Effectiveness of Comprehensive Intervention Programme on Quality of life, fatigue, self-efficacy, and psychosocial distress among head and neck cancer patients receiving radiotherapy.

PURPOSE: The study aimed at evaluating the Effectiveness of Comprehensive Intervention Programme (CIP) on Quality of life (QOL), fatigue, self-efficacy, and psychosocial distress among Head and Neck Cancer (HNC) patients receiving radiotherapy treatment. METHODS: Single-centre non-RCT time series study was conducted among 134 HNC patients (67 observed, followed by 67 subjected to CIP). FACT- H&N, FACT-F, Cancer Behavior Inventory and psychosocial distress scales were used to assess QOL, fatigue, self-efficacy, and psychosocial distress respectively. CIP was provided to the intervention arm twice a week during the course of radiation therapy along with the standard care; the control arm received only standard care. Data were collected before commencing radiotherapy, and post-test assessments were carried out at the end of radiotherapy treatment, and at 3 and 6 months after completion of radiotherapy. RESULTS: Repeated measures ANOVA revealed a statistically significant improvement with CIP in QOL (F (1.917) = 454.103, p = 0.001), fatigue (F (2.106) = 183.775, p = 0.001), self-efficacy (F (2.429) = 190.861, p = 0.001), and psychosocial distress (F (2.288) = 290.105, p = 0.001) in the intervention arm. CONCLUSION: The CIP implemented to address multitude of issues in HNC patients receiving radiotherapy, proved to be effective in reducing the impact of treatment on QOL, fatigue, self-efficacy and psychosocial distress in HNC patients receiving radiotherapy.

Interventions to improve quality of life in patients with head and neck cancers receiving radiation therapy: a scoping review.

BACKGROUND: Quality of life (QOL) is impaired in patients with head and neck cancers (HNC) due to illness and treatment-associated morbidity. Although there is evidence from the studies on interventions' role in improving QOL receiving radiation therapy, these are not systematically synthesised. In this scoping review, we searched and synthesised the evidence on interventions to improve the QOL and its impact among patients with HNCs. METHODS: This scoping review was conducted using the framework proposed by Arksey and O'Malley, and the extensions suggested by Levac et al. were incorporated. Two reviewers independently searched four electronic databases using key thesaurus and free-text terms, and the data was extracted, tabulated, synthesised and reported as categories. RESULTS: Seventy-nine papers reported various interventions of diverse nature such as pharmacological, physical, nutritional, complementary and alternative therapies, psychosocial, oral care related, laser and photobiomodulation therapies, rehabilitative, educational, technology-based, surgical, device-related and nurse lead interventions. Most studies reported clinically meaningful impact of interventions on QOL, although the outcome differences were often statistically insignificant. Few studies reported a combination of interventions to address the multidimensional concerns faced by patients with HNCs. None of the studies examined the impact of interventions on QOL among long-term survivors of HNCs. CONCLUSION: As QOL concerns in patients with HNCs are multifaceted, more extensive studies with complex multi-component interventions and robust research designs are warranted.

Impact of a home-based nutritional intervention program on nutritional status of preschool children: a cluster randomized controlled trial.

