|Year : 2016 | Volume
| Issue : 6 | Page : 78-79
|Date of Web Publication||30-Nov-2016|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Palliative Care. J Can Res Ther 2016;12, Suppl S2:78-9
Pain control and improvement in quality of life with intravenous zoledronic acid versus oral ibandronate in management of painful bone metastasis receiving palliative radiotherapy: A prospective randomized study
th Rahul Bhowmick , Abhishek Basu, Krishnangshu Bhanja Choudhury, Koushik Ghosh, Kazi Sazzad Manir, Subir Gangopadhyay
Department of Radiotherapy, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India, E-mail: [email protected]
Objective: In a prospective, randomized, single centre trial, i.v Zoledronic Acid (ZA) was compared with oral Ibandronate (IB) in the patients with painful bone metastases. Objectives were to assess pain control, analgesic requirement, Skeletal Related Events (SREs) and improvement in EORTC-QLQ-C15-PAL. Materials and Methods: Between January 2015 to June 2016, patients with painful bone metastasis, 18 to 70 years, ECOG PS 1- 4 and Brief Pain Inventory pain score ≥4 with normal baseline parameters were randomized into Arm A: PallRT (20 Gy/5#/1 week)+ZA (4 mg IVq28 days) and Arm B same PallRT + IB (50 mg/day) with analgesics as per requirement. Results: 48% patients were males with common primary sites in lung and prostate. For females breast was most common primary site. Only weight-bearings bones were affected in 9/15, ZA against 7/12, IB arms. Onset of pain relief was 9.27 ± 2.31 days ZA against 10.17 ± 2.86 days IB, p value 0.35. 4 patients in ZA vs 3 patients in IB used opioids. Repeated measures analysis showed significant changes in pain scores in both arms over the study period but comparisons between 2 arms were not significant, (F 0.202, 107.133, df 1, P value 0.657). QoL improved for all patients but both arms shows equal efficacy, (F 0.880, 658.065, df 1) P value 0.358. 2 bisphosphonates comparatively do not defer in changes in analgesic scores during the study period (F1.330, 112.149, df1 P value 0.264). SRE were comparable in both arms (ZA, 2 patients) vs (IB, 3 patients). Conclusion: Improvement in QOL, better pain control and decrease in analgesics were comparable in both the arms for the small study population with comparable SREs.
Challenges in psychiatric care for geriatric patients with cancer
th Anil Kumar Dhull , Garima Malik, Rajeev Atri, Rakesh Dhankhar, Vivek Kaushal
Department of Radiotherapy, Post Graduate Institute Of Medical Sciences, Rohtak, Haryana, India, E-mail: [email protected]
Objectives: Geriatric population is increasing rapidly throughout the world and cancer is a leading cause of morbidity and mortality in them. Psychiatric care for older patients with cancer presents a unique challenge for clinicians because of differences in phenomenology, assessment, and treatment for this population and a lack of research in this area of psycho-oncology. There remains a paucity of systematically studied data on the psychosocial effect of cancer and the prevalence of psychiatric disorders in the elderly. Materials and Methods: An electronic search on the Scopus and PubMed database was done for literature, focuses on the assessment and treatment of common psychiatric comorbidities in elderly patients with cancer. Results: Comprehensive geriatric assessment is a multidimensional and interdisciplinary process that helps develop a comprehensive management and care plan for elderly patients with cancer. Cognitive impairment (delirium and dementia) and depressive symptoms were the most commonly encountered geriatric psychiatric syndromes. Other domains included are functional status, nutritional status, socioeconomic issues, comorbid conditions etc. In this analysis, we observed that 3% elderly living in the community and around 15% hospitalized patients faced depression and 18% geriatric patients accounted for all suicide deaths. The prevalence of anxiety was from 21-28% while of delirium was between 30-50%. Conclusion: This study highlights some of the important areas of psychiatric comorbidities that older patients struggle with during their illnesses. The goal of identifying and treating these distressing problems is to improve the overall quality of life and the functional status for geriatric population living with cancer.
