View/Download PDF Download ---Citations--- BibTeX RIS Buy Reprints PDF Translate this page into: English Arabic Chinese (Simplified) Dutch English French German Greek Hebrew Italian Japanese Korean Persian Portuguese Russian Spanish Turkish Urdu Abstracts 27 (3); 471-482 doi: 10.25259/IJPC_8_2021 PDF Download Citations BibTeXRIS Poster Presentation Umesh Bhadani Organizing Secretary, IAPCON 2021, India *Corresponding author: Umesh Bhadani, Organizing Secretary, IAPCON 2021, India. umeshbhadani@gmail.com Received: 2021-07-09, Accepted: 2021-07-09, Epub ahead of print: 2021-11-09, Published: 2021-11-24 © 2021 Published by Scientific Scholar on behalf of Indian Journal of Palliative Care Licence This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. PP-01 Attributes of psychosocial distress from the perspectives of head and neck cancer patients Shalini G. Nayak Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India E-mail: shalini.mcon@manipal.edu. Mobile: 9481375675 Background: Patients diagnosed with head and neck cancer (HNC) face unique challenges in comparison to other types of cancers. Sources of psychosocial distress are multifactorial and recognising key attributes would facilitate better understanding of the experienced distress, potentially enabling directed intervention strategies. Objective: The current research was conducted with the objective of exploring the key attributes of psychosocial distress from HNC patients perspective to develop a tool. Methods: The study adopted a qualitative approach. The data were collected from nine HNC patients receiving radiotherapy through focus group discussion. Data were transcribed, read and re-read through for searching the meanings and patterns, to familiarise with the data and obtain ideas on experiences related to psychosocial distress. Similar experiences identified across the dataset were sorted and then collated into themes. Detailed analysis of themes and related quotes of the participants are reported with each theme. Results: The codes generated from the study are grouped under four major themes; some symptoms are distressing, Distressing physical disability inflicted by the situation, Social Curiosity- a distressing element, and Distressing uncertainty of future. The attributes of psychosocial distress and magnitude of psychosocial problems were reflected from the findings. Conclusion: Psychosocial health of the HNC patient is greatly impacted due to disease and/or treatment. Dynamic patterns of attributes identified from the study contributed in developing a tool on psychosocial distress. Findings of this study also necessitate the need for constructing an intervention for psychosocial distress based on the attributes from the HNC patients perspective. PP-02 Role of radiation therapy in mammary analogue secretary carcinoma of salivary gland Prince Kumar Department of Radiation Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India E-mail: Reticent123@gmail.com. Mobile: 9655466031 Introduction: Recently recognised entity previously diagnosed as Zymogen granule poor Acinic cell Carcinoma Shows morphologic and molecular features similar to the secretory carcinomas of the breast occurs in men and women in both major and minor salivary glands IHC-Positive for S100, MUC4 and Mammaglobin (very specific) specific, novel chromosomal translocation ETV6-NRTK3 fusion gene. t (12; 15) (p13; q25). Case Report: A 45-year-old gentleman presented with a complaint of painless swelling over the right parotid gland swelling was insidious in onset and progressive on examination - 4 x 4 cm, nodular, mobile and nontender swelling found in Right Parotid region. Facial nerve was NOT involved FNAC-Mammary Analogue Secretory Carcinoma Superficial Parotidectomy was performed: Tumour was grey-white in colour, lobular, measuring 2.8 x 1.4 x 0.8 cm and breaching the capsule. He received adjuvant radiation 66Gy/33 fractions with Volumetric Arc Radiation Therapy (VMAT). During course of treatment no significant acute reactions was observed. Discussion: MASC is a newly recognised malignant salivary gland tumour that recapitulates the histology and genetics of SC of the breast reported cases of MASC encompass a broad range of clinical behaviours, from indolent to aggressive. The mean disease-free survival being 92 months (Chiosa et at.). It has high incidence of local recurrence and lymph node metastasis than Acinic cell carcinoma, longer follow-up is warranted (Chiosea et at.) standard of care for low-grade malignant salivary gland tumours is radical surgical resection. Post-operative radiation is reserved for close (<5 mm) margins/incomplete resection, perineural invasion. PP-03 Spirituality in the golden years Bhoopathy Baptist Hospital, Bengaluru, Karnataka, India E-mail: naidums2003@gmail.com. Mobile: 9845797006 Aim: Spiritual care should be inclusive part of geriatric