Does the cancer patient want to know? Results from a study in an Indian tertiary cancer center

Objective: The disclosure of the diagnosis of cancer is a distressing and complex issue. Families and doctors still do not tell patients when they have cancer in the belief that the patient does not want to know and telling him would lead to fear and depression. The aim of this survey was to evaluate the information needs of Indian cancer patients. Materials and Methods: A cross-sectional survey of 300 patients′ views was conducted with the help of an adaptation of Cassileth′s Information Needs questionnaire. Results: A majority of cancer patients exhibited a strong need for information about illness and treatment. Ninety-four percent wanted to know if their illness was cancer. Most patients also wanted to know the chance of cure (92%). Age, education, and type of treatment significantly affect information preferences. Gender did not have an effect on information needs. Conclusion: This study showed that most of the patients wanted to know about their illness, treatment, side-effects, and chances of cure

Induction for classic laryngeal mask airway insertion: Does low-dose fentanyl work?

Background : Laryngeal mask airway (LMA) insertion requires an optimal balance of anesthesia. Propofol with different opioids is a preferred combination. Two doses of fentanyl were compared for the efficacy and side effects. Materials and Methods: 96 patients were randomly distributed into F 1 (fentanyl 1 mcg/kg) and F 2 (fentanyl 2 mcg/kg) groups. The conditions for LMA insertion, hemodynamic profile, bronchoscopic view, and incidence of sore throat were compared. Result: There was no statistically significant difference in any parameter in the two groups except for a significant fall in systolic and mean arterial pressure in F 2 group. Conclusion: Both doses of fentanyl (1 and 2 mcg/kg) provide comparable insertion conditions for LMA. Fentanyl in the lower dose provides a more stable hemodynamic profile

Epidural clonidine for postoperative pain after lower abdominal surgery: A dose - response study

Background: Patient controlled epidural analgesia with local anesthetic and opioid is an effective technique for postoperative analgesia after abdominal surgery. Clonidine has a synergistic effect on epidural local anesthetics. The purpose of this study was to determine the optimal epidural clonidine dose to be added to a solution of bupivacaine and morphine for patient controlled epidural analgesia to deliver an optimal balance of analgesia and side effects. Methods: Sixty patients were randomly assigned to three study groups (C0, C1, C2) of 20 patients each. Before the induction of general anesthesia, epidural anesthesia was induced using 10 mL of 1% lidocaine and epinephrine (1:200,000) and was maintained with a continuous infusion of the lidocaine - epinephrine solution until the completion of surgery. After surgery, groups CO, C1, and C2 received patient controlled epidural analgesia (PCEA) with morphine (0.1 mg/mL) in 0.1% bupivacaine. Group C1 and C2 also received epidural clonidine (1 and 2 mcg/mL, respectively). Pain was assessed at rest, cough, and on movement at 1, 2, 4, 8, 12 h after surgery and on day 1, 2, and 3. Differences in the mean postoperative Numerical Rating Scale (NRS) score and analgesic consumption were assessed by one-way analysis of variance and multiple comparisons. Result: Patients in all the groups experienced adequate pain relief during the 72-h period after surgery. There was no statistically significant difference between the mean NRS scores and CRS scores for pain at rest, cough, or during mobilization between the three groups. The cumulative volumes of analgesic solution were C0, 131 ± 21.285 mL; C1, 89.9 ± 18.44 mL; and C2, 80.1 ± 21.32 mL. There was no significant difference in the PCEA analgesic consumption between group C1 and C2 (P = 0.128). Groups C1 and C2 required lower volume of analgesic solution (P < 0.001) than group C0. Also, the number of rescue doses consumed by clonidine group were less (P < 0.001). Conclusion: The optimal epidural clonidine concentration in a morphine (0.1 mg/mL) and bupivacaine (0.1%) solution after lower abdominal surgery is 1.0 μg/ml. The combination of bupivacaine (0.1 %), morphine (0.1%), and clonidine (both 1 and 2 μg/mL) resulted in excellent pain relief in the 72 hour period after surgery and was not accompanied by significant hypotension, sedation, sensory blockade, or motor blockade

What Does the Informal Caregiver of a Terminally Ill Cancer Patient Need? A Study from a Cancer Centre

Aims: To assess the needs of informal caregivers of terminally ill cancer patients. Materials and Methods: Fifty four informal caregivers of patients registered in our palliative care service were interviewed 3-6 months after the death of the patient with the help of a semistructured questionnaire covering the physical, medical, psychological, social, and information domains. Results: Most of the caregivers were middle aged and had no prior experience of care giving. The caregivers were satisfied by the information and medical support provided to them by their treatment team. Most had an "emergency plan." Caregivers had unmet needs including homecare, psychological support, and financial help. Conclusions: informal caregivers provide most of the nursing and psychological support to the patient. However, palliative care services need to recognize that the caregiver too may need psychological and technical support

An observational study on safety and efficacy of povidone-iodine for pleurodesis in cancer patients

Introduction: Pleurodesis is a time-honored procedure for malignant effusion as one of the palliative procedures to treat recurrent effusions. Various agents have been used in the past such as tetracycline, talc, bleomycin, and povidone-iodine. This paper aims at evaluating safety and efficacy of povidone-iodine for the procedure. Materials and Methods: One hundred and four patients underwent of pleurodesis with povidone-iodine done at our center for malignant effusion between June 2008 and August 2015. The safety and efficacy of the procedure was analyzed. Results: One hundred and four patients of malignant effusion with mean age of 53 years and a mean follow-up of 7.8 months were evaluated. A total of 79% patients did not show any reaccumulation of fluid in their follow-up. There was no periprocedural mortality. Eight patients had severe pain; eleven patients had fever, while one patient had arrhythmia.Conclusion: Povidone-iodine is a simple, cheap, and effective method of pleurodesis with no major complication and a high success rate

Safe perioperative opioid taper in cancer patients needs meticulous multimodal management

Opioid therapy plays a vital role in chronic pain management of advanced cancer patients. Some patients require discontinuation of opioids when an intervention appropriately controls the pain. Safe discontinuation of opioids poses a challenge among lack of evidence-based standardized taper protocol. We report a patient with a soft tissue sarcoma in whom opioid was tapered in the background of acute postoperative pain