data from Indian population. Methods: The prevalence of PLP, stump pain (SP), and PLS was prospectively analyzed from the amputated cancer patients over a period of 2 years in Dr. B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi. The risk factors and the impact of phantom phenomenon on patients were also noted. Results: The prevalence of PLP was 41% at 3 and 12 months and 45.3% at 6 months, whereas that of SP and PLS was 14.4% and 71.2% at 3 months, 18.75% and 37.1% at 6 months, 15.8% and 32.4% at 12 months, respectively. There was higher prevalence of PLP and PLS among the patients with history of preamputation pain, smoking with proximal level of amputation, receiving general anesthesia, receiving intravenous (IV) opioid postoperative analgesia, and developing neuroma or infection. Conclusion: The prevalence of PLP and PLS was higher among the cancer amputees as compared to SP, and a few risk factors responsible for their higher prevalence were found in our study. The PLP and PLS lead to considerable morbidity in terms of sleep disturbance and depression. [ABSTRACT FROM AUTHOR]

Morphine has been used for many years to relieve cancer pain. Oral morphine (in either immediate release or modified release form) remains the analgesic of choice for moderate or severe cancer pain. The dose of oral morphine is titrated up to achieve adequate relief from pain with minimal side effects. Antidepressant and anticonvulsant drugs, when used in addition to conventional analgesics, give excellent relief from cancer pain. Most cancer pain responds to pharmacological measures with oral morphine but some pain like neuropathic and bony pain, pain in children and elderly age group, and advanced malignancy pain are very difficult to treat. Here, we report the management of a similar patient of severe cancer pain and the difficulty that we came across during dose titration of oral morphine and adjuvant analgesic. [ABSTRACT FROM AUTHOR]

Cancer pain is multifactorial and complex. The impact of cancer pain is devastating, with increased morbidity and poor quality of life, if not treated adequately. Cancer pain management is a challenging task both due to disease process as well as a consequence of treatment-related side-effects. Optimization of analgesia with oral opioids, adjuvant analgesics, and advanced pain management techniques is the key to success for cancer pain. Early access of oral opioid and interventional pain management techniques can overcome the barriers of cancer pain, with improved quality of life. With timely and proper anticancer therapy, opioids, nerve blocks, and other non-invasive techniques like psychosocial care, satisfactory pain relief can be achieved in most of the patients. Although the WHO Analgesic Ladder is effective for more than 80% cancer pain, addition of appropriate adjuvant drugs along with early intervention is needed for improved Quality of Life. Effective cancer pain treatment requires a holistic approach with timely assessment, measurement of pain, pathophysiology involved in causing particular type of pain, and understanding of drugs to relieve pain with timely inclusion of intervention. Careful evaluation of psychosocial and mental components with good communication is necessary. Barriers to cancer pain management should be overcome with an interdisciplinary approach aiming to provide adequate analgesia with minimal side-effects. Management of cancer pain should comprise not only a physical component but also psychosocial and mental components and social need of the patient. With risk-benefit analysis, interventional techniques should be included in an early stage of pain treatment. This article summarizes the need for early and effective pain management strategies, awareness regarding pain control, and barriers of cancer pain. [ABSTRACT FROM AUTHOR]

Background: Cancer pain is often intractable and has a considerable impact on the quality of life. Nociceptive pain is easily recognized and managed using conventional analgesics. The neuropathic component makes cancer pain difficult to manage. The epidemiology of neuropathic pain in cancer patients has not been well documented. Aim of the study: This retrospective study attempted to discern the prevalence of neuropathic pain over a period of 2 years, in cancer patients at the Pain and Palliative Care Clinic of a tertiary care cancer center in India. The study also aimed to describe the approach to neuropathic cancer pain alleviation. Materials and methods: A retrospective analysis of 3238 cancer patients who presented with complaints of pain during 2006–2008 was undertaken. Findings including type and intensity of pain, initial evaluation, treatment initiated, and other associated symptoms were recorded at the initial visit and 1 week, 1 month, and 6 months thereafter. Pain with a burning, radiating, or shooting component was considered to be neuropathic. Results: The prevalence of neuropathic pain in cancer pain patients was found to be 11.8%. Oral morphine emerged as the commonest cancer pain management modality (95.8% of patients). However, 29.89% of our patients with neuropathic pain required interventional blocks for adequate pain relief. Conclusion: The present study highlights the significance of neuropathic pain as an integral component of cancer pain and further provides insight into its management. [ABSTRACT FROM AUTHOR]

