Update: IAPCON 2022, Jaipur – Day 1
An Academic and Scientific extravaganza began on 11 February, 2022
The Palliative care community from across the world, tuned in eagerly at 1 p.m. (IST) to participate in the much awaited Day 1 of IAPCON 2022.
The 29th Annual International Indian Association of Palliative Care’s conference (IAPCON), live streamed a total of 10 sessions from two virtual conference halls.
Though the conference organizers had to battle some unforeseen technical challenges, the organizing team was resilient and overcame the technical challenges. The organizing team thanks the palliative care community for their patience, understanding and support during the same.
Below is a snap shot summary from each of the sessions from Day 1 (11th February, 2022) of IAPCON 2022.
We thank all our dear contributors (Dr Akanksha, Dr Arun Ghoshal, Dr Gaurav Chanana, Dr K V Ganpathy, Dr Prableen Kaur Chatha, Dr Roopesh Jain, Dr Savita Butola, Dr Shafika Banoo, Dr Sunitha Daneil, Dr Vandana Mangal, Dr Vidya Viswanath, and Dr Wasimul Hoda) for their support in sharing content towards this report!
1. Session name: Creating Synergy – Integrating Early Palliative Care into Oncology in the Indian setting
Theme Lead:
Dr Vidya Viswanath (Assistant Professor, Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam)
Chairpersons:
Dr Kabindra Bhagabati (Department of Palliative Medicine, Dr B Borooah Cancer Institute, Guwahati, Assam) and Dr Raj Govind Sharma (Professor and Head, Department of Surgical Oncology, Shri Ram Cancer Centre, Mahatma Gandhi Medical College, Jaipur)
Moderator:
Dr Deepshikha Jain (Assistant Consultant, Department of Anaesthesia, Pain and Palliative Care, Bhagwan Mahavir Cancer Hospital and Research Center, Jaipur)
This session on Creating Synergy – Integrating Early Palliative Care into Oncology in the Indian Setting opened with Dr Hemant Malhotra’s (Director- Oncology Services, Sri Ram Cancer and Superspeciality Centre; Professor and Head, Department of Medical Oncology, Mahatma Gandhi Medical College Hospital, Jaipur) session on ‘Advances in Systemic Anti Cancer Therapy – What does the palliative care physician need to know?’. Dr Malhotra emphasized maintaining a delicate balance while providing Systemic Anti Cancer therapy. He affirmed that Best Supportive Care be an integral part of therapy for patients irrespective of a systemic disease directed therapy and that an integrated effort to achieve this was crucial for patient care. He added that cooperation more than confrontation was the key to achieve best patient outcomes.
Dr Deepa Susan Joy Philip’s (Associate Professor, Hematolymphoid Malignancies, RCC Trivandrum) session on ‘Early Palliative Care in Hematolymphoid malignancies’ continued on the same vein and demonstrated evidence to showcase the importance of Early Palliative Care in Haemato Oncology and how far behind the actual reality is in comparison to the ideal model in our country.
Dr Avinash Bonda’s (Associate Professor, Medical Oncology, Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam) session on ‘Challenges with Integration and Early Palliative Care in the Indian scenario’ highlighted integration challenges in the real world which included attitudinal differences, paucity of training in palliative care for oncologists and the inadequacy of a robust policy. He reiterated with evidence that oncologists should absolutely be trained in primary palliative care.
The panel discussion which included surgical oncologists, radiation oncologists and palliative care physicians was represented by Dr Sarbani Ghosh Laskar (Professor, Radiation Oncology, Tata Memorial Centre, Mumbai), Dr Anshika Arora (Assistant Professor, Department of Surgical Oncology, Swami Rama Himalayan University, Dehra Dun), Dr Kalpana Balakrishnan (Professor and HoD, Department of Anaesthesiology, Pain and Palliative Care, Cancer Institute, Adyar) and Dr Anuja Damani (Associate Professor, Department of Palliative Medicine, Kasturba Medical College, Manipal). This panel focused on early palliative care in practice through a case scenario; the benefit of Multi-Disciplinary Teams and the need for early integration along with the need for disease specific palliative care. They also discussed the need to rotate palliative care physicians in oncology and also have oncology residents posted in palliative medicine to mutually empower both groups. The panel hopes that the session would trigger consensus guidelines for early palliative care referrals and plan training to empower oncologists to practice primary palliative care.