BACKGROUND: Undernutrition in under-five children remains a worldwide health issue and is considered one of the leading causes of increased morbidity and mortality. This study aims to assess the impact of home-based nutritional intervention on the nutritional status of preschool children living in rural areas of South India. METHODS: A single-blinded cluster randomized controlled trial evaluated the impact of the intervention, with weight gain as the primary outcome. A cluster of 12 villages was randomized to intervention or control arms. A total of 253 underweight preschool children from 12 clusters (villages) were randomized to intervention (n = 127) and control arm (n = 126). The intervention was composed of a health-teaching program and a demonstration of nutritious food preparation in addition to the regular services provided at the Anganwadi centers. The control arm received only standard routine care provided in the Anganwadi centre. The anthropometric assessment was carried out at the baseline and every month for a year. RESULT: A significant increase in the mean weight kilograms was noted in the intervention group (11.9 ± 0.98 to 13.78 ± 0.89) compared to the control group (11.8 ± 1.03 to 12.96 ± 0.88). In the intervention group, at the baseline, 41.5% were moderately malnourished (> - 2SD-3SD), which decreased to 24% at the end of the year. Similarly, severe malnutrition decreased from 8.69 to 3.16%, while 20.5% of malnourished children achieved normal nutritional status. In the control group, undernourished children demonstrated minimal changes in nutritional status. Analysis of repeated measures of ANOVA results between the intervention and control groups on weight measurements (F (1, 251) = 15.42, p .001) and height measurements (F (2, 1258) = 1.540, p .001) revealed statistical significance. CONCLUSION: The nutritional status of preschool children is found to be improved by home-based intervention, which includes training mothers or caregivers in planning and preparing healthy nutritious diets, providing timely care, and gaining an understanding and knowledge of the nutritional status along with regular home-based diet preparation. TRIAL REGISTRATION: ctri@gov.in CTRI/2017/03/008273 [Registered on: 31/03/2017].

Interventions to support contraceptive choice and use: a global systematic map of systematic reviews.

BACKGROUND: To review the highest level of available evidence, a systematic map identified systematic reviews that evaluated the effectiveness of interventions to improve contraception choice and increase contraception use. METHODS: Systematic reviews published since 2000 were identified from searches of nine databases. Data were extracted using a coding tool developed for this systematic map. Methodological quality of included reviews was assessed using AMSTAR 2 criteria. FINDINGS AND CONCLUSION: Fifty systematic reviews reported evaluations of interventions for contraception choice and use addressing three domains (individual, couples, community); Meta-analyses in 11 of the reviews mostly addressed interventions for individuals. We identified 26 reviews covering High Income Countries, 12 reviews covering Low Middle-Income Countries and the rest a mix of both. Most reviews (15) focussed on psychosocial interventions, followed by incentives (6) and m-health interventions (6). The strongest evidence from meta-analyses is for the effectiveness of motivational interviewing, contraceptive counselling, psychosocial interventions, school-based education, and interventions promoting contraceptive access, demand-generation interventions (community and facility based, financial mechanisms and mass media), and mobile phone message interventions. Even in resource constrained settings, community-based interventions can increase contraceptive use. There are gaps in the evidence on interventions for contraception choice and use, and limitations in study designs and lack of representativeness. Most approaches focus on individual women rather than couples or wider socio-cultural influences on contraception and fertility. This review identifies interventions which work to increase contraception choice and use, and these could be implemented in school, healthcare or community settings.

Designing a mobile health intervention for preterm home care: Application of conceptual framework.

Mobile health (mHealth) solutions are being widely explored in low- and middle-income countries (LMICs) due to its scope in reducing the healthcare access gap and improving health outcomes. The fit of mHealth solutions to specific users and their viability in a particular setting plays a significant role in the successful adoption and sustainable implementation. This article describes the process of designing a sustainable mHealth application for delivering preterm home care to babies discharged from the neonatal intensive care unit (NICU) in India. Intended end-users are the parents, who are primary caregivers at home, especially mothers of preterm babies and healthcare providers who cared for them at the hospital. This mHealth application is designed to facilitate continuity of care for these preterm babies transitioning from an intensive healthcare setting to home with unique and complex health care needs. It is equipped to remotely monitor the growth and development for early detection of growth impairment and developmental delay often seen in preterm babies in their early years. Therefore, a mHealth application was designed applying a relevant conceptual framework for successful adoption and an ecological model for sustainability in the Indian setting.

Effectiveness of music on anxiety and pain among cardiac surgery patients: A quantitative systematic review and meta-analysis of randomized controlled trials.