Assessment of psychological distress, quality of life and social functioning level of cancer patients attending palliative care unit at RCC, JIPMER
K. Gunaseelan, R. Pragna Sagar, th Aswin Joy , V. Parthasarathy
Department of Radiotherapy, RCC, Jipmer, Puducherry, India,
E-mail: [email protected]
Introduction: Psycho-oncology is a broad approach to cancer therapy which treats the emotional, social, and spiritual distress among patients which require evaluation and treatment. This study was designed to assess how these parameters influence their living condition. Objective: To find out the association between psychological distress, quality of life, social functioning level and background variables of the cancer patients in palliative care settings. Methodology: All cancer patients attending palliative care clinic who can understand and speak English or Tamil language were taken into the study. Interview techniques with a questionnaire is used for data collection after informed consent. The questionnaire consists of four sections viz., demographic variables, General health questionnaire (David Goldberg 1972), WHO quality of life questionnaire, Scarf social functioning index. The questionnaires are standardized tools with the scoring method. All questionnaires were translated into the Tamil Language which will be evaluated by experts for content validity. Results: The median scores obtained are physical distress= 44 (11-98), WHO QOL= 64 (36-117) and Social Function=51 (29-79). Out of 257 patients, 30% had severe physical distress, 25% poor QOL, 23.5% with severely affected social function. Age<40 years had more physical distress compared to age>55 (P = 0.108). Lower income status negatively impacted Health Score, WHO QOL and Social Functioning (P < 0.05). Skilled laborers had better scores compared to unskilled laborers (P < 0.05). Family size (<2 children) had a positive impact on the quality of life (P = 0.008). Patients from urban locales had better social functioning than rural counterpart (P = 0.047), but no difference was observed in distress level or QOL. Patients with a history of cancer in the family experienced less physical distress (P = 0.045). Increased GH distress score of the patients had a negative impact on both QOL (R = -0.522) and social function (R = -0.244). QOL correlated positively with social function (R = +0.247). Age at marriage, marital period, educational status, diagnosis, family type, religion did not show the comparable difference between the groups. Conclusions: Decreasing the symptom burden and distress level by palliative care intervention might improve the quality of life and social function. High distress levels were seen in low socioeconomic strata, and the young, and this group need to be given priority care.
Comparing single fraction (8 Gy) versus multifractionated (30 Gy) radiotherapy schedules in the treatment of spine metastasis
th R. Narmadha , N. V. Kalaiyarasi, Giridharan, Baskar, Madhumathi, Sundaresan, Sanjal Kumar, Poongodi, Vijaykarthick
Department of Radiotherapy, Madras Medical College, Chennai, Tamil Nadu, India, E-mail: [email protected]
Introduction: India has a total population of 1.2 billion and it has been estimated that there are 6 million people in need of palliative treatment annually. Bone metastasis may be seen in 85% of patients dying due to cancer of breast, prostate and lung. Radiotherapy is the most useful and cost-effective treatment for bone metastasis. Materials and Methods: Study was done in 60 patients with painful spine metastasis with biopsy proven primay tumour elsewhere without impending fracture of spine or spinal cord compression. Patients with life expectancy more than 3 months were assessed for pain using visual analog scale (VAS) prior to radiation and treated with either 8 Gy given in one day or 30 Gy given in 10 fractions for two weeks. Pain response and toxicity was assessed at week 1, week 4 and week 12 in both the groups and those with persistent pain or recurrent pain were reirradiated. Results: There was no statistically significant difference between both the arms in terms of pain response rate, duration of response or acute toxicity. Response rate did not correlate with primary site histology, age, sex or spine level. Two patients were reiirradiated in the single 8 Gy arm compared to none in the multifractionated schedule. Conclusion: Single fraction radiotherapy of 8 Gy given in one day is equally effective and more convenient for patients and care givers. In high volume centres, short course schedule needs to be considered for palliation as it is cost-effective and more convenient for the treatment unit as well.
Stereotactic radiosurgery in brain metastasis
th V. Singhal , N. Vaid, S. Halder, S. Hukku, D. Chauhan
Department of Radiation Oncology, BLK Super Speciality Hospital, New Delhi, India, E-mail: [email protected]
Objective: Stereotactic radiosurgery has emerged as an effective treatment option for patients with brain metastasis. In this study we compare and analyse the outcome of patients treated with stereotactic radiotherapy with or without whole brain radiotherapy. Materials and Methods: We retrieved the patients with 1-4 brain metastasis, in good general condition, KPS≥70, RPA classification 2 or 3, treated in our department between September 2013 to august 2015 and compare the treatment outcome in patients receiving SRS alone, WBRT alone or SRS with WBRT. Primary endpoint was overall median survival. Results: There were 70 eligible patients, of whom 39 patients were lost to follow up. Out of 31 patients, 11 received WBRT with SRS; 11 received WBRT alone and 9 received SRS alone. 15 patients were male and 16 patients were female. Demographic distribution revealed 16 patients were of carcinoma lung; 9 patients carcinoma breast; 3 patients of unknown primary and one of ovary, melanoma and cervix each. Subset analysis of three groups had shown that there is no differences in three groups with respect of age (<50 yr or >50 yr), number of metastasis (single or multiple) and status of primary (controlled or uncontrolled). Median overall survival in SRS only and SRS with WBRT groups was 12 months and in WBRT only group was 5 months (P = 0.523). Conclusion: SRS alone or in addition with WBRT improves overall median survival in comparison to WBRT alone. Large sample size and more thorough study is needed to assess the neurocognitive outcomes and local recurrences.