standard care. Background: Patients with terminal disease and in pain are looking for answers like why me. Hence, there is a dire need for spirituality in their life so that they can gain self-knowledge about themselves and life. Development of a spiritual culture among patients, their families and community will go a long way in helping patients. Methods: 15 elderly patients selected randomly and orally questioned about (1) need for longevity of life, (2) aspiration to live with family, (3) need for more medical benefits, (4) need for more counselling and (5) importance to die gracefully and peacefully. Results: About 80% said no to living long at any cost. About 50% do not want to stay with family and would prefer old age community centre with good facilities. About 70% said government and hospitals need to do more for them. About 80% feel government existing are sufficient, but need better implementation. About 90% feel private healthcare is costly and this stresses them. Discussion and Conclusion: Elderly care culture should be imbibed by youngster in schools. Importance of spirituality should be taught in all stages of life. Awareness of importance of spirituality in overall elderly care in the hospital and among doctors, nursing staff should be developed in a systemic fashion. It should be standardised and protocol driven including regular assessment of cognition, social and emotional assessment and specifically tailored counselling and other support systems. Approaching death with grace is spirituality. PP-04 Golden butterflies magic envelop: An innovative art and recreational package during COVID-19 Ramalakshmi Golden Butterflies Children’s Palliative Care Foundation, Chennai, Tamil Nadu, India E-mail: ramviyenar95@gmail.com. Mobile: 6380660206. Background and Aim: Golden butterflies (GB) provides counselling and arts-based therapy for child-patients and their families; finance for nutrition, tests and treatment; a home away from home; and conducts trainings and awareness programs on palliative care and counselling, in Chennai. GB magic envelope was initiated in response to the COVID-19 pandemic, when group sessions of art and recreational therapy with as child-patients was no longer possible. Magic Envelope is an A4 envelope that includes a small therapeutic craft activity, a puzzle, colouring/drawing sheets and a gift “all age appropriate. All raw materials required to do the craft activity are enclosed, along with child-friendly illustrations/pictorial instructions/cues. Assembling of these edutainment kits is done by GB volunteers, guided by an art-based therapist. As a pilot, magic envelopes were couriered to six child-patients at their residences. This study was conducted to evaluate the effect of engaging with GB magic envelopes on child-patients and their caregivers. Methods: Telephonic interviews using a structured questionnaire were conducted with 6 caregivers of child-patients, who had been consistently receiving magic envelopes for 6 months. Results: GB magic envelope was found to have kept the child-patient engaged, alleviated their boredom during the pandemic and stimulated their creative talents. Observing the child-patient creatively occupied was de-stressing for their caregivers. Interestingly, siblings of the child-patients also evinced interest in completing the activities. Conclusion: Magic Envelope edutainment kits can be used as a safe alternative to face-to-face group sessions with child-patients. PP-05 Introducing a psychosocial care pathway for a comfortable dying at home T. J. Jose Babu Alpha Palliative Care, Thrissur, Kerala, India E-mail: drjosebabu@gmail.com. Mobile: 9074342844 Background and Aims: Ensuring a good death is one of the aims of palliative care. Pain and symptom management alone is not sufficient to add life to their days. This pilot study among advanced cancer patients by implementing a novel care pathway developed by Team Alpha aims to improve the quality of dying and death. Methodology: Thirty advanced cancer patients were included in this pilot study. Home based interventions such as life review, communication using a question prompt list, discussions on unfinished businesses, living will, legacy projects and vigil plan (which constitutes the care pathway) were done serially by a trained social worker. Bereavement visits were done to take feedback and death review was conducted by the palliative care team. Results: The interventions such as life review and discussions using question prompt list were carried out on all the participants (100%). About 96% of participants responded to questions on unfinished businesses and also on living will. About 75% of the participants responded positively to the discussion on Legacy projects. About 88% of participants responded to Vigil plan. Discussion and Conclusion: The Life review step had a positive impact and the