Homecare and the COVID-19 Pandemic - Experience at an Urban Specialist Cancer Palliative Center.

BACKGROUND: With the COVID-19 pandemic wreaking havoc globally, the extremely vulnerable subset of cancer palliative care patients has to go through the worst nightmare. Difficulty in accessing medical care in the event of increased symptom burden, obstacles in reaching hospitals at time of emergencies or end of life, limited access to medication, social distancing causing isolation, leading to psychosocial burden, lack of bereavement support, are few of the issues we identified. Palliative home care is an important tool to allay the anxieties and address the fears of cancer patients and caregivers, by ensuring continuity of care and providing the much needed handholding in these difficult times. This article aims to highlight the home-based care strategy and experience of the Cipla Palliative Care and Training Center during the COVID-19 lockdown. MATERIALS AND METHODS: We have utilized the data of documentation of the process of designing the protocol, the data entered by the team on unique data management software that is used at the palliative care center to record all palliative care interventions and reflections of the team on their experience of home visits during this period. RESULTS: Continuity of care through home visits will ensure better management of patients in terms of physical symptoms, psychosocial support, allaying fears, and anxieties, as well as the ultimate goal of an improved quality of life. Physical symptoms (24%), morphine drop off (19%), psychosocial support (15%), end of life care (33%), and procedures (9%) were the major indications of visits. CONCLUSION: The COVID-19 pandemic has increased the need for support, thus reiterating the importance of continuity of care. With abundant precautions and protocols in place, home care through visits is possible. With the lockdown and restrictions now entering their fourth phase, we need to be ready now more than ever to adapt to changing times and evolving definitions of the "New Normal."

'Inflammatory breast cancer' due to metastatic adenocarcinoma of lung.

A 67-year-old woman with a history of lung adenocarcinoma presented with 3 weeks of redness, pain, swelling and skin changes in her right breast. Her vital signs and physical examination were within physiological limits except for the right breast. She had extensive red streaks radiating from the right nipple with peau d'orange appearance of her overlying skin. Her breast was tender on examination and did not have any associated cervical or axillary lymphadenopathy. Her mammography revealed thickening of the skin, increased parenchymal markings and shrinkage the breast. Multiple skin biopsies demonstrated moderately differentiated lung adenocarcinoma with lymphovascular invasion. The patient made an informed decision to undergo radiotherapy following discussion with her oncologist and breast surgeon. She succumbed to her illness 2 months after the diagnosis of metastasis to her breast.

The gammadelta variant of T cell large granular lymphocyte leukemia is very similar to the common alphabeta type: report of two cases.

The vast majority of cases of T cell large granular lymphocyte (T-LGL) leukemia have a CD3+, CD4-, CD8+ phenotype and express the alphabeta T cell receptor. Whether the rare gammadelta variant should be included in the same diagnostic category is currently unclear. Two well-characterized cases of gammadelta T-LGL leukemia were identified by our laboratory in 2007. These two cases and other reports of gammadelta T-LGL leukemia were compared with the common alphabeta variant. Other than more often being negative for both CD4 and CD8 (in about 35% to 40% of cases), the gammadelta variant of T-LGL leukemia is similar to the common alphabeta type in virtually all respects and should be included in the general category of T-LGL leukemia. However, it is important to exclude other more aggressive gammadelta T cell lymphoproliferative disorders.