Pallium India Newsletter: September 2010
- From: Pallium India Newsletter <info@xxxxxxxxxxxxxxxx>
- To: "" <palliumindia@xxxxxxxxxxxxx>
- Date: Wed, 29 Sep 2010 20:45:53 +0000
Pallium India
Care Beyond Cure
SPOTLIGHT…
HOW MUCH PROGRESS HAS PALLIATIVE CARE MADE IN INDIA DURING THE LAST
DECADE? TREMENDOUS, IF WE COUNT THE NUMBER OF PALLIATIVE CARE CENTRES
[HTTP://PALLIUMINDIA.ORG/CLINICS/] .
BUT THEN WE ARE BUSY PLAYING THE NUMBERS GAME?
Morphine consumption is only one part of pain management, and no doubt
pain management is only one aspect of palliative care. However, the fact
remains that morphine consumption is the only reliable indicator of palliative
care access that we have and particularly because morphine is the only step III
oral opioid available in India.
As other existing systems of estimating morphine consumption are
unreliable, we go by the quantity of morphine that goes out of the GOVERNMENT
OPIUM AND ALKALOID FACTORY. And with some sadness we find that the consumption
in 2009 is not significantly greater than in previous years:
ABOVE ALL, LET US HOPE THAT INCREASED AVAILABILITY OF PALLIATIVE CARE SERVICES
MEAN THAT MORE PEOPLE ARE RECEIVING BETTER ASSESSMENT AND GUIDANCE.
-
NEWS…
PALLIATIVE CARE IMPROVES QUALITY OF LIFE, PROLONGS SURVIVAL
A study in The New England Journal of Medicine reported that among 151
patients with newly diagnosed metastatic lung cancer, those who received
palliative care along with standard cancer therapy had better outcomes. They:
* Had a better quality of life
* Experienced less depression
* Were less likely to receive aggressive end-of-life care
* Lived nearly three months longer than those who received cancer
treatment alone
DOWNLOAD THE PDF REPORT HERE…
[HTTP://PALLIUMINDIA.ORG/CMS/WP-CONTENT/UPLOADS/2010/08/NEJM-AUG-19-10-EARLY-PALL-CARE-FOR-LUNG-CANCER.PDF]
-
COMMENT: WHAT SHOULD MEDICINE DO WHEN IT CAN’T SAVE YOUR LIFE?
Dr Michael Minton comments on an article
[http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande?currentPage=all]
in The New Yorker by Dr Atul Gawande:
_“THIS IS A VERY INSIGHTFUL ARTICLE BY AN AMERICAN SURGEON WHO AS A RESULT OF
HIS CONCERNS ABOUT HOW MODERN MEDICINE CAN POORLY SERVE THE TERMINALLY ILL
PATIENT, TAKES A JOURNEY OF DISCOVERY AND RESEARCHES WHAT THE PALLIATIVE CARE
APPROACH HAS TO OFFER HIS PATIENTS.”_
"
[HTTP://WWW.NEWYORKER.COM/REPORTING/2010/08/02/100802FA_FACT_GAWANDE?CURRENTPAGE=ALL]
LETTING GO: WHAT SHOULD MEDICINE DO WHEN IT CAN’T SAVE YOUR LIFE?
[HTTP://WWW.NEWYORKER.COM/REPORTING/2010/08/02/100802FA_FACT_GAWANDE?CURRENTPAGE=ALL]
_by Atul Gawande, The New Yorker – 2/8/10_
Sara Thomas Monopoli was pregnant with her first child when her doctors
learned that she was going to die. It started with a cough and a pain in her
back. Then a chest X-ray showed that her left lung had collapsed, and her chest
was filled with fluid. A sample of the fluid was drawn off with a long needle
and sent for testing. Instead of an infection, as everyone had expected, it was
lung cancer, and it had already spread to the lining of her chest. Her
pregnancy was thirty-nine weeks along, and the obstetrician who had ordered the
test broke the news to her as she sat with her husband and her parents. The
obstetrician didn’t get into the prognosis—she would bring in an oncologist for
that—but Sara was stunned. Her mother, who had lost her best friend to lung
cancer, began crying.
The doctors wanted to start treatment right away, and that meant
inducing labor to get the baby out. For the moment, though, Sara and her
husband, Rich, sat by themselves on a quiet terrace off the labor floor. It was
a warm Monday in June, 2007. She took Rich’s hands, and they tried to absorb
what they had heard. Monopoli was thirty-four. She had never smoked, or lived
with anyone who had. She exercised. She ate well. The diagnosis was
bewildering. “This is going to be O.K.,” Rich told her. “We’re going to work
through this. It’s going to be hard, yes. But we’ll figure it out. We can find
the right treatment.” For the moment, though, they had a baby to think about.