participants were relieved a lot after venting out. Questions on unfinished business helped them to set priorities. The advance directives were documented. Patients have been inspired to write messages to their kids, to be cherished even after death. Vigil plan discussed about the arrangements at the last hours. This ‘care pathway’ improves the quality of dying and death experience among advanced cancer patients as per bereavement feedback and needs further study. PP-06 Psilocybin and medical cannabis in palliative care using real world evidence R. Praveenlal Fellow in Palliative Medicine E-mail: praveenlalravi@gmail.com. Mobile: 9447382516 Background: Cancer patients often develop a chronic psychosocial distress having depressed mood, anxiety and reduced quality of life, up to 40% of cancer patients meeting criteria for a mood disorder. Psilocybin and medical cannabis tend to have promising effects on management of cancer related distresses. Aim: The aim of the study was to bring Psilocybin and medical cannabis as an integral part of palliative medicine using real world evidence to enhance quality of life and empathy. Methodology: Randomised article search in various data bases including Science Direct, Scopus, Google Scholar, PubMed and EMBASE using bullion terminologies. Results: Majority preferred CBM over placebo for cancer/therapy related symptom management. In most cases, no serious adverse events were attributed to THC: CBD. High dose psilocybin produced large decrease in depressed mood and anxiety with increase in QOL, life meaning and optimism and decrease in death anxiety. Six month follow-up these changes were sustained with 80% of participants. Conclusion: Historically safe profile of cannabis could make data from other clinical trial more admissible to formulate reliable clinical practice guidelines. Single dose psilocybin produces substantial and enduring decrease in depressed mood and anxiety with increase in QOL. Reference: RR Griffith et al. Psilocybin produces substantial decreases in depression and anxiety in patients with life-threatening cancer: Journal of psychopharmacology vol 30, 2016. Carhart Harris et al.: Neural correlates of psychedelic states determined by fMRI studies with psilocybin; PNAS, Feb 7 2012 Vol 109. Cannabis in palliative care: ANN Palliat med 2018. PP-07 Multidisciplinary team involvement to overcome body image distress in a palliative care patient with facial edema A case study Srushti Hiremath Consultant Physiotherapist E-mail: srushti.hiremath@ciplacare.com. Mobile: 9561681438 Introduction: Facial oedema is common and distressing symptom among patients who have undergone head and neck surgery/radiation therapy. Up to 75% of patient’s manifest facial oedema and approximately 77% patients have body image distress in head/neck cancer. Case: A 51-year-old male patient diagnosed with Ca right retro molar trigone area and operated for right hemi mandibulectomy with the right radical neck dissection with flap, presented to us with severe facial oedema, non-healing wound at right submandibular region and sever pain at wound site which was aggravated on facial/neck movements. He had difficulty in eye opening, expressing his emotions through facial expressions and overall communication was hampered. We noticed him observing his own face in the mirror frequently. He was embarrassed about his looks, drooling from his mouth and didn’t wish to meet anyone. His body image distress caused frustration, anxiety, anger and irritability. Discussion: Aggressive pain management led to reduction in pain. Patient became more open for communication and suggestions. Nursing care of wound with dressing and bandaging reduced odour and oosing. Physiotherapy was started which resulted in drastic reduction in facial oedema. Psychosocial interventions were carried which helped patient to express and cope with body image. This resulted in reduction in anxiety and frustration. He was encouraged to communicate and express his feelings in written format. Thus, the entire team came together to target this complex distress of the patient. Patient cantered goals helped him to overcome his distress and smile on his face was truly satisfying for us as team. PP-08 Palliative care in elderly Covid-19 patients Aditya Kumar Chauhan Government Medical College, Haldwani, Uttarakhand, India E-mail: adidon27@gmail.com. Mobile: 9410349997 Background: While the whole population is at risk from infection with the COVID-19, elderly people with comorbidities are at higher risk for severity and fatality. These patients whose outcome are not certain and have end of life situation calls for good palliative care. Aims: The aim of the study was to provide good palliative care including supportive care and pharmacological treatment symptomatically. Methods: A group of 71 patients were taken, age >65 years and all recommended