Arun Ghoshal

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Verified

Arun verified their affiliation via an institutional email.

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• MD, MRes
• Physician at Manipal Academy of Higher Education

Introduction Financial toxicity from cancer treatment is a significant barrier to equitable care and an important clinical and public health concern. This scoping review systematically review the financial toxicity assessment pattern in cancer care across global settings and generate an inventory of domains and sub-domains of questions used to asse...

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...

Purpose Head and neck cancer is the seventh most prevalent cancer, with over 660,000 new cases and 325,000 annual fatalities, accounting for 30% of all cancer cases. Chronic cancer-related pain affects 15–75% of patients, with myofascial pain being especially common in those with head and neck cancers, ranging from 11.9 to 44.8%. Surgery and radiot...

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...

Objectives Essential medicines lists (EMLs) guide the public sector procurement and supply of medications to impact access to adequate and appropriate palliative care drugs. This study evaluates the adequacy of India’s national and sub-national EMLs that can directly impact palliative care for 5.4 million patients. Methods In this qualitative docu...

Introduction Advanced cancer poses unique difficulties for patients, caregivers, and health care providers. Prognostic discussions are pivotal in shaping care decisions during this stage. These conversations involve health care professionals conveying disease progression, expected outcomes, and estimated life expectancy. Research consistently under...

Objectives In this study, our primary objectives were to validate the palliative prognostic index (PPI) tool in the context of palliative care for patients with advanced cancer. Specifically, we aimed to assess the accuracy of the PPI in predicting actual survival in these patients through prospective validation. Materials and Methods To achieve o...

Background Estimating prognosis can be a barrier to timely palliative care involvement. The modified Hospitalized‐patient One‐year Mortality Risk (mHOMR) score uses hospital admission data to calculate the risk of death within 12 months and may be a useful tool to trigger a referral to palliative care. Methods The mHOMR tool was retrospectively ap...

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...

Background: The 10-item Montgomery-Åsberg Depression Rating Scale (MADRS) is a commonly used measure of depression in antidepressant clinical trials. Numerous studies have adopted classical test theory perspectives to assess the psychometric properties of this scale, finding generally positive results. However, its network configural structure and...

Objectives: Essential Medicines Lists (EMLs) guide the public sector procurement and supply of medications to impact access to adequate and appropriate palliative care drugs. This study evaluates the adequacy of India's national and sub-national EMLs that can directly impact palliative care for 5.4 million patients. Methods: In this qualitative doc...

Objectives The 2017 Lancet Commission reports ‘Serious Health-related Suffering’ (SHS) as an abyss in healthcare services. It lists 20 common health conditions and 15 symptoms as commonly associated with SHS. In 2015, 80% of SHS prevalence, an estimated 61 million, was noted as from low-middle-income countries. Acknowledging the high prevalence of...

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 The 10-item Montgomery-Åsberg Depression Rating Scale (MADRS) is a commonly used measure of depression in antidepressant clinical trials. Numerous studies have adopted classical test theory perspectives to assess the psychometric properties of this scale, finding generally positive results. However, its network configural structure and s...

ASCO Guidelines provide recommendations with comprehensive review and analyses of the relevant literature for each recommendation, following the guideline development process as outlined in the ASCO Guidelines Methodology Manual . ASCO Guidelines follow the ASCO Conflict of Interest Policy for Clinical Practice Guidelines . Clinical Practice Guidel...

Background Network analysis (NA) is a modern statistical method for exploring relationships and patterns in complex data. NA techniques can also be used to eliminate unstable or nonperforming items, potentially reducing measurement error. However, the use of NA to improve measures used in randomised controlled trials has been limited, and it is unk...

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...

Access to palliative care (PC) holds significance for hospital-admitted patients grappling with the symptoms of life limiting illnesses. Nonetheless, numerous such patients who could gain from PC fail to receive it promptly or even at all. We can leverage the prior year's historical data extracted from electronic health records of hospitalized pati...

Objectives Patients on anticancer therapy attending palliative care services often have oral health problems, but not enough is known in this regard (in India). This cross-sectional study aimed to elucidate this issue. Methods Participants were 98 patients with metastatic cancer (52 males, 46 females) who attended the palliative care clinic and we...

Income tax deductions aimed at alleviating the financial strain of catastrophic health expenses, prove inadequate in supporting cancer care in India. First, the stringent eligibility criteria for accessing this tax deduction restrict its availability to a narrow segment of the population. Typically, it is granted only to those who receive treatment...

The commodification of academic publishing refers to the process of turning academic research and scholarship into a marketable product that can be bought and sold for profit. This has become an increasingly prevalent issue in recent years, as academic publishing has become dominated by a small number of large commercial publishers who control acce...

Manjusha Nair Hospice care plays a vital role in providing compassionate and holistic support to terminally ill patients and their families. While hospice care has gained recognition and acceptance globally, its implementation and understanding in the context of pediatric patients in India remain limited. This article aims to explore the pediatrici...

This TPPCR commentary discusses the 2023 paper by Agrawal et al., “Challenges and opportunities in providing palliative care services to children with a life-limiting illness: A systematic review” published in The National Medical Journal of India.