AIM: The aim of this study is to evaluate the effectiveness of music on anxiety and pain among patients following cardiac surgery. BACKGROUND: Cardiac surgery affects patients physically, psychologically and socially. Anxiety and pain are the usual problems among patients following cardiac surgery. DESIGN: The study design is a systematic review and meta-analysis. DATA SOURCES: The Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), Excerpta Medica database (EMBASE) and Web of Science databases were searched for randomized controlled trials from January 2000 to December 2017. REVIEW METHODS: The Cochrane collaboration guidelines were followed and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to summarize the quality of evidence. RESULTS: Fourteen studies were included in systematic review and 13 in meta-analysis. The meta-analysis revealed that there was a significant reduction in anxiety and pain among patients who received musical intervention compared with those who did not. CONCLUSION: Music has positive benefits on anxiety and pain. However, well-designed and high-quality trials are needed to generate higher quality evidence.

Depression among older adults: a systematic review of South Asian countries.

The world's population has been evolving rapidly; every country in the world is facing this drastic progression in the number and the percentage of the elderly in their net population. As the chronological age advances, physiological and psychosocial decline will be evident among all older adults. The potentially relevant literature was identified using appropriate search terms in electronic databases such as PubMed MEDLINE, Scopus, ProQuest, Web of Science, CINAHL, IndMed, and Google Scholar. Articles published from 2006 to 2019, reported the prevalence and the risk factors for depression among older adults living in the community, old age homes, or hospitals of the South Asian countries. Articles were published in the languages other than English and those reporting the categorised or mean depressive scores were excluded from the review. After quality check for all the retrieved articles from different databases, 120 articles were included for the meta-analysis. The data were extracted based on a validated data extraction form, and the reviewer contacted the authors for clarification of the missing data whenever required. The estimates were pooled using the random effect model for meta-analyses. Sub-group and sensitivity analyses were also performed. The overall pooled estimate (random effect models) of the prevalence of depression among the elderly was 42.0% (95% CI: 0.38-0.46), Chi-squared P-value <0.001, and I2 99.14%. The pooled estimate of the prevalence was higher in the community settings than the old age homes (44.0%; 95% CI: 39.0-49.0 vs. 42.0%; 95% CI: 34.0-49.0). Depression is a common problem among the elderly population and the pooled estimate of depression would give directions to the healthcare providers, policymakers, and future researchers to plan some measures (either pharmacological or non-pharmacological interventions) to effectively tackle the burden of geriatric depression in the future.

First responder's care package on management of road traffic accident victims of Udupi: Study protocol.

AIM: To evaluate the effectiveness of 'first responder's care package' on knowledge and skill on the management of road traffic accident (RTA) victims. The outcomes relate to the quality of first responder's care by autorickshaw drivers. METHODS: Autorickshaw drivers (N = 1,040) will be assessed to identify the impediments and knowledge to provide the first responder's care to RTA victims following which, 150 autorickshaw drivers will be selected based on a cut-off knowledge score to train half of them using workshops. Drivers below 55 years and willing to participate will be recruited and drivers with serious health issues, homophobia and who cannot read English or Kannada will be excluded. Randomized controlled trial with repeated measures design will be adopted. Funding for the research is by the Indian Council of Medical Research and it is registered in the Clinical Trial Registry of India. DISCUSSION: Road traffic accidents are responsible for 85% of the total global mortality and 90% of the 'Disability Adjusted Life Years' in the developing countries amounting to an annual loss of $65 billion to $100 billion. India's rate of RTA deaths is high and postcrash care is not addressed efficiently by any agencies in India. Autorickshaw drivers could be ideal candidates for teaching the first responder's care package in India as they are a constant presence on the roads and reach all the main roads and small lanes of the country. IMPACT: The research will add to knowledge on quality of first responder's care provided to accident victims. If the intervention is found to be fruitful for the accident victims of the locality, it can be recommended to be implemented all over the state.

Randomized controlled trial on effectiveness of mHealth (mobile/smartphone) based Preterm Home Care Program on developmental outcomes of preterms: Study protocol.