pharmacological measures according to patient condition were adapted with psychological therapy. Results: A total of 71 patients were taken which were all severely ill and provided with timely therapeutic approach and psychosocial support to reduce the suffering and outcome. Out of which 38 patients improved and 33 patients expired. Conclusion: Elderly patients are particularly susceptible to adverse clinical outcomes in COVID-19 pandemic. Both pharmacological methods and psychosocial support improve the outcome even in severely ill cases of elderly patients. PP-9 Effect of palliative radiotherapy on malignant fungating wound of breast cancer Deepika Sharma DNB Resident E-mail: 1991.deepika30@gmail.com. Mobile: 9671674290 Background and Aims: Incurable malignant fungating ulcer in breast cancer patients invariably suffer from general symptoms such as breast pain, bleeding, ulceration and discharge, malodour and thus require palliative radiotherapy. Hypofractionated RT has many advantages in palliative settings, but very few studies on incurable malignant wound have been conducted. This study will be conducted to see effects of hypofractionated RT on symptomatic patients. Methods: Twenty patients with incurable malignant fungating ulcer underwent hypofractionated palliative RT were retrospectively analysed. RT was performed at a total dose of 20gy in 5 fractions with 4Gy per fraction. The treatment effects were evaluated with respect to symptom improvement, tumour response and treatment related toxicity. Results: The main symptoms that the patients complained of before RT were pain, bleeding and discharge, malodour and fungating wound. Rest of the results to be elaborated in poster presentation. Discussion and Conclusion: Hypofractionated radiotherapy could safely and effectively relieve symptoms among incurable malignant fungating wound in breast cancer patients. PP-10 An interesting case of rheumatological bone disorder mimicking metastatic bone tumour Prajakta Dilip Bhagat Tata Memorial Centre, Mumbai, Maharashtra, India E-mail: paarijaat90@gmail.com. Mobile: 9004549363 Introduction: Malignancy and autoimmune disorders can present with diagnostic complexities. Patients presenting with any unusual bump and lump in the bone can often be mistaken for malignancy. Case Description: A 40-year-old Muslim lady presented to oncology OPD with the right ankle swelling for 1 year, biopsy confirmed the presence of osteoid producing malignant tumour consistent with osteosarcoma, CECT chest showed symmetrical pattern of involvement with some calcified areas suggestive of ?metastasis. Patient was advised palliative amputation which she did not consent to. She was referred to Palliative Medicine unit for further symptom management. On evaluation patient had severe left shoulder pain and movement restriction. MRI shoulder showed bulky left subscapularis muscle, fluid collection with synovial thickening in subacromial and subdeltoid bursae, with fluid within the biceps tendon sheath, minimal joint effusion, few prominent retropectoral and interpectoral nodes. Based on MRI findings, rheumatologist opinion was sought. Patient was evaluated for any underlying autoimmune condition/ connective tissue disorder affecting joints/muscles. Furthermore, an orthopaedic opinion was sought to identify any underlying local/systemic infective aetiology. At present, patient is under evaluation to assess whether there is an underlying malignancy or other systemic condition mimicking the same. Discussion: Systemic and rheumatological disorders should be differentiated from malignancy. If not diagnosed correctly can result in undue suffering, pain, affecting patient’s quality of life, financial loss and adding up to psychological stress. We must have high index of suspicion for connective tissue and autoimmune disorders, if the clinical, radiological, pathological and laboratory investigations don’t show concordance. PP-11 COVID-19 response with online deceased body care training B. K. Manju Green Pastures Hospital, International Nepal Fellowship, Pokhara, Nepal E-mail: manju.bk@nepal.inf.org. Mobile: 9779805156829 Introduction: Community organisations like churches take responsibility caring for bodies of their deceased members. During May/June 2020, in early response to the COVID-19 pandemic while initial numbers were low in Nepal, Green Pastures Hospital Palliative Care team offered online training in small interactive sessions using WHO guidelines adapted by Nepal Medical Association via Zoom platform to 65 church leaders on managing deceased bodies in COVID-19 context. Information and useful resources were shared and follow-up poster and guidelines were sent to participants. The link to a video made by PC team demonstrating safe care (using a dummy) was shared with participants 6 weeks after the initial training. Methods: An online structured questionnaire (using Google Forms) of 22 questions exploring views was sent to all participants 4 weeks after the training. Results: 30/65 participants responded to the online questionnaire. 