489 Background: Radical cystectomy (RC) with or without perioperative chemotherapy is considered the standard treatment option for Muscle invasive bladder cancer (MIBC), despite poor oncological outcomes. However, RC is often burdened by significant impact on quality of life (QoL); Continence preserving methods (e.g continent cutaneous urinary dive...

For patients with a broad range of serious life-threatening illness, loss of function and independence is a common struggle and a significant contributor to diminished quality of life. Among the factors that can contribute to loss of function are prolonged hospitalization, deconditioning, pain, fatigue, depression, malnutrition, organ failure, neur...

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...

Introduction Adolescents with cancer experience several psychosocial concerns. Cancer among adolescents contributes to one-fifth of cancers in India. Most of the published empirical literature on adolescents’ views about their cancer experience is from high-income countries. Objectives The objectives of the study were to explore the experiences of...

Introduction It is difficult to comprehend a child's understanding of disease-related information as they might be unwilling to talk or feel inhibited about raising their concerns. Understanding children's perception is important to facilitate better communication in palliative care. Objectives To study child's understanding of advancing disease w...

Objectives To describe the key initiatives that were successful in planning and implementing hospital- and community-based Paediatric Palliative Care (PPC) services designed for a resource-limited setting in Maharashtra, India, in collaboration with DfID. Materials and Methods The CPC project was a 5-year service development project (April 2010–Ma...

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...

Purpose To provide evidence-based recommendations on the management of malignant bowel obstruction (MBO) for patients with advanced cancer. Methods The Multinational Association for Supportive Care in Cancer (MASCC) MBO study group conducted a systematic review of databases (inception to March 2021) to identify studies about patients with advanced...

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...

Background Globally, there is a rise in chronic disease, including cancer, major organ failure and dementias. Patients and their families in low- and middle-income countries (LMICs) pay a high proportion of medical costs out of pocket (OOP), and a diagnosis of serious illness often has catastrophic financial consequences. We therefore conducted a r...

Although medical mistrust (MM) may be an impediment to public health interventions, no MM scale has been validated across countries and the assessment of MM has not been explored using item response theory, which allows generalisation beyond the sampled data. We aimed to determine the dimensionality of a brief MM measure across four countries throu...

This TPPCR commentary discusses the 2021 paper by Battista et al, “Advance Directives for Adolescents and Young Adults Living with Neuromuscular Disease: An Integrative Review of the Literature.” published in Journal of Hospice and Palliative Nursing.

Purpose To provide evidence based recommendations on the management of malignant bowel obstruction (MBO) for patients with advanced cancer. Methods The Multinational Association for Supportive Care in Cancer (MASCC) MBO study group conducted a systematic review of databases (inception to March 2021) to identify studies about patients with advanced...

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...

Objectives Malignant fungating breast cancers are a definite challenge to treatment due to limited knowledge and prevailing distressing symptoms. Various treatment protocols with regard to radiotherapy (RT) and chemotherapy have been reported in the literature but the knowledge of proper integration of these regimes with effective palliative care n...

Objectives Access to early palliative care (EPC) for all patients with metastatic lung cancer is yet to be achieved in spite of recommendations. This quality improvement (QI) project was initialized to improve the rates of such referrals from the thoracic oncology clinic for all new outpatients in a premier cancer center in India. Materials and Me...

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...

Background Worldwide, many patients with cancer, are infrequently referred to palliative care or are referred late. Oncologists and haematologists may act as gatekeepers, and their views may facilitate or hinder referrals to palliative care. This review aimed to identify, explore and synthesise their views on referrals systematically. Methods Data...

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...

There is evidence that derangement in serum electrolytes like sodium and potassium is associated with increased morbidity and mortality among hospitalized critically ill patients, but their role in the context of cancer survival remains poorly understood. We sought to investigate the association of pre-diagnostic serum sodium and potassium with ris...

Background The “Children's Palliative Care Project” was initiated in October 2010 in the Indian state of Maharashtra with a view to improve the quality of life of children with life-limiting conditions. This study evaluates its education and training component through a questionnaire. Materials and Methods A cross-sectional survey was carried out...

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...

Chronic inflammation is one of the underlying risks associated with thyroid cancer. We ascertained the association between commonly measured serum biomarkers of inflammation and the risk of thyroid cancer in Swedish Apolipoproteinrelated MORtality RISk (AMORIS) study. 226,212 subjects had baseline measurements of C-reactive protein, albumin and hap...

The label “translational research” (TR) has become ever more popular in the biomedical domain in recent years. It is usually presented as an attempt to bridge a supposed gap between knowledge produced at the laboratory bench and its use at the clinical bedside. This is claimed to help society harvest the benefits of its investments in scientific re...

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...

Purpose To evaluate the association between commonly measured serum biomarkers of inflammation and penile and testicular cancer risk in the Swedish Apolipoprotein-related MORtality RISk (AMORIS) study. Materials and methods A total of 205,717 subjects had baseline measurements of C-reactive protein, albumin, and haptoglobin. The association betwee...

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 Early palliative care is beneficial in advanced lung cancer patients. We aimed to assess the feasibility of introducing early palliative care in ambulatory advanced lung cancer patients in an Indian tertiary cancer center. Methodology In a longitudinal, single–arm, and single-center study, fifty patients were recruited and followed up ever...

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...