Health

Docyard | Palliative care is need of the hour

Docyard | Palliative care is need of the hour
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In the last two decades, the technologies for early diagnosis of cancer, advanced applications for giving radiotherapy with minimal side effects and 1/10th the radiation dose, discovery of new molecules for chemotherapy / Immunotherapy, decoding of genome and development of surgical skills have really changed the cancer scene. The end results is that we now have better techniques for preventing cancer and diagnosing it at an early stage, (when it is curable completely), development of newer techniques for doing Bone Marrow Transplants (specially Haploidentical (Half Matched) to save precious lives.

However, the biggest dilemma facing by our country is that we still get 60-70 per cent of cancer patients who can’t be cured (because of reporting at very late stages) and require symptomatic relief and compassionate care. Some patients, who may come with less advanced cancer, may not respond to cancer treatment and therefore, they are put on Palliative Care, after stopping the active treatment.

PAllIATIVE CARE

Palliative Care means to provide care which will make the patients comfortable by relieving their physical and emotional symptoms including pain and suffering. The goal of Palliative Care is to improve the quality of seriously ill patients and their families during and after treatment.

OBJECTIVES OF PAllIATIVE CARE

  • Integrating the physical, psychological and spiritual aspects of patient care.
  • Providing relief from pain and other distressing symptoms
  • Offering a support system to help patients live as actively as possible until death.
  • Offering a support system to help the family cope during patient’s illness and in their own bereavement.
  • Enhancing quality of life that may also positively influence the course of illness.
  • Identifying the most important symptoms in Palliative Care i.e. pain, breathlessness, fatigue, respiratory tract secretions, anxiety, depression, delirium, loss of appetite, nausea, vomiting, constipation and diarrhea.
  • Improving performance status score (ECOG) at least 50 per cent from the base line score.
  • Identifying appropriate pharmacological approaches for management of individual symptoms.
  • Determining effectiveness and safety of identified pharmacological approaches.

Palliative care is applicable early in the course of illness in conjunction with other therapies that are intended to improve the quality of life and includes investigations required to better understand and manage distressing symptoms

BASIC INVESTIGATIONS & PROCEDURES REQUIRED

  • lab Tests: Haemaogram, biochemistry and cultures
  • Radiology Tests: X-ray and ultrasound

MEDICAl PROCEDURES

  • Pleural, ascetic and pericardial tapping (Drainage of extra fluid from the body)
  • yles tube insertion (For feeding)
  • nCatheterisation to drain out routine

SURGICAl PROCEDURES

Tracheostomy, feeding jejunostomy, colostomy, suprapubic catheterization, percutaneous nephrostomy, toilet mastectomy, intercostal drainage and external carotid artery ligation 

FACIlITIES AND SERVICES REQUIRED

  • Day-care radiation
  • Palliative surgery, first line antibiotics / antifungal pain relief, dressings, adequate diet
  • Physiotherapy, occupational therapy
  • I/V fluids, blood / blood components
  • Good and compassionate nursing care, yoga, meditation, spiritual discourses etc.
  • Preparing for death
  • Training of attendants in home care

FACIlITIES NOT TO BE PROVIDED

  • Unnecessary high end investigations
  • Chemotherapy, ICU care, ventilator support high end antibiotics, high end surgeries

WHERE IS PAllIATIVE CARE GIVENIJ

Depending on the condition of the patient and circumstances like facilities at home and geography, palliative care can be given at home by the family members or caretaker, palliative care OPD, palliative care unit of hospitals, palliative care homes or centres and primary health centres. The best palliative care is given at home by doctors and nurses trained in palliative care who visit the patient at their home, do the counselling, give morphine in required dosage, do the dressing of the chronic wound, motivate the patient and make him laugh.

PAllIATIVE CARE POlICY

As of now, Central Government and Delhi Government don’t have palliative care policy. The draft of palliative care policy is almost ready. Hopefully the policy will be implemented in the next few months.

FUTURE PlANNING

My dream is to open multiple palliative care centres across Delhi. I have requested Delhi Government to provide us 10 to 20 bedded wards in each Government hospitals where nurses and doctors trained in palliative care by us can provide the services. This will hopefully happen soon.

We are also planning to start DNB Programme in palliative care. In collaboration with Narayana Hrudayala ltd, Dharamshila Hospital And Research Centre is shortly starting other super-specialities like Neurosciences, Cardiothoracic, Gastroenterology, Nephrology, Urology, Organ transplantations, Joint Replacements etc.

(The writer is founder of Dharamshila Hospital And Research Centre & President of Dharamshila Cancer Foundation And Research Centre)

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