Background: Approximately one half to two thirds of patients with cancer-related pain experience breakthrough pain (BTP) in their daily activities. Objective: This is the first report to determine the prevalence and characteristics of BTP experienced by patients with head and neck cancer. Methods: This was a prospective cross-sectional study conducted in patients with head and neck cancer on stable doses of opioid (morphine) for at least 1 week. This study was designed as a cross-sectional study using a series of breakthrough pain questionnaires (BPQ). Results: Prevalence of BTP in our study was 48% (average of 3.85 episodes per day) of which more than 50% of episodes were of gradual onset but with severe intensity. Incident pain was predominate (50%) followed by spontaneous (25%) and end of dose failure (20%) and in 5% the nature of pain was unknown or mixed. Unlike other studies the onset of BTP in this present study with head and neck cancer was more gradual and lasted longer than 30 minutes. Conclusions: Patients with head and neck cancer do suffer a lot because of the high incidence of BTP (48%). The majority of patients suffering from BTP are not satisfied at all with the measures taken for their BTP. The majority of patients in India have head and neck cancer; we must approach this matter as a challenge and new technique and therapy should be introduced for the benefit of these patients. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

To determine equivalence of modified gemcitabine and oxaliplatin compared with gemcitabine and cisplatin in unresectable gallbladder cancer (GBC). Primary end-point was overall survival (OS). Open label, prospective, randomised phase III equivalence study. Inclusion criteria included histologically proven unresectable GBC, 18 years or older, adequate organ functions and Eastern Cooperative Oncology Group ≤2. 108 patients were required in each arm to have an equivalence margin of ±2 months with power of 80%. Modified gemcitabine and oxaliplatin (mGemOx)—gemcitabine 900 mg/m2, oxaliplatin 80 mg/m2, maximum 6 cycles; gemcitabine + cisplatin (CisGem)—gemcitabine 1000 mg/m2, cisplatin 25 mg/m2, maximum 8 cycles, all day 1 and 8 every 3 weeks. Two hundred sixty subjects were recruited between February 2011 and July 2015. Two hundred forty-three patients (119, mGemOx and 124, CisGem) received at least 1 dose and analysed for safety and efficacy (modified intention to treat). Median OS was 8·5 months for whole group (95% confidence interval [CI]: 7·9–9·1). Median OS in mGemOx was 9 months and 8·3 months in CisGem; p = 0·057 (hazard ratio = 0·78; 95% CI = 0·60-1·02). Restricted mean OS for follow-up limited to 30 months was 11·2 months (95% CI: 9·8–12·6) in mGemOx and 10·4 months (95% CI: 9·1–11·7) in CisGem. Difference of the mean was 0·8 months with 95% CI, exceeding 2 months (−1·1 to 2·7), hence rejecting equivalence. Peripheral neuropathy, thrombocytopaenia in mGemOx and nephrotoxicity was higher with CisGem. This trial failed to show equivalence of eight cycles of CisGem to six cycles of mGemOx. Numerically OS was better with mGemOx. Toxicities were different. The trial was not powered to answer superiority. CTRI/2010/091/001406. • No randomised controlled trials have compared CisGem and mGemOx in unresectable gallbladder cancer. • A phase III randomised equivalence study with 2 months of equivalence margin was conducted. • 243 subjects were analysed in modified ITT analysis. • Median overall survival in mGemOx was 9 months and 8·3 months in CisGem. • Results confirmed that 8 cycles of CisGem were not equivalent to 6 cycles of mGemOx. [ABSTRACT FROM AUTHOR]

Breast cancer is one of the most prevalent cancers amongst women in the world. Unfortunately, even after adequate treatment, some patients experience severe pain either due to disease progression or due to treatment related side effects. The persistent pain causes a negative physical and psychosocial impact on patients' lives. Current rational pain management is patient-centred and requires a thorough psychological assessment. Usually adequate analgesia is achieved by adopting the WHO's three step analgesic ladder. As the disease progresses, the pain experienced by the patient also increases. This necessitates the administration of opioids and adjuvant analgesics to the breast cancer patients experiencing severe pain. However, opioid use is associated with intolerable side effects like constipation, nausea, vomiting, fear of dependence, and tolerance. Concomitant medications are required to combat these unacceptable side effects. Adjuvant analgesics need to be added to provide adequate and satisfactory analgesia. These factors worsen the psychological state of patients and deteriorate their quality of life. Hence, there is a need to develop therapeutic modalities to provide adequate analgesia with minimum side effects. This review article focuses on the current treatments available for cancer pain management, their limitations, and novel targets and non-pharmacological measures under investigation which have the potential to produce a radical change in pain management measures for the breast cancer patients. [ABSTRACT FROM AUTHOR]