2. Session name: IAPC’s Annual Quiz
The much awaited IAPCON’s Annual quiz began with a great start. The session began with Dr K V Ganpathy (Clinical Psychologist and Volunteer, Department of Palliative Medicine, Tata Memorial Hospital, Mumbai) welcoming the participants and audience and also thanking the organizers for their support towards the Quiz.
He then introduced the participants to the Rules of the Quiz. Participants were grouped into 5 teams (North Zone, South Zone, East Zone, West Zone and North East Zone). Participants competed against each other in 2 team-based rounds and one exciting Rapid-fire round.
Drs Pallavi Singh and Shrenik Ostwal (both Consultants, Pain and Palliative Medicine, SRJ CBCC Cancer Hospital, Indore) and Dr Kahkasha (Associate Professor, AIIMS Deoghar) were the able quiz architects who concocted a perfect blend of questions covering both from the theory and the practice perspectives.
The experienced Quiz Masters were able to establish connect with participants and pulled off the quiz successfully despite the intermittent technical problems. The winners from this captivating session will be announced during the valedictory function.
3. Session name: Plenary 1: Equity in access to palliative care in India
Chairperson:
Ms Harmala Gupta (Founder, CanSupport, New Delhi)
Moderator:
Dr Anjum Khan Joad (Director, Onco Anesthesia and Palliative care, BMCHRC, Jaipur)
The plenary began with Dr Sushma Bhatnagar’s (HoD, Department of Onco-anesthesia and Palliative Medicine, AIIMS New Delhi, and President, IAPC) presentation on ‘Equity in Access in Palliative Care: Teaching and Training’ which detailed the IAPC’s and the AIIMS initiative’s to improve the quality of palliative care delivery by training professionals.
This was followed by the respected Dr Pawanindra Lal’s (Director and Professor, HoD Surgery, Chairman, Division of Minimal Access Surgery, MAMC, New Delhi) session on ‘Initiatives taken by the National Board of Examination (NBE) in the past few years’, which elaborated the various initiatives taken by the NBE over the past two years to begin DNB in Palliative Medicine across institutions in India. Dr Pawanindra Lal shared that 5 centres with 10 seats for DNB (Palliative Medicine) were approved in September 2021, and that the admission process was currently underway.
It was an absolute honour to have the very eminent Professor Dr Vinod K Paul (Member, NITI Ayog, Government of India) participate at IAPCON 2022, virtually. Dr Paul shared pearls of wisdom in the form of valuable insights regarding the Government’s policies to support the delivery of palliative care in India. He emphasized the critical need for us to adopt a public health approach to ensure palliative care coverage until the grassroots. He urged and advised palliative care champions to utilize the already existing public health care delivery system (at all levels until the primary health care level) and leverage the ASHA workers. Dr Paul also highlighted the need to engage the AYUSH workforce and integrate Palliative care into the country’s public health care delivery system.
4. Session name: Clinical Excellence in Palliative Care
Chairpersons:
Dr. Shiv Iyer (Professor and Head, Critical Care Medicine, Bharatiya Vidyapeeth, Pune)
Dr. Umesh Kumar Bhadani (Professor and Head, Department of Anesthesiology, Dean – Academics, AIIMS Patna, Bihar)
Moderator:
Dr Arun Ghoshal (Clinical Fellow, University Health Network, Toronto, Canada)
Dr. Karl Lorenz (Professor of Medicine, Primary Care And Population Health, Division of Palliative Care, Palo Alto VA Health Care System, Stanford University School of Medicine, Palo Alto, California) presented on ‘Quality Improvement in Palliative Care in India’. Dr Lorenz explained enthusiastically that quality was central to healthcare and even more so in the field of palliative care. According to him, the palliative care approach is centered around discovering the various facets of care that are crucial to improving the quality of life of patients; be it symptom control, emotional concerns, impact on social roles or reviving the sense of spiritual connectedness.