AIM: To describe a randomized controlled trial protocol designed to evaluate the effectiveness of mobile health based Preterm Home Care Program (mHealthPHCP) known as "NeoRaksha" mobile health application in improving parent-infant-interaction, growth and development of preterms. DESIGN: A prospective, randomized controlled clinical trial. The protocol is approved and funded by Department of Biotechnology, Government of India on 2 August 2016. METHODS: A total of 300 preterm-mother dyads admitted to neonatal intensive care unit of a tertiary care hospital will be recruited and randomized to intervention and control group. The intervention group would receive mobile health based Preterm Home Care Program and the control group would receive standard preterm care. Intervention group will be followed up at home by community health workers known as Accredited Social Health Activist who will be trained in using the NeoRaksha mobile health application. Preterms outcomes will be assessed during follow-up at hospital. DISCUSSION: Supporting continuity of preterm care is vital as parents and preterms experience transition from Neonatal Intensive Care unit to their home. Empowering mothers and community health workers by integrating mobile technology into health care can help promote healthy preterms, enhance development outcomes and follow-up, which in turn can reduce the mortalities, morbidities, and disabilities associated with prematurity. IMPACT: The results of this study could open up new horizons in integrating hospital and home based preterm care through technology, which paves way to scale up the model across the countries.

Symptom Interference and Relation between the Domains of Quality of Life among Cancer Patients of Tertiary Care Hospital.

INTRODUCTION: Quality of life (QOL) should be considered as the main outcome measure for patient with advanced cancer. QOL of cancer patients is affected by several factors. OBJECTIVES: The objective of the study was to assess the symptom interference and the relation between the domains of QOL among cancer patients. METHODOLOGY: An exploratory survey conducted among 768 patients diagnosed as Stage III or IV of cancer of breast/cervix/head and neck/gastrointestinal tract/lung/colorectal. Data were collected using pretested reliable structured interview questionnaire. RESULTS: Out of 768 cancer patients, symptoms burden was interfered completely in their relationship with others among 445 (57.9%), sleep among 491 (63.9%), and QOL among 433 (56.4%). The domains of QOL were general well-being, physical well-being, psychological well-being, familial relationship, sexual and personal abilities, cognitive well-being, economic well-being, informational support, doctors' cooperation, and body image. Since the data were not following the normal distribution, Spearman rho was computed to assess the relationship between the domains. The data revealed that there is a positive statistically significant correlation between the domains of general well-being of the participants with physical wellbeing (r = 0.265, P = 0.001), psychological well-being (r = 0.195, P = 0.001), sexual and personal abilities (r = 0.278, P = 0.001), and body image (r = 0.168, P = 0.001). The study inferred that cancer patients with good cognitive well-being and high economic status had a sense of positive body image. CONCLUSION: Cancer patients have poor QOL in physical and psychological domains. QOL of patients is affected by the symptoms suffering during the treatment and diagnosis. Symptoms need to be managed effectively to improve the QOL of cancer patients.

Risk factors for malnutrition among preschool children in rural Karnataka: a case-control study.

