The number of cases of advanced urological cancers and the consequent demand for palliative care are on the rise, especially in areas where access to cancer and supportive care is still limited. The purpose of this review was to summarise the existing evidence concerning palliative care for urological malignancies in India and to point out the gaps that are relevant to clinical practice. A PubMed search was undertaken using terms relating to palliative care and the renal or kidney, urothelial or bladder, prostate, testicular and penile cancers. Only studies that were carried out in India or involved Indian populations and were published from 2019 onwards were considered, with nine studies meeting the stated eligibility criteria. The available evidence addressed quality of life, palliative radiotherapy, the management of refractory bone pain, ^177Lu-PSMA therapy, malignant urinary obstruction, cancer-related fatigue and some metastatic situations. Nevertheless, the body of evidence was small and heterogeneous, with several studies including mixed cancer populations and consisted of individual case reports. Major difficulties included scarce resources, high treatment costs, geographical barriers and inadequate palliative-care infrastructure. There is a need for larger prospective and multicentre studies in order to establish effective and equitable palliative-care pathways for patients with advanced urological malignancies in India.
Objectives: To explore the lived experiences of bereaved informal caregivers who provided end-of-life care to patients with cancer in marginalised coastal hamlets of Pondicherry and Chennai during the COVID-19 pandemic. Materials and Methods: This qualitative study used a hermeneutic phenomenological approach guided by van Manen’s interpretive framework. Ten bereaved informal caregivers were purposively recruited for in-depth, voice-only interviews conducted in Tamil between July 2022 and April 2023. The caregivers had provided care to patients with cancer who died between April 2020 and December 2021. Recruitment ceased after the ninth and tenth interviews yielded no new themes, as determined by the research team. Data were analysed manually using an interpretive approach informed by van Manen’s framework. Results: Two overarching themes were identified: (1) barriers to supportive and end-of-life care, encompassing societal, institutional and personal factors; and (2) unmet needs across physical, psychological, spiritual, social and informational domains. Participants described financial hardship, fear of infection, interruptions in healthcare services, difficulties accessing information and medicines, disrupted cultural and religious practices, and restrictions on family presence at the end of life. These accounts informed the overarching interpretation of compounded abandonment arising from the interaction of pandemic-related disruptions and pre-existing structural disadvantages. Conclusion: Bereaved caregivers in the participating coastal communities described substantial challenges in providing end-of-life cancer care during the COVID-19 pandemic. The findings highlight the need to strengthen community-based palliative care, improve access to essential medicines and information, develop culturally responsive bereavement support, and maintain continuity of care during public health emergencies.
Objectives: To evaluate the oral hygiene status of patients receiving PC using the modified oral assessment guide (OAG). Secondary objectives included assessment of oral and systemic symptom burden using the modified Memorial Symptom Assessment Scale (MSAS) and evaluation of functional status using the Palliative Performance Scale (PPS). Materials and Methods: A descriptive, cross-sectional pilot study was conducted among 59 participants selected through convenience sampling. A structured questionnaire was used to collect sociodemographic data, primary diagnosis and the impact of oral health on QoL, alongside PPS assessment. Oral hygiene and symptom burden were evaluated using the modified OAG and modified MSAS, respectively. Data were analysed using Statistical Package for the Social Sciences software (version 23), with descriptive statistics and Spearman’s rank correlation to examine relationships between functional status and symptom severity. Results: The mean PPS was 82.54 ± 8.22, indicating relatively preserved functional status. Despite this, mild-to-moderate oral impairments were common. Lower PPS scores were significantly associated with greater oral symptom burden, with the strongest correlation observed between PPS and total MSAS oral symptom score (ρ = −0.395, p = 0.002). Conclusion: Patients receiving PC commonly experience mild-to-moderate oral symptoms, particularly xerostomia, despite relatively preserved functional status. Lower functional status was associated with greater oral symptom burden. These findings support routine oral assessment and integration of oral healthcare into multidisciplinary palliative care to facilitate early identification and management of oral problems.
This scoping review evaluates the efficacy, safety and dosing regimens of topical ketamine mouthwash for managing oral mucositis pain in cancer patients undergoing chemotherapy and/or radiotherapy. Oral mucositis, characterised by painful inflammation and ulceration of the mucosa, significantly impairs quality of life (QoL) and often requires opioid analgesics. Ketamine, an N-methyl-D-aspartate receptor antagonist with peripheral antinociceptive and anti-inflammatory effects, has been explored as a topical treatment to address refractory mucositis pain. The review included six studies comprising case reports, retrospective audits, a prospective phase II study in adults and a randomised placebo-controlled trial in paediatric patients. Adult studies generally reported pain reduction, improved function and opioid-sparing effects, with good tolerability and minimal adverse events. However, the paediatric trial found no significant benefit at the tested dose. Variability in dosing, formulation and study design limits definitive conclusions. Pharmacokinetic data support localised action with minimal systemic absorption and toxicity. Topical ketamine mouthwash shows promise as an adjunctive therapy for difficult-to-control oral mucositis pain, potentially improving patient comfort and reducing opioid use. Larger, well-designed randomised controlled trials are needed to establish optimal dosing, long-term safety and comparative efficacy against standard treatments. Integration of topical ketamine into supportive care protocols may enhance pain management and QoL for affected patients.
Malignant bowel obstruction (MBO) is a distressing complication of advanced cancer with poor survival and substantial symptom burden and often requiring intensive supportive management. Data on its management in lower-middle-income countries (LMICs) are limited. We retrospectively reviewed records of 25 adults with inoperable MBO managed by a palliative care (PC) unit at a tertiary cancer centre in India between November 2021 and October 2023. Demographic, clinical, radiological and treatment data were collected; symptoms at admission and discharge, survival and place of death were recorded. Eighteen patients (72%) were female. Ovarian and gastric cancers were the most common primary malignancies (6 each; 24%), followed by rectal cancer (5; 20%). Abdominal pain (17; 70.8%) and vomiting (15; 62.5%) were the most common symptoms. Nasogastric tubes were inserted in 13 patients (52%), of whom 8 (61%) had them removed before discharge. Dexamethasone (22; 88%) and metoclopramide (21; 84%) were the most frequently used medications. Symptom control at discharge was achieved in 20/23 patients (87%), and 19 (79%) tolerated oral liquids. Nearly 80% died within 60 days of diagnosis. Multidisciplinary medical management with PC involvement was associated with symptom control in most patients with inoperable MBO in this resource-constrained setting.