Dr. Meera Agar’s (Professor of Palliative Medicine, University of Technology, Sydney) follow up presentation on ‘Clinical Reasoning – Practices for enhancing clinical judgement, rigorous systematic ways, decrease chances of errors, evidence base’ was about enhancing clinical care excellence in practice, to bring together the best components of existing knowledge and training programs into one cohesive and comprehensive program. She emphasized that information must be readily accessible from the boardroom to the frontlines, across sectors, disciplines and institutional levels to yield better return on investments. She also went on to highlight the need to foster a field-owned culture of improvement, accountability and sustainability to deliver quality care for patients across the continuum of care and offer better value for money.
Dr May Ann Muckaden’s (Professor, Department of Palliative Medicine Tata Memorial Centre, Mumbai) session on ‘Lifelong learning in the Clinical Excellence – How to continually grow ideas to establish specific goals and learning plans’ pointed out that clinicians interested in providing quality patient-focused care must be self-directed, lifelong learners, and take active responsibility for professional development. “Currency of knowledge, skills, and attitudes become even more important in a young and rapidly evolving discipline such as palliative care as it works to engender the community’s confidence in the care provided” said Dr Muckaden.
Key take away points:
- Palliative care is a science first, and it is enriched with elements from humanities
- Clinical excellence is a must in palliative care
- Integrate evidence base in palliative care practice
- Integrate audit cycle to improve service provision
5. Session name: Bringing Death back to Life: Ideas from the LANCET Commission on the Value of Death
Moderator:
Dr Vandana Mangal (Senior Professor, Department of Anaesthesiology, SMS Medical College, Jaipur)
This very important and interesting session was delivered by several stellar Faculty. Dr Soumya Swaminathan (Chief Scientist, World Health Organization) provided the ‘Introductory remarks to the session’. Dr Jocalyn Clark (Executive Editor, LANCET) presented the ‘Coordinators introduction to the Lancet Commission’. The very able Ms Smriti Rana (Head, Strategic Programs and Partnership, Pallium India), shared her thoughts on ‘Person with lived experience in the family’. Dr. Richard Smith (Co Chair, Lancet commission on the value of death) presented her thoughts on ‘Transformation of tamed death to forbidden death’. Dr Libby Sallnow (Senior Consultant palliative care, St. Christopher’s Hospice and University College, London) went on to then deliver a thought provoking session on ‘The Lancet commission recommendations’. The session concluded with Dr. M Rajagopal’s (Director, Trivandrum Institute of Palliative Sciences, Founder Chairman, Pallium India) session on ‘Translating the recommendations to a plan of action of India’.
The participants of this session opined that as a result of medical progress, death had become ’Forbidden’ and something which ‘can be denied and defied’. However, they advocated that death is a reality which had to be accepted gracefully. Treating patients beyond a point might add days, months or years but at a heavy cost to the patient in terms of physical and emotional suffering. They also urged the delegates to take initiatives to discuss Death and dying socially and to develop and strengthen experiences, rituals, traditions and support systems. They also collectively opined for the need to implement National policies effectively.