READ THE FULL ARTICLE AT THE NEW YORKER…
[HTTP://WWW.NEWYORKER.COM/REPORTING/2010/08/02/100802FA_FACT_GAWANDE?CURRENTPAGE=ALL]
"
DR MINTON CONTINUES…
_“He learns that patients who have the opportunity to receive
palliative care alongside their anticancer treatment fared better than those
who had treatment (usually chemotherapy) alone. The former patients used
hospital and intensive care (ICU) less. They were more likely to achieve their
wishes which often included being able to die at home. Their carers at 6 months
after the death were better emotionally adjusted. The surgeon was also
surprised to learn that in some groups of patients (eg cancer of lung and
pancreas) even lived longer than those receiving palliative chemotherapy. He
had previously believed that patients choosing palliative care always died
sooner._
_He came to appreciate that the majority of people are prepared to
discuss their wishes for the future and write advance directives. In particular
he was amazed to realise that carefully conducted consultations can help
patients, families, and their doctors identify the expectations and anxieties
which enable more patient orientated care to be given. __He concludes that
doctors must be prepared to discuss end of life issues and help patients plan
for their future even while pursuing further treatment._
_He highlights a hospice doctor who reminds him that effective
communication is an acquired skill and requires no less experience than
performing a surgical operation. The key features of an interview are to allow
and facilitate the patient to explore their understanding of the illness and
prognosis, including anxieties about the future. This requires the doctor to
actively listen and acknowledge these concerns without necessarily trying to
provide all the answers._
_THIS IS AN HONEST AND REVEALING ARTICLE OF A SURGEON WHO STOPS TO THINK ABOUT
HIS DYING PATIENTS AND LEARNS WHAT PALLIATIVE CARE CAN OFFER HIS PATIENTS. I
URGE YOU TO ENCOURAGE ANY SCEPTICAL COLLEAGUES TO READ _ _THE ARTICLE_
[HTTP://WWW.NEWYORKER.COM/REPORTING/2010/08/02/100802FA_FACT_GAWANDE?CURRENTPAGE=ALL]
_.”_
.
[Dr Gawande has written some eye-opening articles on the US healthcare
system. Read them at the The New Yorker
[http://www.newyorker.com/magazine/bios/atul_gawande/search?contributorName=atul%20gawande]
website and many others on Gawande.com [http://gawande.com/articles]
- including the commencement speech to graduates at the Stanford School of
Medicine: \"The Velluvial Matrix\"
[http://www.newyorker.com/online/blogs/newsdesk/2010/06/gawande-stanford-speech.html]
]
-
TELL ME THE TRUTH: CONVERSATIONS WITH MY PATIENTS ABOUT LIFE AND DEATH…
Australia’s Brisbane Times [http://www.brisbanetimes.com.au] speaks to
Monash Medical Centre
[http://www.southernhealth.org.au/page/Hospitals/Monash_Medical_Centre/] and
Dandenong Hospital [http://www.southernhealth.org.au/page/Hospitals/Dandenong]
oncologist Ranjana Srivastava
[http://www.cancervic.org.au/artsawards/art-gallery/2008_arts_awards_entries/short_story2008.html]
about her new book, TELL ME THE TRUTH: CONVERSATIONS WITH MY PATIENTS ABOUT
LIFE AND DEATH
[HTTP://WWW.PENGUIN.COM.AU/PRODUCTS/9780670074402/TELL-ME-TRUTH-CONVERSATIONS-MY-PATIENTS-ABOUT-LIFE-AND-DEATH]
, in which she says not all 100,000+ Australians diagnosed with cancer this
year will get the medical treatment they deserve: "
[HTTP://WWW.BRISBANETIMES.COM.AU/NATIONAL/THE-BEST-MEDICINE-20100902-14ROQ.HTML]
THE BEST MEDICINE
[HTTP://WWW.BRISBANETIMES.COM.AU/NATIONAL/THE-BEST-MEDICINE-20100902-14ROQ.HTML]
AS A child growing up in the impoverished Indian state of Bihar in the
1980s, Ranjana Srivastava’s first encounter with cancer broke her heart. In
what felt like a matter of weeks, the disease transformed her energetic
grandmother into a vulnerable, ailing person who spent her last days confined
to a hospital bed.
