Novel corona virus disease 2019 (COVID-19) is an ongoing pandemic that has impacted the entire world. The Indian government has responded strongly and very stringently to the crisis, through a nationwide lockdown. The health-care (HC) systems in the country are striving hard to maintain equitable care across illness spectra, while responding the emergencies imposed by the COVID-19 crisis. Under these circumstances, guidelines for managing several diseases including that for cancer care have been modified. As modified guidelines for cancer care have their focus on disease management, cancer pain management and maintaining continuity of care for patients with advanced progressive disease have taken a backseat in the available cancer care guidelines. This article describes the challenges, approaches to solutions with evidence-based practices that can be utilized to ensure competent management of cancer pain during the COVID-19 pandemic in India. It provides an overview of adapting to telehealth consultations for identification, evaluation and management of cancer pain, safe and rational use of analgesics and adjuvant drugs, recognizing and responding to holistic care needs and addressing the total pain, ensuring continuity of pain management, and strategies when complying with narcotic drug regulations, while ensuring safety of patients and HC providers.
Background: Recent pandemic Coronavirus disease 2019 has brought the whole world to a standstill. In India too, phases of the lockdown of the country were declared. This hampered the availability of essential health-care services to needy patients. With full emphasis on the pandemic, patients suffering from other diseases and palliative oncology patients requiring essential palliative care services were affected due to the shutting down of regular health-care services. Aim: In this study, we emphasize that in the middle of a pandemic, we need to continue serving the needs of palliative care patients, and simultaneously, necessary steps should be taken for the prevention of the spread of virus by following guidelines, training, support, and monitoring. Materials and Methods: In this study, we analyzed electronic medical record of 1161 patients who received palliative care from our institute in the first two lockdown periods, regarding their demographics, extent of travel, type of malignancy, and opioid utilization. Results: Of 1161 patients, male outnumbered female and the patient suffering from head-and-neck malignancy were in the maximum number (48.7%). Our essential opioids utilization rate was 34.2%, and patients who traveled from different states were 21.6%. Conclusion: During this pandemic, we cannot overlook the need for essential palliative care services. We can continue regular services with proper precautions as advised and by training the staff. Collaboration with different palliative centers across the country should be done to minimize patient movement.
Introduction:Myiasis, tissue infestation by housefly larvae, is commonly found in malignant fungating wounds of cancer patients from climatic condition and lower socio-economic strata.Aim of study:It was aimed to study the effectiveness of systemic Ivermectin, Albendazole& Clindamycin (Triple Therapy) in reducing signs & symptoms associated with maggots in malignant head and neck wounds.Method:25 adult, advanced head and neck cancer patients presenting with maggots either from wound, oral cavity or nostril, with ECOG score 3 or less were enrolled in this study. Symptoms were assessed using Edmonton Symptom Assessment Scale (ESAS) and wound by Wound Assessment Tool – Hospice, at baseline and then Days 1, 3, 5, and 7. All patients received 3 days course of oral Ivermectin 12 mg per day, Albendazole 400 mg twice per day and Clindamycin 300 mg three times per day for 5 days along with Terpentine oil dressing. All patients received oral Morphine as per their pain score.Results:Mean age (yrs) and weight (Kg) were 42.15 ± 8.23 and 52.31 ± 5.18 respectively. 84% patients were male. Mean oral morphine dose was 100.38 mg. There was significant decrease in number of maggots from day 0 (77.28 ± 13.465) to day 1 (20.60 ± 7.263; 73.34% reduction) to day 3 (1.52 ± 2.104; 92.62% reduction). We found statistically significant improvement (P = <0.05) in scores of wound and all other related symptoms on days 1, 3, 5 & 7, except bleeding, edema, nausea, anxiety, appetite loss and feeling of wellbeing, which remained same on Day 1, but improved afterward. Side effects were self-limiting.Conclusion:Systemic treatment with Ivermectin, Albendazole and Clindamycin (Triple Therapy) enhances the removal of maggots, early recovery and relief from distress and associated symptoms.
Background:Head and neck cancer pain is intractable and difficult to manage. Many a times it is difficult to treat with oral opioids and adjuvants.Aim:This study aims to study the effects of transnasal sphenopalatine ganglion block (SPGB), administered using cotton swab/ear bud by patients’ caretaker, at home, for pain management.Study Design:This is a prospective, single-arm observational study conducted on 100 head and neck cancer patients, from January 2014 to December 2015. Patients and caretaker were given a demonstration of the procedure using sterile cotton swab/ear buds. They were advised to repeat the procedure when their visual analog score (VAS) was more than 5. They continued with the oral analgesics. They kept the records of pre- and post-procedure pain score (VAS), the frequency of repetition, ease of performance of procedure, and morphine requirement. A paired t-test (SPSS software) was used for statistical analysis.Results:A significant reduction in pain was noted by a decrease in mean VAS from 8.57 ± 1.31 to 2.46 ± 1.23 (P < 0.0001), immediately on first administration. The mean duration of analgesia was 4.95 ± 3.43 days. Pre- and post-procedure mean morphine requirement were 128.2 ± 84.64 and 133.8 ± 81.93 (P > 0.05) mg per day, at the end of 2 months. Ease of performance was observed in 88 patients.Conclusion:The home-based application of SPGB is an easy, safe, and cost-effective method to manage cancer pain. It provides excellent immediate pain relief with a minimum side effect. It can be performed bilaterally, repeatedly and even with a feeding tube in place.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.