6. Session name: From the journal to the Bedside – Knowledge Translation
Chair person:
Dr. Kalpana Balakrishnan (Professor and HoD, Department of Anaesthesiology, Pain and Palliative Care, Cancer Institute, Adyar)
Moderator:
Dr. Akanksha Dutt (Consultant Anesthesia, Bhagwan Mahaveer Cancer Hospital and Research Center, Jaipur)
Dr Shoba Nair (Professor and Head, Department of Pain and Palliative Medicine, Amrita Institute of Medical Sciences, Kochi) explained uses of Nefopam in her session on ‘Nefopam’. Dr Gayatri Palat (Head, Department of Pain and Palliative Medicine, MNJ Institute of Oncology & RCC Hyderabad) in her session on ‘Recommendations for the care of Patients receiving Conservative Kidney Management with a focus on Chronic Kidney Diseases and Symptoms’ pointed out that Conservative Management of Chronic Renal disease has been recommended over dialysis. Dr Suresh Reddy (Professor, University of Texas and Anderson Cancer Centre) in his session on ‘Advances in management of fatigue in advanced cancer’ said that multimodal management is recommended to manage fatigue in advanced cancer, including pharmacological (steroids) and non-pharmacological interventions (yoga, acupuncture, etc.).
7. Session name: Sustaining the Palliative Care Workforce
Chairperson:
Ms Sangamitra Iyenger (Psychiatric Social Worker, Founder of Samraksha, Bengaluru)
Moderator:
Dr Gaurav Chanana (Senior Consultant, Pain & Palliative Medicine, Max Super Speciality Hospital, Saket, New Delhi)
This session began with a very relevant session on ‘Self Care – Compassion & Humanity’ presented by Dr Moihra Leng (Global Palliative Care Specialist, Physician, Makerere University). Dr Leng talked about self-care, and its essential need for palliative care professionals to be aware of compassion fatigue and mechanisms to prevent burnout.
A panel discussion on ‘Let’s talk about money’ took stage next and was moderated by Dr Nandini Vallath (Professor, Department of Pain and Palliative Medicine, St. John’s National Academy of Medical Sciences, Bengaluru). The session focused on how finances need to taken into consideration and what key considerations need to be factored in to offer specialist palliative care services are across various organizations.
The NGO sector was represented by Dr Ambika Rajvanshi (CEO, Cansupport, New Delhi) as she shared the journey of her NGO while toughing upon the individual and corporate funding that Cansupport receive.
Dr Gayatri Palat (Professor, Department of Palliative Medicine, MNJIO & RCC, Hyderabad), represented the Government health sector to share insights about the availability of funding from the State and Central Governments towards developing palliative care in a State, based on her experience in Telengana.
Dr Navin Salins (HoD, Department of Palliative Medicine and Supportive Care, Kasturba Medical College and Hospital, Manipal) presented his views on the long term prospects of education, services with inter-disciplinary association from other specialists, and the role of grants for developing services.
Dr Raghavendra Ramanjulu (Head, Pain, Palliative and Rehabilitation Medicine, Aster Group of Hospitals, Bengaluru) presented his views about the value that is added to patient care due to provisioning pain and palliative care services for patients, extending care services for patients and their families in corporate institutes and how these services can also be made financially viable and sustainable.
‘Quality of Service’ was the key word discussed in the session, and the panel consented that Quality translated into patient satisfaction ensured funding.
8. Session name: Integration of Palliative Care in Interstitial Lung Disease (ILD)
Moderator:
Dr. Sunitha Daniel (Specialist Medical Officer, General Hospital Ernakulam, India)
Chair Persons:
Dr. Ankit Bansal (Consultant, Pulmonology & Critical Care, Fortis, Jaipur)
Dr. Sumita Mohanty (Associate Professor, Department of Anaesthesiology, Pain & palliative care Unit, AHPGIC, Odisha)
The first lectures in this session was delivered by Prof. Miriam Johnson (Professor, Palliative Medicine, Director, Wolfson Palliative Care Research Centre) on ‘Needs assessment of patients with ILD’. Next, Dr. Sujeet Rajan (Consultant, Chest Physician, Bhatia General Hospital, Mumbai) presented her views on ‘Respiratory – Palliative Joint Clinics: Need for the future’. The session concluded with Dr. Rajam Iyer’s (Pulmonologist and Palliative Care Physician, Bhatia and Hinduja Hospitals, Mumbai) session on ‘Palliative care outcomes: How we have made a difference to ILD patients’.