Despite being treated by one of the best cancer specialists in the
region, Srivastava’s ”Nanima” did not receive good care. As she was shunted
through the health system for a multitude of tests and procedures, her doctors
fed only morsels of information to her eldest son, who, despite his best
efforts, struggled to understand what it all meant for his mother.
Towards the end of Nanima’s life, the lack of communication between
these doctors and her family led to a tragic end. Without knowing her
grandmother’s prognosis, Srivastava, then 10, and her mother flew to Britain to
visit family. While they were gone, their beloved matriarch fell into a coma
and died. She was cremated before they could get back to see her one last time.
There were things they wanted to say. They did not get a chance to say goodbye.
[..]
”WE SPEND A LOT OF MONEY ON FUTILE MEDICINE AND INTENSIVE CARE AT THE END OF
LIFE AND IF WE HAVE LIMITED RESOURCES LIKE EVERY NATION DOES, WE NEED TO BE
THINKING ABOUT HOW THOSE RESOURCES ARE BEST ALLOCATED. I THINK INVESTING IN
PALLIATIVE CARE AND BOOSTING SUPPORT SERVICES FOR SICK PEOPLE IS VERY
IMPORTANT. THOSE THINGS SHOULD NOT BE AN ADJUNCT…”
READ MORE AT THE BRISBANE TIMES…
[HTTP://WWW.BRISBANETIMES.COM.AU/NATIONAL/THE-BEST-MEDICINE-20100902-14ROQ.HTML]
"
-
NEW YORK’S PALLIATIVE CARE INFORMATION ACT
Here is a new development from USA reported by the New York Times, “
Frank Talk About Care at Life’s End
[http://www.nytimes.com/2010/08/24/health/24brod.html?_r=1] “: "
[http://www.nytimes.com/2010/08/24/health/24brod.html?_r=1] Last week,
over the objections of New York State’s Medical Society [http://www.mssny.org/]
, Gov. David A. Paterson signed into law a bill — the NEW YORK PALLIATIVE CARE
INFORMATION ACT
[HTTP://ASSEMBLY.STATE.NY.US/LEG/?DEFAULT_FLD=&BN=+A07617%09%09&SUMMARY=Y&ACTIONS=Y&TEXT=Y]
— REQUIRING PHYSICIANS WHO TREAT PATIENTS WITH A TERMINAL ILLNESS OR CONDITION
TO OFFER THEM OR THEIR REPRESENTATIVES INFORMATION ABOUT PROGNOSIS AND OPTIONS
FOR END-OF-LIFE CARE, INCLUDING AGGRESSIVE PAIN MANAGEMENT AND HOSPICE CARE AS
WELL AS THE POSSIBILITIES FOR FURTHER LIFE-SUSTAINING TREATMENT."
The report also quoted the recent article in NEW ENGLAND JOURNAL OF
MEDICINE ( see our blog
[http://palliumindia.org/2010/08/palliative-care-improves-quality-of-life-prolongs-survival/]
) along with an October 2008 study published in the Journal of the American
Medical Association [http://jama.ama-assn.org/] , in which Boston researchers
found that patients who had end-of-life discussions with their physicians: "
“.. WERE MORE LIKELY TO ACCEPT THAT THEIR ILLNESS WAS TERMINAL, PREFER
MEDICAL TREATMENT FOCUSED ON RELIEVING PAIN AND DISCOMFORT OVER LIFE-EXTENDING
THERAPIES, AND HAVE COMPLETED A DO-NOT-RESUSCITATE ORDER.”"
The bill was developed by Compassion and Choices, calling the decision
“A Sea Change in End-of-Life Care” in the Huffington Post
[http://www.huffingtonpost.com/barbara-coombs-lee/new-yorks-palliative-care_b_688386.html]
: "
The bill, developed by Compassion & Choices
[http://compassionandchoices.org/] in concert with our New York affiliate
[http://www.compassionandchoicesofny.org/] , passed the Assembly and Senate by
large margins, but the governor’s signature remained in doubt because the
Medical Society of New York pressed him for a veto. The Society’s inane claim
that doctors who ask if their patients want to talk about palliative care,
won’t also “fight” for their patients or “go the extra mile” to “aggressively
recommend treatment options” defies both common sense and medical research. –
Read more…
[http://www.huffingtonpost.com/barbara-coombs-lee/new-yorks-palliative-care_b_688386.html]
"
-
ECONOMIC EFFECT OF TERMINAL ILLNESS ON FAMILIES
[http://www.liebertonline.com/doi/pdfplus/10.1089/jpm.2010.0055]
A small international study, published in the Journal of Palliative
Medicine [http://www.liebertpub.com/products/product.aspx?pid=41] , reports
that FAMILIES OF TERMINALLY ILL PATIENTS SUFFER SIGNIFICANT ECONOMIC EFFECTS
RELATED TO THE ILLNESS, FORCING SOME HOUSEHOLDS TO ACCRUE LARGE DEBTS AND
RENDERING THEM UNABLE TO AFFORD FOOD OR ATTEND GOVERNMENT-FUNDED EDUCATION
PROGRAMS.