60% (18/30) respondents found this training very useful and 26% (8/30) quite useful for their work and ministry. For 56% (17/30) the content was very useful and for 43% (13/30) quite useful; whereas 40% (12/30) were very satisfied and 60% (18/30) quite satisfied with the delivery. About 70% (17/30) said using and removing personal protective equipment (PPE) was new and training helpful for 100%. The topic was very new for 86% respondents. After the training, 80% felt quite confident to safely care for a deceased body. Discussion and Conclusion: This interactive online session and follow-up enabled respondents to develop new skills on safely using and handling PPE, deepen COVID-19 knowledge and feel empowered to care for deceased bodies in their communities. PP-12 Impact of pharmacist intervention in palliative care Shubhangi Bhogale Pharmacist E-mail: shubhangi.bhongale@ciplacare.com. Mobile: 8010032542 Background: Social structure adaptation from joint families to nuclear families, with superadded effect of COVID19, most palliative care patients are now preferring home based care to getting hospitalised. Palliative care patients are on high-risk medications such as opioids, antidepressants, sedatives and oral chemotherapy, which have significant side effects, drug interactions and medication errors need to be avoided. To avoid complications, patient compliance with prescribed medication and instructions is of utmost importance. A pharmacist plays an important role in counselling, recording and reporting of deviations. Objective: We aimed to assess the rate of deviation from compliance to medication and clinician instructions by patients and the scope of pharmacist intervention in terms of counselling, to avoid untoward effects. Method: (i) Data analysis of completed medication reconciliation forms of homecare patients. (ii) Review of clinical outcomes determined by homecare team which included: number of patients screened by pharmacist, number of medications reviewed and interventions done. Sample Size: 30. Results: Medication reconciliation forms filled for 30 patients, out of which 66.66% patients were non-compliant. Based on findings, simple interventions brought to light several loopholes in current system of prescription and compliance. Counselling by the pharmacist in addition to the clinical team could bring down medication errors manifold. Conclusion: Pharmacist intervention in form of medicine reconciliation, documentation, counselling in palliative home care patients will lead to early identification, intervention by clinical team and ultimately reduction in medication errors, improving overall medicine management. PP-13 Telehealth pilot during COVID-19 pandemic Tan Shermin Green Pastures Hospital, International Nepal Fellowship, Pokhara, Nepal E-mail: shermin.tan@inf.org. Mobile: 9810065704 Background and Aims: The coronavirus disease 2019 (COVID-19) pandemic has impacted access to healthcare in Nepal due to travel restrictions. To improve healthcare accessibility and provide psychosocial support to patients and caregivers in the early stages of the pandemic, a telehealth pilot for community-dwelling palliative care patients and caregivers residing within Gandaki Province of Nepal was conducted. Methods: 15 patients and 16 caregivers were interviewed over the phone by trained healthcare professionals in May/June 2020 using a structured questionnaire. Urgent issues identified were escalated to our medical team, health education was provided and clients were referred to district care providers and government aid, for example, food where needed. Results: About 47% patients and 67% caregivers were unaware of the symptoms of COVID-19; 40% patients and 31% caregivers were unaware about disease prevention. About 67% patients and 81% caregivers were unaware who to contact for non-COVID-related emergencies. About 20% patients and 27% caregivers had insufficient and/or serious concerns about food supply. None of patients and 13% caregivers reported feeling nervous and stressed in the past month, 93% patients and 88% caregivers were confident about their ability to handle personal issues and 86% patients and all caregivers reported having someone to seek help from when their emotional stress increased. Discussion and Conclusion: Patients with palliative care needs are among those who are especially vulnerable to the impacts of COVID-19. Telehealth is a feasible way to increase COVID-19 awareness and prevention and improve accessibility to healthcare and food security among these patients. PP-14 Quality of life and mental health in caregivers of patients with cancer in palliative phase A. L. Anjitha DNB Resident E-mail: