|LETTER TO EDITOR
|Year : 2020 | Volume
| Issue : 1 | Page : 116-117
Health related quality of life and needs speak a global language that seek local solutions
Rajani Surendar Bhat, Manjiri Dalvi Dighe
|Date of Submission||16-Jan-2020|
|Date of Acceptance||18-Jan-2020|
|Date of Web Publication||24-Feb-2020|
Rajani Surendar Bhat
92, Supreme Enclave, Mayur Vihar Phase I, Delhi - 110 091
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bhat RS, Dighe MD. Health related quality of life and needs speak a global language that seek local solutions. Cancer Res Stat Treat 2020;3:116-7
|How to cite this URL:|
Bhat RS, Dighe MD. Health related quality of life and needs speak a global language that seek local solutions. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Aug 3];3:116-7. Available from: http://www.crstonline.com/text.asp?2020/3/1/116/279105
We read with interest the original article on quality of life and needs of Indian advanced cancer patients receiving palliative care by Asthana et al. We congratulate the authors for providing a better understanding of quality of life and needs of Indian advanced cancer patients receiving palliative care.
The authors have used popular, validated tools such as the PNPC questionnaire to elicit a detailed measure of patients' needs. Of note, fatigue and need to be informed of treatment options and side effects were prominent. This finding in the Indian population mirrors that of prior reviews in Western literature in patients and caregivers. As the authors elaborate in their discussion of findings of surveys in various countries, the assessment of needs can inform future plans to expand the woefully inadequate state of access to palliative care services in the present day.
The authors note that needs were higher in female patients in this study. This is similar to findings in smaller studies in the west where female patients expressed greater needs, especially for communication with their doctors, outlining expectations for the future. It is possible that different cultural factors may be at play although the perceived need as measured may be the same. Increasingly, studies in Indian populations validate the practicing doctors' subjective experience that patients with advanced cancer are more similar across the world, except for a few cultural differences. Recent studies have debunked the previously held notions that Indian patients are averse to discussions about prognosis and have shown that they would prefer disclosure of diagnosis and prognosis. The findings overall point to a need for improved communication between doctors (GPs and specialists) and patients. If the perceived need for communication were still high in those with access to palliative care, it would be safe to presume that the need would be higher in those without access to palliative care services. We often find female patients deprived of agency in decision-making due to cultural and financial reasons. The authors' findings bolster the physicians' ethical view of restoring agency with evidence to counter patriarchal arguments. It is only recently that the medical education curriculum in India has mandated training in communication with the introduction of the Attitude, Ethics and Communication modules. Communication training workshops are needed to address development of this competency.
Another contributing factor to greater unmet needs of patients with advanced cancer is caregiver stress. Unmet caregiver needs translate to unmet patient needs. Addressing these as a whole unit may offer more impactful solutions.
We thank the authors for this exploratory study. Just as this study highlights the existing needs, the editorial by Dr. Salins in the same issue directs us toward future research in the development of interventions to address these needs and to measure the efficacy of the interventions. That would be the natural next step to aid the mammoth task of addressing the unmet palliative care needs of advanced cancer patients countrywide.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Asthana S, Bhatia S, Dhoundiyal R, Labani SP, Garg R, Bhatnagar S. Quality of life and needs of the Indian advanced cancer patients receiving palliative care. Cancer Res Stat Treat 2019;2:138-44. [Full text]
Wang T, Molassiotis A, Chung BP, Tan JY. Unmet care needs of advanced cancer patients and their informal caregivers: A systematic review. BMC Palliat Care 2018;17:96.
Ullrich A, Grube K, Hlawatsch C, Bokemeyer C, Oechsle K. Exploring the gender dimension of problems and needs of patients receiving specialist palliative care in a German palliative care unit – The perspectives of patients and healthcare professionals. BMC Palliat Care 2019;18:59.
Ghoshal A, Salins N, Deodhar J, Damani A, Chowdhury J, Chitre A, et al
. Understanding patients' and family caregivers' preferences and attitudes towards disclosure of cancer related diagnosis and prognosis. J Clin Oncol 2018;15 Suppl 36:e22130.
Salins N. Health-related quality of life: Is it a missing feature in the Indian cancer setting? Cancer Res Stat Treat 2019;2:213-4. [Full text]