Anuja Damani

• Doctor of Medicine
• Professor (Associate) at Manipal Academy of Higher Education

Background End-stage kidney disease (ESKD) significantly burdens healthcare systems and increases mortality. In India, approximately 175,000 individuals are relying on maintenance hemodialysis (mHD). This study aims to analyze the place of death, mortality patterns and clinical issues surrounding death in patients with ESKD undergoing mHD at a tert...

Background Advanced care planning (ACP) and advance medical directives (AMDs) are vital for aligning medical decisions with patient preferences, particularly for end-of-life care. The 2018 Supreme Court judgment in India established the legality of AMDs, enabling patients to exercise their autonomy. Recent amendments in 2023 simplified procedural r...

India is facing a growing burden of cancer, resulting in high cancer-associated mortality. However, the rise in cancer incidence is disproportionately high compared to access and provision of palliative care. This review aims to identify gaps in Indian cancer palliative care and recognises initiatives instituted to mitigate them. The narrative revi...

Introduction: Advance care planning (ACP) is essential in managing patients with end-stage kidney disease (ESKD), yet its integration into clinical practice remains limited, particularly in low- and middle-income countries. This study explores the preferences, attitudes and perceived barriers of nephrology healthcare providers toward ACP for patie...

Intensive care units (ICUs) have significant palliative care needs but lack a reliable care framework. This umbrella review addresses them by synthesising palliative care practices provided at end-of-life to critically ill patients and their families before, during, and after ICU admission. Seven databases were systematically searched for systemati...

Introduction Palliative care, with a focus on enhancing the quality of life for individuals facing life-limiting illnesses, relies on effective pain management as a fundamental component. Opioids, particularly methadone, play a crucial role in addressing moderate to severe pain in palliative care due to their unique pharmacological properties. Meth...

Background Globally, children with cancer often experience delays in palliative care referral or are infrequently referred. Therefore, we conducted a qualitative study to gain insight from paediatric oncologists into what enables or deters palliative care referral. Strategic solutions to develop integrated palliative care was a critical study theme...

Background Patients with paraquat poisoning (PP) have a mortality rate comparable to that of advanced malignancies, yet palliative care is seldom considered in these patients. This audit aimed to identify triggers for early palliative care referral in critically ill patients with PP. Methods Medical records of patients with PP were audited. Predic...

Pain management constitutes a pivotal aspect of palliative care. Certain instances of distressing pain are significantly relieved through interventional pain methodologies, demanding the expertise of pain specialists. Our perspective revolves around the integration of these 2 facets, envisaging a symbiotic relationship that could enhance patient ou...

Objectives This umbrella review will summarize palliative and end-of-life care practices in peri-intensive care settings by reviewing systematic reviews in intensive care unit (ICU) settings. Evidence suggests that integrating palliative care into ICU management, initiating conversations about care goals, and providing psychological and emotional s...

Objectives To develop and validate an English and Kannada version of the questionnaire to assess awareness and knowledge of advance care planning (ACP) among end-stage kidney disease (ESKD) patients, caregivers, and healthcare providers. Methods The questionnaire was developed from the published literature on ACP use in ESKD setting after a litera...

Objectives End-stage kidney disease (ESKD) is a life-limiting illness that leads to significant health-related suffering for the patients and their caregivers. Moreover, disease-directed options such as dialysis and renal transplant might not be universally accessible. Inadequate assessment and management of symptoms often lead to diminished qualit...

Prognostic information in advanced cancers is distressing. We surveyed 30 parents of children with advanced cancer from a tertiary cancer center in India to understand parental preferences for prognostic information. We found that 17/20 (85%) parents desired as much information about prognosis as possible and wanted it expressed numerically. All pa...

Objective: Palliative care services in India were established in the 1980s but there is no detailed up-to-date knowledge about the quality-of-service provision nationally. We aim to describe the current quality of palliative care provision in India, as measured against nationally adopted standards. Method: A digital survey adapted from the India...

Context: Breathlessness is one of the devastating symptoms experienced by patients with advanced cancer and can be very challenging to manage. Objectives: To find the point prevalence of dyspnoea in advanced cancer patients presenting to palliative care out-patient clinics, and the usage of opioids in palliation of dyspnoea. Methods: We conduc...