anjitha1992@gmail.com. Mobile: 9497891405 Background: Cancer with metastases has shifted from being fatal in the short-term in most patients towards often being a chronic disease requiring long-term palliative treatment. In the palliative phase, primary caregivers (PC) who provide demanding care to severely ill patients undertake an increased responsibility and challenge of care provision. This may lead to negative as well as positive effects on PCs mental health and health-related quality of life (QOL). The caregiver situation influences the PCs due to stressful conditions, for example, care tasks over time, medical management, decision-making and dealing with emotional aspects, which may lead to subjective and objective burden or cost. Limited research has been done on mental health and health-related quality of life (QOL) of primary caregivers (PCs) to patients staying at home with advanced cancer. This study examines anxiety, depression and QOL in PCs of patients with cancer in the palliative phase. Aim: The aim of this study was to examine anxiety, depression and QOL in PCs of patients with metastatic cancer in the palliative phase cared for at home compared with gender and age-adjusted norm data (norm). Patients and Methods: The sample consisted of 40 PCs of patients receiving palliative treatment for various cancers. QOL was rated with the Medical Outcome Study Short Form (SF-36) and mental health with the hospital anxiety and depression scale (HADS). The findings were compared with age- adjusted norm data (norm). Result: Regarding the outcome of our study, we posed the following hypotheses: (1) PCs of both genders show higher levels of anxiety and depression and lower levels of QOL than norm. (2) In both males and females PCs depression, anxiety and QOL are associated with the patients performance status and their need for care in daily life activities. The outcome will be elaborated in the poster. Conclusion: We anticipate an impaired mental health and QOL in many PCs compared to age- and gender-adjusted norm samples. PP-15 The effect of palliative radiotherapy in bone metastases T. Rajavel DNB Resident E-mail: rajavelthangavel5991@gmail.com. Mobile: 944242047 Background and Aim: Bone metastases represent an important complication of malignant tumours. Despite improvement in surgical techniques and advances in the systemic therapies, management of patients with bony metastatic disease remains a powerful cornerstone for the radiation oncologist. The primary goal of the radiation therapy is to provide pain relief and preserving the quality of life. The aim of the study is to determine the effect of radiotherapy (i.e., response to pain) in bone metastases with various primary tumours. Method: The sample consists of 50 patients with bony metastases of various primary tumours who received palliative radiation of 20Gy in 5 fractions with 4Gy per fraction at Mahavir Cancer Sansthan and Research Center were retrospectively analysed. The treatment effect was evaluated with response to pain by the International Bone Metastases Consensus Working Party on Palliative Radiotherapy. Results: This study would tell the treatment response on 20Gy in 5 fractions which would be elaborated in poster presentation. Conclusion: Multiple prospective randomised trials have shown pain relief equivalency for dosing scheme including 30Gy in 10 fractions, 24Gy in 6 fractions, 20Gy in 5 fractions and a single 8 Gy fraction. This is to conclude that, the effect of 20Gy in 5 fraction which is being practiced at our institution. PP-16 The importance of empathy in the hospital standard care culture D. Bhoopathy Bangalore Baptist Hospital, Bengaluru, Karnataka, India E-mail: naidums2003@gmail.com. Mobile: 9845797006 Aim: The aim of the study was to build empathetic culture and environment in the hospital and palliative service. Objective: The objective of the study was to implement empathetic components as medical tool to train medical and para medical staff in empathy culture. Background: Bangalore Baptist Hospital (BBH) implemented empathetic components. Components (cognition, emotional and compassion): they are useful in training doctors (Dr), medical nurses ((GMN), Community Health Workers (CHWs), social workers (SW), volunteers (Vs), social service, guest relation members as well as Front line employees (FO) such as clerks, security and house keepers. BBH social service and Guest relation sections, Community Heath Division work hand in hand to assist the patient through the medical care. Tools and Methods: 5Dr, 3GMN, 3SW, 5Vs, 3CHWs and eight patients, orally questioned about the empathy impact, its benefits, about it barriers and job satisfaction. Results: About 90% Drs fallowed cognitive empathy beneficial in care planning in terminally ill patients. About 70% of SWs, CHWs and GMNs are happy with compassion empathy. About 80% versus