Indian Journal of Palliative Care最新文献

Objectives: Pain is a prevalent and debilitating symptom in cancer patients, significantly affecting their quality of life. This study aimed to evaluate pain severity, its management and associated factors in patients undergoing chemotherapy in a tertiary care centre.

Materials and methods: A single-centre observational study was conducted at the Department of Medical Oncology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India, from January 2024 to June 2024. One hundred and four chemotherapy patients were assessed using the numerical rating scale to evaluate pain severity. Data on demographic characteristics, chemotherapy regimens and pain management strategies were collected.

Results: Of 104 patients, 54% were female and 46% were male. Pain scores indicated mild (45%), moderate (28%) and severe pain (10%) levels, with females reporting higher pain scores than males. Cancer staging revealed that 15% of patients were in Stage I, 20% in Stage II, 40% in Stage III and 25% in Stage IV. Pain intensity correlated with cancer progression, with severe pain predominantly observed in Stage III and IV patients. Individualised pain management using weak-to-moderate analgesics was effective in reducing pain intensity, though advanced-stage patients required stronger opioid-based interventions.

Conclusion: Effective pain management tailored to individual pain levels significantly improved patient comfort. Future research should focus on refining pain management protocols and integrating non-pharmacological interventions to improve quality of life.

Objectives: Brain tumour, either primary or secondary, has produced various widespread or localised symptoms in the patient. They may have a detrimental impact on the quality of a patient's life regardless of subsequent treatment. Palliative care is most effective when it is started early in the disease trajectory. Hence, we conducted this study to assess symptom burden and quality of life (QoL) in brain tumour patients and impact of early palliative care on them.

Materials and methods: Prospective analytical study conducted in patients of primary or secondary brain tumour within 4 weeks of their diagnosis. After taking informed consent, all patients were assessed from time of enrolment up to 6 months. Integrated palliative care outcome scale (IPOS) tool was used for symptom burden assessment, and European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Brain Neoplasm 20 (EORTC-QLQ-BN-20) tool was used to measure QoL. To know the impact of palliative care, baseline data of these scores were compared with 1^st month, 3^rd month and 6^th month follow-up data.

Results: Total 100 patients enrolled. In IPOS score, statistically significant improvement was noted at subsequent follow-up among physical, emotional and communication scores along with total score. For QoL, significant improvement was noted at subsequent month follow-up in headache, seizures, future uncertainty, bothering due to hair loss and itchy skin among EORTC-QLQ-BN-20.

Conclusion: We conclude that brain tumour patients are suffering from various distressing symptoms. Early involvement of palliative care specialists with neuro-oncology treatment can help in better management of various physical and psycho-social symptoms, which lead to better QoL of patients and their caregivers.

Moral distress is a prevalent and disruptive force in palliative care practice, undermining clinicians' capacity to uphold ethical integrity amid systemic and situational constraints. As frontline providers are increasingly challenged by complex end-of-life scenarios, the cultivation of moral resilience emerges as an essential strategy for sustaining compassionate, ethically grounded care. This short communication advocates for a deliberate shift toward fostering moral resilience through education, interprofessional collaboration and institutional reform to safeguard healthcare providers' well-being and enhance ethical practice in palliative settings.

Malignant pleural effusion (MPE) causes significant morbidity in advanced cancer, yet traditional management often delays care for bedbound patients. This case demonstrates how integrated home-based palliative care and hospital-based Palliative Medicine Point-of-Care Ultrasound (PM-POCUS) enabled rapid diagnosis and intervention. A 44-year-old female with metastatic breast cancer developed severe dyspnoea (ESAS-R 10/10) due to MPE. Home care teams identified the emergency, while PM-POCUS in a palliative outpatient department (OPD) guided thoracentesis despite extensive chest wall lesions. PM-POCUS bridges home and hospital care, offering timely symptom relief while avoiding hospitalisations. This model highlights the need for portable diagnostics in palliative training programs.

Objectives: This retrospective study aimed to evaluate the utilisation and clinical impact of palliative medicine POCUS (PM-POCUS) in a specialist palliative care OPD, in a tertiary cancer centre in India. Patients with advanced cancer frequently present to palliative care outpatient departments (OPDs) with symptoms such as dyspnoea and abdominal distension, often due to pleural effusion, ascites or deep vein thrombosis. Timely diagnosis of these conditions is critical for symptom relief, yet access to imaging is frequently delayed, particularly in resource-limited settings. Point-of-care ultrasound (POCUS), performed by the treating physician, offers a rapid, bedside diagnostic tool that can guide immediate management decisions. While POCUS has demonstrated utility in inpatient and hospice environments, its application and impact in palliative OPD settings remain underexplored.