Background Despite the evidence of palliative care benefits, referrals are infrequent and delayed. Patients and their caregivers are essential stakeholders in the referral process with valuable perspectives. This review systematically explored their perceived facilitators and barriers to palliative care referral. Methods 4 subject-specific databas...

Background Demand for home-based health care services has increased considerably in India. Traditionally, home-based care services are physician-led which puts pressure on the understaffed healthcare sector. This study aims to pilot a new model, the Nurse coordinated Home Care (NCHC) service in suburban Mumbai (India). Methods In this pilot interv...

Objectives The Lancet Commission on Global Access to Palliative Care and Pain Relief reported significant levels of health-related suffering globally, with the highest incidence in the low- and middle-income countries. The report describes suffering as health-related when it is associated with illness or injury of any kind and suffering as serious...

Introduction The concept of total pain encompasses a person’s physical, psychological, social, spiritual, and practical struggles. Effective pain and symptom management are the core elements of palliative care which aims at reducing suffering and improving quality of life (QOL) throughout the course of illness and need to be addressed with multidis...

Objectives Patients needing palliative care prefer to be cared for in the comfort of their homes. Although private home health-care services are entering the health-care ecosystem in India, for the majority it is still institution-based. Here, we describe a model of home-based palliative care developed by the Tata Memorial Hospital, a government te...

Purpose Hospitals and healthcare organizations are today operating in an extremely competitive environment, with increasing pressure to improve quality while reducing costs. In responding to this dynamic situation, transformation of any organization requires the will to organize delivery around the needs of patients. Recent Findings Providing pall...

e24002 Background: Patients with advanced malignancy have complex symptoms towards end of life. Some of these symptoms include febrile illness and infections. Benefits of treating infection and fever with antibiotics should be weighed out with goals of care for these patients. This study aims to understand the frequency of use of antibiotics and it...

The global pandemic involving severe acute respiratory syndrome-coronavirus-2 has brought new challenges to clinical practice and care in the provision of palliative care. This position statement of the Indian Association of Palliative Care (IAPC) represents the collective opinion of the experts chosen by the society and reports on the current situ...

Objectives This study aimed to identify gaps in palliative care (PC) provision across the National Cancer Grid (NCG) centres in India. Methods We performed a cross-sectional validated web-based survey on 102 NCG cancer centres (Nov ’17 to April ’18). The survey questionnaire had seven sections collecting data relating to the capacity to provide ca...

The global pandemic involving severe acute respiratory syndrome–coronavirus-2 has brought new challenges to clinical practice and care in the provision of palliative care. This position statement of the Indian Association of Palliative Care (IAPC) represents the collective opinion of the experts chosen by the society and reports on the current situ...

Novel corona virus disease 2019 (COVID-19) is an ongoing pandemic that has impacted the entire world. The Indian government has responded strongly and very stringently to the crisis, through a nationwide lockdown. The health-care (HC) systems in the country are striving hard to maintain equitable care across illness spectra, while responding the em...

PURPOSE To understand the preferences and attitudes of patients and family caregivers on disclosure of cancer diagnosis and prognosis in an Indian setting. METHODS Overall, 250 adult patients with cancer and 250 family caregivers attending the outpatients of a tertiary cancer hospital for the first time were recruited purposively. The mean ages of...

Rates of malignant melanoma have been increasing in frequency. Studies have shown that up to 46% of patients with melanoma will experience metastases to the central nervous system. Intramedullary spinal cord metastasis of malignant melanoma is rare. In advanced cancers, surgery might not be possible, and radiotherapy with corticotherapy is a viable...

Introduction: Dyspnea is a subjective, multidimensional experience of breathing discomfort, commonly seen in patients with advanced cancer. This study is a secondary analysis to seek the clinical prevalence of dyspnea on a subset of patients with lung cancer. Improving the quality of life (QoL) in dyspnea requires aggressive symptom management, wh...

Context: Frequency of passive decisional control preferences (DCPs) has been variably reported but is generally higher among patients living in developing countries. Objectives: This prospective cross-sectional study aimed to determine the frequency of passive DCP among patients with advanced cancer in a tertiary cancer center in India and to id...