A sample of eleven patient-caregiver dyads (22 individuals) who visited
Pallium India [http://PalliumIndia.org ] ‘s Palliative Care Clinic in
Trivandrum, Kerala, India completed a survey.
All of the respondents said that as a result of the illness they had to
sell assets and it left them unable to work at the same level as before the
illness.
A majority of caregivers said that they would have accepted outside
help and they thought that having someone else to tend to their loved one would
have prevented some sacrifices.
THE FULL STUDY CAN BE DOWNLOADED HERE (PDF): ECONOMIC IMPACT OF TERMINAL
ILLNESS AND THE WILLINGNESS TO CHANGE IT
[HTTP://WWW.LIEBERTONLINE.COM/DOI/PDFPLUS/10.1089/JPM.2010.0055]
-
AWARD AT 13TH WORLD CONGRESS ON PAIN
[http://www.iasp-pain.org/AM/Template.cfm?Section=World_Congress_on_Pain&Template=/CM/HTMLDisplay.cfm&ContentID=9948]
On 2 September, Dr M.R. Rajagopal received the annual award of International
Association for Study of Pain ( IASP [http://www.iasp-pain.org] ) for
EXCELLENCE IN PAIN MANAGEMENT FOR DEVELOPING COUNTRIES.
Sir Michael Bond, chairman of the developing countries’ working group
of IASP presented the award at the 13th World Congress on Pain
[http://www.iasp-pain.org/AM/Template.cfm?Section=World_Congress_on_Pain&Template=/CM/HTMLDisplay.cfm&ContentID=9948]
in Montréal, Canada. The congress was attended by more than 6,500 delegates.
-
UNIVERSITY OF WISCONSIN-MADISON CARBONE CANCER CENTER SEEKS POLICY RESEARCHER
[http://ohr.wisc.edu/pvl/pv_064877.html] The Pain & Policy Studies
Group ( PPSG [http://www.painpolicy.wisc.edu/] ) at the University of
Wisconsin-Madison Carbone Cancer Center
[http://www.uwhealth.org/cancer-for-researchers/uwccc/28373] is seeking a
suitable candidate for the position of full-time Policy Researcher
[http://ohr.wisc.edu/pvl/pv_064877.html] . The PPSG is seeking:
* a motivated professional
* ideally with experience in legal and policy analysis related to
health or drug control law
to help achieve:
* its mission to improve global availability of, and patient access to,
essential controlled medications for pain relief and opioid substitution
therapy.
APPLICATION DEADLINE: OCTOBER 4TH, 2010
FULL DETAILS AND APPLICATION INFORMATION HERE….
[HTTP://OHR.WISC.EDU/PVL/PV_064877.HTML]
-
TAILPIECE…
PEOPLE KEEP ASKING US HOW WE MANAGE TO FIND THE FUNDS FOR OUR SERVICE, WHEN 82%
OF OUR PATIENTS NEED TO BE GIVEN FREE TREATMENT INCLUDING FREE SUPPLY OF
MEDICINES AND CARE OF ONE PATIENT COSTS AN AVERAGE OF RS1000 PER WEEK. HERE IS
HOW…
* One year old “S” will have no birthday party. Oh, yes, there will be
a cake and celebration within the family. But what would have gone towards a
party for friends and the extended family has now been handed over to us. “She
will be blessed!”, her mother said simply.
* When 45 year old MR. K.N. died, there was no typical “Sanchayanam
breakfast” for hundreds of people on the 5th day-rituals. Instead, the money
came to us.
* POOJA qualified as an engineer and got a job. 10% of her first salary
came to us.
* MS P.B. disposed of some property. A certain percentage of the
proceeds, Rs. 70,000, was donated to Pallium India.
THESE ARE JUST A FEW EXAMPLES. WE ARE BLESSED!
Other related posts:
- » Pallium India Newsletter: September 2010 - Pallium India Newsletter
