A Global Collaboration to Develop and Pilot Test a Mobile Application to Improve Cancer Pain Management in Nepal

INTRODUCTION: Quality palliative care, which prioritizes comfort and symptom control, can reduce global suffering from non-communicable diseases, such as cancer. To address this need, the Nepalese Association of Palliative Care (NAPCare) created pain management guidelines (PMG) to support healthcare providers in assessing and treating serious pain. The NAPCare PMG are grounded in World Health Organization best practices but adapted for the cultural and resource context of Nepal. Wider adoption of the NAPCare PMG has been limited due to distribution of the guidelines as paper booklets. METHODS: Building on a long-standing partnership between clinicians and researchers in the US and Nepal, the NAPCare PMG mobile application (“app”) was collaboratively designed. Healthcare providers in Nepal were recruited to pilot test the app using patient case studies. Then, participants completed a Qualtrics survey to evaluate the app which included the System Usability Scale (SUS) and selected items from the Mobile App Rating Scale (MARS). Descriptive and summary statistics were calculated and compared across institutions and roles. Regression analyses to explore relationships (α = 0.05) between selected demographic variables and SUS and MARS scores were also conducted. RESULTS: Ninety eight healthcare providers (n = 98) pilot tested the NAPCare PMG app. Overall, across institutions and roles, the app received an SUS score of 76.0 (a score > 68 is considered above average) and a MARS score of 4.10 (on a scale of 1 = poor, 5 = excellent). 89.8% (n = 88) “agreed” or “strongly agreed” that the app will help them better manage cancer pain. Age, years of experience, and training in palliative care were significant in predicting SUS scores (p-values, 0.0124, 0.0371, and 0.0189, respectively); institution was significant in predicting MARS scores (p = 0.0030). CONCLUSION: The NAPCare PMG mobile app was well-received, and participants rated it highly on both the SUS and MARS. Regression analyses suggest end-user variables important to consider in designing and evaluating mobile apps in lower resourced settings. Our app design and pilot testing process illustrate the benefits of cross global collaborations to build research capacity and generate knowledge within the local context

Interstitial brachytherapy for internal mammary node in breast cancer: A case report

This case study reports the feasibility, safety, and efficacy of interstitial brachytherapy for internal mammary nodal recurrence in a 68-year-old woman with triple-negative breast cancer. The patient had previously undergone mastectomy followed by chemotherapy and radiotherapy. However, an internal mammary node was discovered during a routine follow-up a year later, which was confirmed as metastatic carcinoma by fine needle aspiration, with no other metastatic lesions. The patient underwent interstitial brachytherapy under ultrasound and computed tomography (CT) guidance, with a prescribed dose of 20 Gray in one fraction. Follow-up CT scan imaging over a 2-year period of treatment showed a complete resolution of internal mammary node. Therefore, brachytherapy may be considered a potential treatment option for cases of isolated internal mammary node recurrence in breast cancer

The supportive care needs survey short form 34 (SCNS-SF34): translation and cultural adaptation into the Nepali language among patients with cervical cancer in Nepal

Abstract Background A questionnaire developed in one language must be translated and adapted when it will be used with patients speaking a different language and care should be taken to maintain equivalence between the source language (SL) version and its translated version. The objective of this study was to test the linguistic and cultural validity of a Nepali language version of the Supportive Care Need Survey – Short Form 34 (SCNS-SF34) used with the Nepali population. Methods Translation of the SCNS-SF34 was carried out by following Beaton’s guidelines and Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) by a research team. The translated version was administered to patients with cervical cancer in Nepal. The following steps were performed as part of the study: translation, content validity assessment, reliability assessment and measurement of errors. Results The study reports item content validity (I-CVI) was > 0.78 and scale content validity (S-CVI) was − 0.89, 0.91 and 0.90 respectively in semantic, cultural, and conceptual aspects. The study found a content validity ratio (CVR) of 0.9 to 1, Cronbach’s α of 0.90, correlation significant at the 0.01 level (2-tailed), and clarity of the questionnaire at 91.29%. The standard error of measurement (SEM) and small detectable changes (SDC) for overall care need scores were measured 2.70 and 7.47 respectively. All items were accepted as per the original SCNS-SF34. Following the respondents’ suggestions, simpler Nepali words were chosen in some items to replace the words in the preliminary Nepali version of SCNS-SF34. Conclusion Preliminary findings show that the Nepali translation of SCNS-SF34 is practical and applicable to the Nepali population. Financial supportive care needs, supportive care for caretakers and problems during patient hospital stays are essential to include in the questionnaire to further explore supportive care needs