A prospective study on changes in quality of life in patients with multiple brain metastases treated with palliative course of whole brain radiotherapy
th Indranil Khan , Amitabha Manna, Pronoy Kanti Mondal, Sourav Sinha, Mannavi Suman, Pandimit Lepcha, Shyamal Kumar Sarkar
Department of Radiotherapy, Medical College and Hospital, Kolkata, West Bengal, India, E-mail: [email protected]
Background: Brain metastases is the most common type of intracranial tumor worldwide. Around 20-40% of all cancer patients develop brain metastases with progression of disease. Objectives: The primary objective of this study is to assess whether there is any improvement in quality of life in patients with multiple brain metastases as measured 6 weeks and 12 weeks after a palliative course of whole brain radiotherapy. Materials and Methods: Since September 1, 2014 till March 31, 2016, 96 patients presenting with multiple brain metastases at a tertiary cancer care centre in India were incorporated into the study. All these patients were asked to fill out the Functional Assessment of Cancer Therapy Brain (FACTBR) questionnaire independently at the time of initial presentation, following which they were treated with whole brain radiotherapy hypofractionated course of 20 Gy in 5 fractions. The same FACTBR was again conducted at 6 weeks and at 12 weeks after completion of whole brain radiotherapy. Sign test was performed to detect significant changes in global quality-of-life scores. Results: It was observed that there was significant improvement in Quality-of-Life scores at 6 weeks. However, no further statistically significant changes were noted in Quality-of-Life scores at 12 weeks. Conclusion: Palliative course of whole brain radiotherapy does improve the Quality of Life in patients with brain metastases treated with palliative course of whole brain radiotherapy at 6 weeks after treatment, with no further gains at 12 weeks.
A prospective comparative study evaluating the impact of hemi body irradiation versus focal RT plus ZA in management of painful skeletal metastases
th Abhishek Basu , Pratyusha Mukherjee, Avik Maji, Bidyut Mandal, Anish Bandopadhyay, Swapan Kumar Sikdar
Department of Radiotherapy, Medical College and Hospital, Kolkata, West Bengal, India, E-mail: [email protected]
Objectives: The primary objective of our study is to evaluate the effect of Hemi Body Irradiation and Focal Radiotherapy with Zoledronate on pain management in patients with extensive bone metastases after completion of definitive treatment. The secondary objective is to evaluate the toxicities and Skeletal Related Events eg. fracture. Materials and Methods: We have analyzed the difference in pain reduction comparing two groups of patients in a prospective non randomised study. The first group comprised of 10 patients treated with Hemibody Irradiation (HBI), the second one included 14 patients treated with focal radiotherapy and zoledronic acid, 4 mg iv, 4 weekly (RT + ZA). In both groups single fraction radiation of 8 Gy (UHBI = 6 Gy) was given & followed up for 3 months. All patients were assessed before, during and after treatment with a questionnaire that rated the grade of pain, type of analgesic therapy and patient's performance status. Response assessment was done using Visual analogue scale, percentage of pain relief and total score reduction on a scale of 0 - 20. Acute & chronic haematological and GI toxicities were assessed as per standard guidelines. Statistical analysis was done by Chi square test & Mann-Whitney U test. Results: Long term pain score & total score reduction was more in (RT + ZA) arm (P = 0.002 & 0.001) with less toxicity (P = 0.002) and SRE (P = 0.011). Conclusions: Focal RT with ZA showed better result on long term pain management and may be preferred in cancer patients with longer median survival. As our sample size was small, study with larger sample size is warranted.