BACKGROUND: The prevalence of malnutrition among children in developing countries is very high. As a step towards reducing the prevalence of malnutrition, there is a need to identify the important determinants of malnutrition in the specific population so that preventive and control measures can be implemented. The objective of the study is to determine the risk factors for malnutrition among preschool children in Rural Karnataka, South India. METHODS: A case-control study was carried out among preschool children, aged between three to six years, attending the Anganwadi centers and their mothers' in Udupi district of Karnataka, India. A total of 570 children (190 cases and 380 controls) were selected by multistage cluster sampling technique. A semi-structured risk factors questionnaire was used to identify the risk factors for malnutrition among children. RESULTS: The majority (45.8 and 45.5%) of the children in the study were in the age group of 3.0 to 4.0 years in case and control groups respectively. There was a slight preponderance of illiterate parents among cases in comparison to the controls. Largely, 87.4% of the children belonged to poor socio-economic status in the case groups compared to 82.4% in the control group. After adjusting for the confounders, underweight was significantly associated with socio-economic status of the parents (aOR: 2.05, 95% CI: 1.06, 3.96), birth weight < 2000 g (aOR: 25, 95% CI: 0.10, 0.59), recurrent diarrhoea (aOR: 2.74, 95% CI: 1.56, 4.83), recurrent cold and cough (aOR: 3.88, 95% CI: 1.96, 7.67), worm infestation (aOR: 2.0, 95% CI: 1.19, 3.38) and prelacteal feed given (aOR: 3.64, 95% CI: 2.27, 5.86). CONCLUSION: Parental education, childhood illness, short birth interval, open defecation, type of weaning and complimentary food given to children were some of the significant determinants of underweight that were found in the study. Information, Education and Communication (IEC) campaigns alleviating food habits and taboos and promoting birth spacing is the need of the hour for preventing the occurrence of undernutrition among preschool children.

Randomized controlled trial on the effectiveness of a multicomponent intervention on migraine: A study protocol.

AIM: To describe a randomized controlled trial protocol that evaluates the effectiveness of a multicomponent intervention in improving the outcomes (quality of life, disability, intensity, frequency and duration) of patients with migraine. BACKGROUND: Migraine affects various facets of Quality of Life and results in moderate to high levels of disability among migraineurs. Migraine pain can be intense and unremitting that can interfere with the daily routine and reduce the ability to think and function normally. Many people can lower their risk of a migraine by simply avoiding stress, getting enough sleep, eating regularly and by avoiding triggers. Hence, the present study aims at evaluating the effectiveness of a multicomponent intervention in managing migraine headaches. The multicomponent intervention includes behavioural lifestyle modification program and sessions of pranayama (a form of yogic breathing exercise). DESIGN: The study is a prospective, randomized, controlled, single-blinded trial with parallel arms. METHODS: The study participants are randomized to intervention and control arms. The participants randomized to the intervention arm would receive the specific multicomponent intervention based on the protocol. The participants in the control arm would receive routine care. They are followed up for 24 weeks and the outcomes are assessed. DISCUSSION: Various studies report that non-pharmacological therapies and integrative therapies play a major role in the management of migraine headaches. The findings of the study are expected to open up new horizons in health care arena emphasizing the use of non-pharmacological therapy for less focused areas of primary care health problems such as migraine. TRIAL REGISTRATION: The trial is registered with the Clinical Trials Registry India (CTRI). The CTRI India is one of the primary registries in the WHO registry network (Ctri.nic.in, ). CTRI reference ID: CTRI/2015/10/006282.

A Randomized controlled trial to evaluate the impact of a Nurse Navigator Programme on outcomes of people with breast cancer: study protocol.

AIM: To evaluate the effectiveness of a Nurse Navigator Programme on anxiety, psychological distress and quality of life in people with breast cancer. BACKGROUND: Breast cancer is the most frequently detected malignancy and a major cause of cancer death among women around the world. The lengthy course of illness from initial diagnosis to treatment and subsequent follow-up causes deterioration in physical, psychological and social status among patients. Nurses have a major role in cancer care. As women with breast cancer have to undergo various treatment modalities, continued care by a pivot nurse is thought to enhance treatment adherence. Limited studies have been reported from developing countries on Nurse Navigation Programmes. DESIGN: A Stratified Randomized controlled trial with repeated measures. METHODS: One hundred and twenty newly diagnosed women with breast cancer admitted to surgery wards of a tertiary care hospital in South India will be recruited. (Project funded in Octo"ber 2014). Women are randomly allocated to a control and intervention group. The outcome variables are anxiety, psychological distress and quality of life. Data on outcome measures will be collected at five different time points: before surgery, at discharge, beginning of adjuvant therapy, middle of adjuvant therapy and at the end of adjuvant therapy. DISCUSSION: This study may give evidence on the effectiveness of a Nurse Navigator Programme for women with breast cancer. If significant effects were detected, the programme could be integrated into hospital services to improve the patient care.