Ethno-geographic distribution and histopathological classification of nasopharyngeal carcinoma in a single center in Nepal.

IntroductionNasopharyngeal carcinoma (NPC) shows geographic and ethnic variation with specific etiopathogenesis. This study characterized the distribution of NPC patients stratified by ethnicity, geography, and histology in a tertiary-level cancer center in Nepal.MethodsA descriptive retrospective study was designed to analyze NPC cases from different regions among patients visiting the hospital from 2016 to 2021. Demographic and clinical information was obtained from medical records. Ethical approval was granted by the Nepal Health Research Council (NHRC). Data analyses and visualization were carried out with R software.ResultsDuring the six-year period, a total of 65 individuals were diagnosed with NPC, comprising 42 males and 23 females. Patient median age was 43 years (range 11-85 years). A bimodal age distribution of cases was observed with peaks in patients aged 30-39 years and 50-59 years. Of the NPC patients studied, 29 were from Koshi Province, with 7 cases from Ilam district and 6 cases from Morang district. There were 18 patients in Bagmati Province, and Kathmandu district had the highest number of cases within this region, with 8 patients. The highest proportion of cases were observed among patients of Janajati ethnicity (60%), including Rai, Limbu, and Sherpa people. Histologically, undifferentiated non-keratinizing NPC was the most commonly observed subtype, accounting for 43.1% of cases, followed by 20% differentiated non-keratinizing NPC and 4.6% keratinizing NPC across the entire sample population. The majority of patients (75.3%) were diagnosed at an advanced stage (stage III or IV) with none diagnosed at stage I.ConclusionsIn our study, most cases of NPC occurred in patients from provinces in eastern Nepal (Koshi province), and of the Janajati ethnic community. The most common histological subtype was undifferentiated non-keratinizing carcinoma. Further epidemiological studies could address differences in prevalence and the challenge of late presentation of NPC patients in Nepal

Breaking barriers: supporting hematopoietic stem cell transplant program through collaborative radiation therapy service from a physically distant center

Abstract Background Total body irradiation (TBI) for hematopoietic stem cell transplant (HSCT) has certain distinct advantages, such as uniform dose distribution and lack of drug resistance, but it is not widely available in resource-constrained settings. To overcome the limitations of in-house radiotherapy services in hematology centers, we evaluated the feasibility of conducting HSCT programs in coordination with two physically distant centers using a reduced-intensity TBI protocol. Methods Thirty-two patients with a median age of 20.5 years were included in the study. Fifteen patients were diagnosed with aplastic anemia, 10 patients with acute myeloid leukemia (AML), 3 patients with acute lymphocytic leukemia (ALL), and 4 patients with other hematological conditions. Conditioning regimens used were fludarabine plus cyclophosphamide in 29 cases, fludarabine-cytarabine ATG in 2 cases, and busulfan plus fludarabine in 1 case. The TBI dose was 3 Gy in 28 cases and 2 Gy in 4 cases. Patients were followed monthly after TBI, and the major toxicities were recorded. Results The median follow-up was 22 months. The most common acute complication was acute graft-versus-host disease (GVHD), which occurred in 15.6% of patients. The major late complications were chronic GVHD (9.3%), Cytomegalovirus (CMV) infection (34.3%), and CMV-induced secondary graft failure (6.2%). Seventy-five percent of patients were alive, 21.9% were dead, and 1 patient was lost to follow-up. Conclusions HSCT based on TBI is feasible even if the center lacks a radiotherapy facility by coordinating with a remote radiotherapy facility. without compromising the patient's outcome