Factors associated with knowledge of diagnosis, prognosis & distress in cancer patients receiving palliative care - A retrospective cohort analysis.

Background & objectives: Demographic attributes of cancer patients are associated with the awareness of diagnosis, the prognosis of cancer and their associated psychological distress. This study was aimed to assess the knowledge of diagnosis, prognosis and psychological distress among patients reporting to the pain and palliative care department in a tertiary cancer hospital, south India. Methods: Data of all patients visiting the palliative care outpatient department of a tertiary cancer centre in south India between January and June 2018 were included in the study (n=754). A structured pro forma was used to collect information on the sociodemographic details and clinical aspects and a distress thermometer was used to assess the level of distress. Information, thus collected, were analysed using descriptive statistics and logistic regression. Results: Around 16.2 per cent of the patients were unaware of their diagnosis while two third (68%) were unaware of the prognosis. More than half of the patients reported significant distress (54.1%). Gender, education, not working and being diagnosed with head-and-neck cancers were associated with knowledge of diagnosis, while educational level predicted the knowledge of prognosis. Younger age group, head-and-neck cancer, haematology cancer, state of being unaware of diagnosis and prognosis were found to be associated with distress. Interpretation & conclusions: Higher educational levels and better socio-economic status increase the likelihood of patients being aware of their diagnosis and prognosis. Being unaware of the prognosis remains associated with the higher level of distress.

Status of Palliative Care Services in Tamil Nadu - A Descriptive Report.

Objectives: Advanced cancer patients attending tertiary cancer centres from rural places are referred back to local physicians for symptom management. Due to lack of networking with palliative care centres (PCCs), the referred patients do not receive appropriate palliative care (PC) services. Hence, an attempt was made to map the PCCs in Tamil Nadu to make the referral system efficient. Material and Methods: PCCs in Tamil Nadu were identified from the National Health Mission directory, online sources and from morphine license annexure of drug control department. The details regarding nature of facility, PC model, service type, procedures, cost, morphine availability and type of personnel involved in their PCCs were collected from government and private centres. The data were analysed using descriptive statistics and geomapping of all the centres identified was created. Results: A total of 371 PCCs were identified, of which 32 were government headquarter hospitals (GHQH), 281 were government community centres and 58 were private. Eighty-three of the 90 centres (including GHQH and private) were active and 60 responded to the survey. More than half of the centres were hospital-based (61.7%) and 28.3% were community-based. The majority of the PCCs had in-patient (75%) and out-patient (63.3%) facilities and 63.3% had regular home visits. Forty-six centres provide PC service free of cost. Nearly 80% provide morphine for pain management, wherein 41 have obtained a license. In total, ten centres had a social worker and four had a psychologist. Conclusion: The number of PCCs is disproportionate, in which majority of the centres are clustered in urban areas. Integrating PC services into the existing health system is the way forward.