The one hour session touched upon the needs assessment tool that can be used in patients with ILD, how joint palliative respiratory clinics make a difference in the care provided to patients, and presented data on caregiver satisfaction of those clinics. They shared that the Needs Assessment Tool – Progressive disease – ILD (NAT-PD-ILD) was a valid and reliable tool that helps identify and triage patients and help professionals identify physical and psychosocial symptoms. They also shared that joint clinics allow pulmonologists, patients, families and palliative care physicians to be on the same page which markedly improves the patient experience, reduce the financial burden on patients, address sufferings of chronic respiratory disease patients which includes prolonged hospital stays, ICU issues, mental stress and dependency.
9. Session name: Palliative Care in Parkinsons Disease and Related Disorders
Moderator:
Dr Shafika Banoo (Consultant, Palliative Medicine, Cancare Foundation Palliative Trust, Apollo Cancer Speciality, Chennai)
Chairpersons:
Prof. Rajinder K Dhamija (HoD, Department of Neurology, Lady Hardinge Medical College and SSK Hospital, New Delhi)
Dr. Ashwin Mathur (Professor and HoD, Palliative Medicine, SMS Medical College and Associated Group of Hospitals, Jaipur)
Dr Jessica Baker (Consultant, Neurologist, University of Wisconsin) presented a session on ‘Palliative Care needs across the spectrum of Parkinsons disease and related disorders’ and Dr Zacchary Macchi (Instructor/Fellow, Departments of Internal Medicine & Neurology, University of Colorado School of Medicine, USA) presented a session on ‘The role for Specialist PC in PDRD: evidence & practice’.
Both speakers covered the need for early integration of palliative care in Parkinsons while also highlighting the indictors for this chronic illness that need to be considered for palliative care referrals.
10. Session name: Update in Pharmacology
Moderator:
Dr Roopesh Jain (Professor and Incharge, Palliative Unit, L. N. Medical College, Bhopal)
Chairperson:
Dr Sandip Mukhopadhyay (Deputy Director, ICMR, Kolkata)
Ms Saroja Gangaiah (Chief Pharmacist, Kidwai Memorial Institute of Oncology)
The speakers highlighted the role and importance of pharmacology of different drugs and their role in treating patients who needed symptomatic relief. Dr Nikki Pease (Palliative Care Consultant, Cardiff University, UK) in her presentation on ‘Cancer Associated Thrombosis – Update on Direct Oral Anticoagulants (DOACs)’ enlightened the delegates on the importance of oral anticoagulant in advanced cancer patients. While Dr Arun Ghoshal’s (Clinical Fellow, University of Toronto, Canada) presentation on ‘Urinary Anti-Muscarinics’ clarified how and when to use medications to prevent hyperactive bladder. The session concluded with Dr Megan Doherty’s (Consultant, Paediatric Palliative Care, Two Worlds Cancer Collaboration, Canada) session on ‘Analgesics for Neuropathic Pain in Children’, discussed how to diagnose and assess neuropathic pain in children and the evidence-based treatment for neuropathic pain in children.
11. Session name: Expressions: An arena for creative expressions
Moderator:
This year at IAPCON 2022, the conference organizers introduced an exciting event, ‘Expressions: An arena for creative expressions’ which provided delegates with an opportunity to showcase talents by sharing creative work related to Palliative care themes. We received paintings, poems, and stories as entries for this session.
Entries were submitted by Ms. Shriya Raina, Dr Praveenraj V, Shree Gopal Kabra, Dr Raghav Gupta, Dr Arkanil and Dr Reena George. The Organisers of IAPCON 2022 congratulates each participant for their active participation.