Effectiveness of self-management programmes in diabetes management: A systematic review.

BACKGROUND: Diabetes is a major noncommunicable disease, which is increasing, and approximately 415 million people are affected around the globe. Since diabetes is a lifelong disease, patients require better understanding and knowledge of the condition to become self-reliant in making diabetes-related decisions. AIMS: This systematic review was performed to assess the effectiveness of diabetes self-management programs in people with type 2 diabetes. METHODS: A comprehensive literature search was undertaken to identify all published English language articles through EBSCO discovery services in the following electronic database: Science Direct, CINAHL Plus with Full Text, MEDLINE, and Access Medicine. Studies were published from January 2000 to October 2015. The initial search retrieved 37 566 studies and based on the inclusion criteria, 14 studies were selected for review. RESULTS: Of 14 studies, most findings favoured diabetes self-management. But the overall effectiveness of individual interventions was not conclusive. A wide variety of interventions was used including diabetes education as a major component in self-management programs. CONCLUSION: Interventions used varied strategies in differing composition, and further work is needed to find out the effectiveness of individual interventions.

Effect of Complementary Therapies in Patients Following Cardiac Surgery: A Narrative Review.

Cardiovascular diseases are increasing rapidly and have become a major health problem worldwide. The incidence and prevalence of cardiovascular disease are increasing rapidly, predominantly in the developing countries. Patients with cardiovascular disease who do not respond to routine medical treatment will have to follow cardiac surgical procedures. The objective of this study was to apprise the evidence of the effect of various complementary therapies on postoperative outcomes among patients undergoing cardiac surgery. A comprehensive literature search was made on PubMed-Medline, CINAHL, Science Direct, Scopus, Web of Science, and the Cochrane Library databases for original research studies published between 2000 and 2015. Original articles that reported the effect of complementary therapies in patients undergoing cardiac surgery were included. Twenty-eight studies were analyzed, and they have produced conflicting results. Most of the studies (n = 25) have documented the effects of complementary therapies on improving postoperative outcomes of patients, whereas other studies (n = 3) found no evidence of improvement. Although methods varied considerably, most of the studies included in this review reported positive results. Therefore, there is some evidence that complementary therapies can lead to positive postoperative outcomes. Evidence of the efficacy of complementary therapies in cardiac surgical patients remains inconclusive. Additional research is needed to provide a strong evidence base for the use of complementary therapies to improve postoperative outcomes and recovery in patients undergoing cardiac surgery.

Effect of Preoperative Education on Postoperative Outcomes Among Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis.

PURPOSE: The objective of this review was to assess the effect of preoperative education on postoperative outcomes among patients undergoing cardiac surgery. DESIGN: Systematic review and meta-analysis. METHODS: A comprehensive literature search was made on PubMed, CINAHL, Ovid, ProQuest, ScienceDirect, Scopus, Web of Science, and the Cochrane database between 1995 and 2015. Fourteen randomized controlled trials were included. Data analysis was performed with RevMan software and created the Supplementary Appendix using the GRADE approach. FINDINGS: Meta-analysis showed that preoperative education reduced anxiety scores (standardized mean difference = -0.96, 95% confidence interval: -1.37, -0.54; P < .0001). However, there was no significant effect of preoperative education on pain, depression, and length of hospital stay. There is low-quality evidence, and reasons for downgrading are due to study design limitations, inconsistency, and imprecision of effect estimates. CONCLUSIONS: The results show that preoperative education can effectively decrease anxiety in patients undergoing cardiac surgery.

Quality of Life among Cancer Patients.