Treatment of paediatric malignancies without anesthesia: A feasible method
th A. N. Aswin , G. Selvaluxmy
Department of Radiotherapy, Cancer Institute (WIA), Chennai, Tamil Nadu, India, E-mail: [email protected]
Introduction: The main aim of this study is to provide safe Radiation delivery in children with malignancies without anesthesia. Materials and Methods: 27 children were treated without anesthesia from January 2015 to August 2016. The malignancies treated were ALL (22%), RMS & Ewing's Sarcoma (19% each), Lymphomas (15%), Wilm's tumor (11%), Nasopharynx and Brain tumors (7% each). 15 children were between 3-7 years group and remaining 12 were between 8-12 years age group. Results: The latter age group children were co-operative and completed the treatment without anxiety. Though the former age group children had anxiety in the beginning, they completed the treatment without anesthesia with the help of distraction techniques. The planning, delivery and after care of radiotherapy for children is a complex multi-professional activity. It requires Clinical Oncologists, Radiotherapists, Mould room staff, Play specialists, Nurses, Physicists, Dosimetrists and Psychologists. Multiple visits to the mould and treatment room are required in order to get familiarity with the treatment place and to reduce anxiety. Immobilization and simulation were done in a child friendly environment with distraction aids. The children were treated daily in the same machine, so that they were familiar with the treating personnel. Daily set up verification of portals were done prior to delivery. Conclusions: Children of different ages have different needs. Careful explanation and listening to and responding sympathetically to concerns, is essential to achieve understanding and to reduce stress and anxiety. Although the process is time consuming, time must be made available in order to make the treatment safe and effective.
Analysis of clinical outcome in patients with atypical teratoid/rhabdoid tumour: A retrospective analysis
th Asha Arjunan , Gouri Somanath, P. Kusuma Kumari, T. Priyakumari, Anitha Mathews, R. Binitha, T. Manjusha, Jagath Krishna,
Beela Sarah Mathew, K. Ratheesan
Department of Radiotherapy, Regional Cancer Centre, Thiruvananthapuram, Kerala, India, E-mail: [email protected]
Introduction: Atypical teratoid/rhabdoid tumor (ATRT) is a highly malignant central nervous system neoplasm in early childhood. It was added to the World Health Organization Classification of Tumours of the Central Nervous System in 2000. We retrospectively evaluated the treatment outcomes for ATRT at our institute. Materials and Methods: Clinical data on patients with histologically proven ATRT since Jan 2005 were reviewed. Overall survival (OS) and progression free survival (PFS) were calculated from date of surgery. Progression was determined as date of first radiologic evidence of disease recurrence/progression. Results: 10 patients were identified, 5 females & 5 males. Median age at diagnosis: 7 years (range: 1-15 years). 4 patients were ≤3 years of age. 2 patients had cerebrospinal dissemination at diagnosis. All children underwent surgery as primary treatment (Gross Tumour Resection-5, Subtotal Resection-5). 4 patients did not receive adjuvant treatment due to poor general condition. 1 child aged <3 years received chemotherapy alone and 3 children received chemotherapy and CSI (30 to 36.0 Gy to neuraxis with boost of 54.0-55 Gy). 1 child received focal radiotherapy alone (55.8 Gy). Median follow- up was 74 months (range, 46-101 months). Only 2 patients (20%) were alive at the time of analysis. Median survival was 6 months. Both the children who are alive underwent GTR followed by CSI and chemotherapy. OS at 2 year was 30%. Conclusions: Our results are comparable with existing literature reports which show that children with ATRT have a poor prognosis, however long-term survival is possible in some children.
To evaluate the frequency CNS relapse after prophylactic cranial irradiation in pediatric patients (age 1-9 years) of acute lymphoblastic leukaemia: A retrospective study
th Ashutosh Das Sharma , Jyoti Poddar, Sonal Patel Shah, U. Suryanarayana, Ankita Parikh, Maitrik Mehta
Department of Radiotherapy, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India, E-mail: [email protected]
Aim: To analyse the frequency of CNS relapse in pediatric patients of ALL after receiving Prophylactic Cranial Irradiation. Materials and Methods: A retrospective single arm study of 179 patients of High risk ALL (of age >1 year and <10 year) was done treated between January 2012 to December 2013. All the patients were administered MCP 841 chemotherapy regimen, and received prophylactic cranial irradiation (18 Gray/10 #) as part of the treatment protocol. The patients were followed up after the completion of radiation for a median follow up time of 30 months for development of CNS relapse. Results: Out of 179 patients, 15 had CNS relapse. 9 were CSF positive relapse, 6 were Clinical relapse. Out of the total 15 CNS relapse, 4 were isolated CNS relapse. The minimum time interval after PCI when CNS relapse was seen was 3 mnths and maximum was 45 mnths with a median disease free survival of 30 mnths. The CNS disease free survival was calculated by multivariate analysis and Kaplan Meier survival plots. Conclusions: PCI can still be contemplated in patients of ALL for preventing CNS relapse where newer chemotherapy regimens are beyond the reach of the patient and where chemotherapy tolerance and treatment compliance are important issues. Though it is challenged because of the long term side effects of radiation, PCI still holds good in low and middle income countries.
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