Background: The frequency of passive decisional control (patients prefers physician to make decisions) has been reported to be variable but generally larger among patients living in developing countries. Aim: This study aimed to determine the frequency of passive DCP among patients with advanced cancer in a tertiary cancer center, and identify its...

Emergencies in palliative care need to be defined by the potential distress that a clinical issue raises for a person. A 58-year-old male with carcinoma vallecula referred for palliative care presented with recurrent syncopal attacks. On examination, a swelling at the left angle of mandible pressing on the carotid sinus was detected. A clinical dia...

Context Patients with chronic life-limiting conditions on palliative care (PC) prefer to be treated at home. Medical care by family physicians (FPs) reduces demand on costly and busy hospital facilities. Working of PC team in collaboration with FPs is thus helpful in home-based management of patients. Aims This study aimed at exploring the extent...

Context Dyspnea is a subjective, multidimensional experience of breathing discomfort, commonly seen in patients with advanced cancer. To find the impact of dyspnea on the quality of life in this population, it is important to understand the prevalence and factors influencing dyspnea. Aims This study aimed to determine the prevalence, intensity, an...

Only a few studies have assessed the economic outcomes of palliative care in India. The major areas of interest include hospice care, the process and structure of care, symptom management, and palliative chemotherapy compared to best supportive care. At present, there is no definite health-care system followed in India. Medical bankruptcy is common...

Context: Assessment of dyspnea in patients with advanced cancer is challenging. Cancer Dyspnea Scale (CDS) is a multidimensional scale developed for measurement of dyspnea. It is available only in Japanese, English and Swedish and has not been validated before in the Indian languages. Objective: To describe the process of validation and reliabil...

Purpose Fatigue is one of the most common symptoms seen in patients with advanced cancer. It is known to influence the Quality of Life (QoL) of patients. This study examines the interrelationship of fatigue and QoL in patients with advanced cancer on palliative care. Methods A prospective cohort study was conducted in the outpatient clinic of the...

The survival of newborn babies born with various problems has improved with the access to life sustaining technologies. Despite this, death in the neonatal intensive care unit (NICU) is an inevitable reality. For babies suffering from life limiting illnesses, the health care team has a duty to alleviate the physical suffering of the baby and to sup...

Background Fatigue is one of the most common symptoms found in patients with advanced cancer. There is interplay between fatigue and other symptoms. AimTo examine the factors associated with fatigue in patients with advanced cancer and the impact of symptom control on improvement in fatigue. Design Prospective observational study. Patients were ass...

Purpose: To audit referral practices of pediatric oncologists referred to specialist pediatric palliative care services. Patients and Methods: Retrospective review of medical case records of pediatric palliative care patients over a period of 5 years from January 1, 2010 to December 31, 2014. Descriptive summaries of demographic, clinical variables...

Introduction: There is a gradual increasing trend in childhood cancers in India and pediatric palliative care in India is an emerging specialty. Prescribing pain and symptom control drugs in children with cancer requires knowledge of palliative care formulary, dosing schedules, and prescription guidelines. This study is a retrospective audit of pre...

Malignant bowel obstruction (MBO) is commonly seen in patients with advanced abdominal cancers. The incidence of pediatric MBO in a patient with Burkitt's lymphoma and ataxia telangiectasia is rare, with no published case reports till now. Conservative management of inoperable MBO results in relief of symptoms and improves quality of life. An 11-ye...

Levofloxacin is a commonly prescribed antibiotic for managing chest and urinary tract infections in a palliative care setting. Incidence of Levofloxacin-associated anaphylaxis is rare and delirium secondary to Levofloxacin is a seldom occurrence with only few published case reports. It is an extremely rare occurrence to see this phenomenon in combi...

Hemichorea hemiballismus (HCHB) is a rare and debilitating presentation of hyperglycemia and subcortical stroke. Early identification, proper assessment and management of HCHB can lead to complete symptom relief. We describe a case of HCHB presenting to a palliative care setting. A 63-year-old diabetic and hypertensive lady, with history of ovarian...

The Palliative Care unit at Tata Memorial Hospital has a multidisciplinary home care team serving Mumbai based population for over a decade. Study the relevance of Canadian Health Care Evaluation Project (CANHELP) questionnaire in Mumbai based patients and families registered with Palliative Medicine Department, Tata Memorial Centre who are being p...