INTRODUCTION: Cancer is a leading cause of death. People living with cancer experience a variety of symptoms. Quality of life (QOL) is a major concern of patients with terminal cancer. Symptoms affect their QOL. Management of symptoms improves distress and QOL. OBJECTIVE: The objective of the study was to assess the QOL among cancer patients. MATERIALS AND METHODS: A survey was conducted among 768 cancer patients selected by a convenient sampling technique. Data was collected from cancer patients by interview technique using structured and validated interviewed schedule. RESULTS: Out of 768 cancer patients, 30.2% patients were in the age group of 51-60 years, majority with head-and-neck cancer (40.1%), and 57.7% had stage III disease. QOL of majority of patients was influenced by their symptoms. 82.3% of them had low QOL scores. CONCLUSION: Cancer patients experienced many symptoms that affected their QOL. There is a need to develop interventions for effective management of symptoms that will empower the patients to have a greater sense of control over their illness and treatment and to improve the QOL.

Experiences of Mothers on Parenting Children with Leukemia.

INTRODUCTION: Childhood cancer is the leading cause of death among children. Leukemia is one of the most common childhood cancers. OBJECTIVE: The objective of this study was to explore the experiences of mothers on parenting children with leukemia. MATERIALS AND METHODS: A qualitative approach with phenomenological design was used. To collect depth information from the mothers of children with leukemia, purposive sampling technique was adopted. Data were collected from ten mothers. Semi-structured interview schedule was used to collect the data. Data were analyzed using Husserl's method. RESULT: The themes derived are the pivotal moment in life, the experience of being with a seriously ill child, having to keep distance with the relatives, overcoming the financial and social commitments, responding to challenges, experience of faith as being key to survival, health concerns of the present and future, and optimism. CONCLUSION: The study concluded that chronic illness such as leukemia in children results in negative impact on the child and on the mother.

Symptoms experienced by cancer patients and barriers to symptom management.

BACKGROUND: People living with cancer experience wide variety of symptoms. If symptoms are not managed well, it may hamper an individual's ability to continue his or her activities of daily life. Treatment of symptoms relieves suffering and improves the rate of recovery as well as the quality of life. OBJECTIVES: To assess the symptoms of suffering among cancer patients and to identify the perceived barriers to their symptom management. MATERIALS AND METHODS: A cross-sectional study was carried out among 768 cancer patients selected by stratified sampling with a proportionate selection from each stratum. Data were collected from cancer patients by interview technique using structured validated questionnaire. RESULTS: Majority of the samples (30.2%) belonged to the age group of 51-60 years, most of them were diagnosed with head and neck cancer (40.1%) and 57.7% had stage III disease. The majority of the patients studied had pain (77%), tiredness (96.5%), disturbed sleep (96.4%), weight loss (63.3%), and irritability (85.7%). Most of the patients had lack of appetite (89.4%), feeling of sadness (96.6%), worry (94.5%), and feeling of nervousness (82.8%). Majority of the patients had some misconception regarding symptoms, that is, increasing pain signifies disease progression (92.7%), medicine to control pain may weaken the immune system (89.9%) and pain is inevitable for cancer patients (78.5%). Seventy-seven percent of samples reported that the anxiety or depression is expected after the diagnosis of cancer. CONCLUSION: This study provides an overview of symptoms among cancer patients and barriers experienced by them.

Health Related Quality of Life of Children with Chronic Illness.

A descriptive survey was carried out with the aim of determining the health related quality of life (HRQOL) of hospitalised children .with chronic illness. Data was col- lected from 148 children with chronic illness admitted in selected paediatric wards of tertiary care hospitals and their parents. The results showed that 51 percent of the children scored below the median of total HRQOL score. Children with cancer 34 (91.9%) and thalassemia 33 (89.2%) reported a low HRQOL. Children with chronic illness especially cancer and thalassemia had signficantly low HRQOL compared to children with other illnesses. Gender, diagnosis, frequency of hospitalisation, duration of illness and type of treatment received were the predic- tive of HRQOL of these children.