Materials and methods: We included adult cancer patients (≥18 years) who underwent PM-POCUS between September and December 2024. All scans were performed by a single consultant to ensure consistency. The primary outcome was the proportion of cases where PMPOCUS influenced clinical management; secondary outcomes included the spectrum of indications and symptom relief.

Results: Ninety PM-POCUS applications were performed in 76 patients, predominantly with gastrointestinal, breast or gynaecological cancers. The most common indications were abdominal distention and dyspnoea. Ascites was diagnosed in 58 cases, pleural effusion in 16. 33% of POCUS assessments led to interventions, including paracentesis, pain blocks and pleural tapping.

Conclusion: Routine integration of PM-POCUS in palliative OPD facilitated rapid diagnosis and intervention, significantly impacting clinical management and symptom relief for advanced cancer patients. These findings support broader adoption and further research on PM-POCUS in outpatient palliative care.

Hip joint disorders are frequently observed in patients with cerebral palsy (CP) due to static encephalopathy, dyskinesia and spasticity. Surgical treatments have shown improved pain relief, but sometimes, due to comorbid conditions, they are not feasible. Hip joint neurolysis is a palliative pain procedure that destroys the sensory nerves responsible for hip joint pain. We present a case of a 23-year-old girl with severe spastic CP, who presented to the pain clinic with severe left hip joint pain. Her surgical reconstruction for hip dislocation was planned, but due to anaesthesia risk and post-procedure morbidities, her mother requested non-surgical options. At the pain clinic, a diagnostic block of the anterior articular sensory nerve of the hip joint (left femoral and obturator) was done to provide 80% pain relief. After 2 weeks, a neurolytic block with 90% alcohol was then performed on the articular nerves of the left hip joint, providing 90% pain relief during routine care activities.

Multiple myeloma (MM) is considered a chronic blood cancer; myeloma patients often experience fatigue and bone pain. They may also have limited mobility, making them dependent on caregivers for everyday tasks. Patients seemed to be less involved in managing their conditions, relying on unpaid caregivers for emotional and practical assistance, while frequently ignoring their own needs. Arksey and O'Malley's framework was used for this review. This scoping review discusses the burdens of caregivers of patients with MM. Search strategies were used in PubMed, Scopus, CINAHL, Embase and Web of Science from published research articles from August 2013 to August 2024. The data were exported, and the duplicates were excluded. Title, abstract and full-text screening were carried out. The data analysis was done qualitatively and quantitatively. The review results revealed that the caregivers, whether family members or professionals, are essential in helping patients to receive long-term care. Because the MM is chronic, caregivers frequently face high levels of stress and unfulfilled needs. Caregivers of patients with MM face a variety of burdens in terms of physical and financial strain, emotional stress and psychological distress, lack of preparedness, lack of social support and social isolation. The results of the review can be used to create supportive care interventions that address the needs of caregivers of patients with MM, who experience a significant burden.

The management of altered mental status in patients with metastatic cancer is a complex task because of various potential causes such as electrolyte imbalances, brain metastasis, cancer treatments and delirium. Anti-cancer drugs such as methotrexate and cisplatin can cause delirium, and it is crucial to recognise and manage these cases early because of the associated increased morbidity and mortality. This case report presents a rare hyperammonaemic encephalopathy induced by 5-fluorouracil (5FU), a pyrimidine uracil analogue used in gastrointestinal cancers. A 60-year-old woman with metastatic pancreatic adenocarcinoma experienced altered sensorium, incoherent speech and ataxia after chemotherapy, including high-dose 5FU infusion. Her symptoms, along with the exclusion of other common causes, led to a diagnosis of 5FU-induced encephalopathy. Palliative care, supportive care and specific treatments resulted in symptom reversal and discharge with improved functional status. This report emphasises the importance of recognising 5FU-induced encephalopathy for its timely and effective management in clinical practice.

Objectives: This study explores the attitudes and practices of healthcare professionals on palliative care of patients with heart failure (HF), uncovers potential barriers and identifies possible interventions to meet the palliative care needs.

Materials and methods: We conducted semi-structured interviews with 12 cardiovascular and palliative care professionals from six hospitals in Beijing, China. Purposive sampling ensured diversity in roles and clinical settings, and we used directed content analysis to analyse the data.

Results: Healthcare professionals discussed their views and experiences on the timing of palliative referral for patients with HF. They stated that patient and family perceptions of illness and palliative care could influence palliative care referral and other barriers to palliative care. They also suggested that quality communication was a key to palliative care implementation.

Conclusion: Hospitals should increase the building of palliative care professional teams and improve the communication skills of healthcare professionals. Palliative care related publicity and education should be carried out for patients, their families and the public to improve their cognition of palliative care. Healthcare professionals should fully assess the needs and disease progression of patients with HF and their families to better integrate palliative care at an earlier stage of disease development to improve patients' quality of life.