Satija Aanchal, Lorenz Karl, DeNatale Michelle, Spruyt Odette, Deo S V S, Bhatnagar Sushma
Department of Onco-anaesthesia and Palliative Medicine, Dr B. R. Ambedkar, IRCH, AIIMS, New Delhi, India.
General Internal Medicine and Palliative Care Physician, Section Chief of the VA Palo Alto-Stanford Palliative Care Program & Professor of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Indian J Palliat Care. 2019 Jan-Mar;25(1):153-155. doi: 10.4103/IJPC.IJPC_142_18.
Head-and-neck cancers (HNCs) are significant in India. Poverty, illiteracy, lack of access to healthcare, and poor treatment infrastructure pose a major challenge in the management of these cancers. The majority of these patients present with advanced stage and are not amenable to curative treatment. The majority have the potential to benefit from palliative care (PC) interventions. Our experience has been that usually the referrals from HNC clinic for PC are at the end-of-life or terminal stage. Unfortunately, in the state of intractable suffering, it is difficult for patients to understand and fully benefit from the role of PC. Developing an effective working relationship and communication between the PC service and referring surgeons or oncologists is a key to foster more timely, appropriate referral, as both patients and clinicians often misunderstand or fail to recognize the role of PC. In preparation for a quality improvement project to improve access to PC for HNC patients at the All India Institute of Medical Sciences, we reviewed the needs, challenges, conceptual models, and potential of early integration of PC in advanced HNC patients.
头颈癌（HNCs）在印度是一个重要问题。贫困、文盲、难以获得医疗保健以及治疗基础设施薄弱，给这些癌症的管理带来了重大挑战。这些患者中的大多数就诊时已处于晚期，无法接受根治性治疗。大多数患者有从姑息治疗（PC）干预中获益的潜力。我们的经验是，通常头颈癌诊所转介到姑息治疗的患者已处于生命末期或终末期。不幸的是，在患者遭受难以忍受的痛苦状态下，他们很难理解并充分受益于姑息治疗的作用。在姑息治疗服务与转诊的外科医生或肿瘤学家之间建立有效的工作关系和沟通，是促进更及时、恰当转诊的关键，因为患者和临床医生常常误解或未认识到姑息治疗的作用。为在全印度医学科学研究所开展一项质量改进项目以改善头颈癌患者获得姑息治疗的机会做准备时，我们审视了晚期头颈癌患者姑息治疗的需求、挑战、概念模型以及早期整合的潜力。
