Progress in Improving Access to Palliative care
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Two Worlds Cancer Collaboration Foundation (2W), also known as INCTR Canada branch, is a not-for-profit, non-governmental charity with a mission to improve cancer control through provision of the necessary infrastructure and to build capacity for high quality palliative care and aspects of cancer control in developing countries.

2W emphasizes long term collaborations with medical institutions and qualified physicians and investigators in resource-constrained countries, including the conduct of clinical trials and laboratory research associated with training and educational programs. 2W also promotes alliances between cancer centers and hospitals within and between countries in order to ensure that available expertise in resource-poor countries is maximally used. 2W also promotes alliances between cancer centers and hospitals within and between countries in order to ensure that available expertise in resource-poor countries is maximally used.

Further information about 2W is available from its web site: www.twoworldscancer.ca. This Newsletter provides an update on the 2W projects underway at the present time in India

India Programs

An independent external evaluation of the Mehdi Nawaz Jung Institute of Oncology and Regional Cancer Centre (MNJ) palliative program in Hyderabad, Telangana was conducted over three days in February. Evaluators Dr Mhoira Leng (University of Edinburgh and Head of Palliative Care in Makerere University, Uganda) and Dr Chitra Venkatesh (Kerala) were supported by Dr Gayatri Palat (MNJIO Director of Pain Relief and Palliative Care Program), Dr Spandana Rayala (Paediatric PC Fellow) and local MNJ team members. Interviews were conducted with MNJ palliative care team members and Two Worlds Cancer team leaders. Documentation regarding the MNJ program and information related to INCTR-Canada /Two Worlds Cancer strategy, support and funding was provided as background. The final report is awaited, however the preliminary debriefing indicated that the MNJ program “is a leading initiative and a model for palliative care program development in India and South Asia”.

The INCTR-Canada/Two Worlds Cancer Collaboration team was in India in February/March 2018 to undertake and participate in a number of activities:

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The MNJ Pain Relief and Palliative Care Program was established in 2007 and has developed, strengthened its core capabilities and reached out to the community through 2010 to 2018. It is now poised to become a Center for Palliative Care for Telangana, and a “hub” for palliative care development in other states in India and in Nepal, Bangladesh and Sri Lanka.

Two pilot projects have been funded by Two Worlds Cancer, supervised by Dr Palat and the local NGO Pain Relief and Palliative Care Society – one an out-patient palliative care clinic in an oncology centre in Anantapuramu and the other a palliative home care service in Visakhapatnam, both in Andhra Pradesh.

The “Zoom Room” and Project ECHO platform: a Zoom video conferencing communication center has been established at MNJ through Two Worlds Cancer’s support (Rix Family Foundation) with a Project ECHO platform capability that is being used to establish:

  • Real-time case conferencing, with teaching, mentorship and clinical service support between MNJ and the rural PSKs.
  • A Pediatric Palliative Care Project ECHO network, led by Dr Megan Doherty (University of Ottawa, Bangladesh, and Two Worlds Cancer), Dr Stuart Brown (Two Worlds

Cancer) and Dr Gayatri Palat (MNJIO and Two Worlds Cancer) linking India, Nepal, Sri Lanka, Bangladesh and INCTR-Canada/Two Worlds Cancer.

  • Regular video conferencing between INCTR–Canada /Two worlds Cancer, Hyderabad, Nepal, Bangladesh and Sri Lanka.

Feasibility of screening for oral cancer

A feasibility study was undertaken in February/March 2018. This initiative was designed to establish whether a population-based oral cancer early detection program could be conducted scientifically and ethically in rural and community settings, deploying volunteer staff of varying technical capabilities, simple procedures and instrumentation, and on-site biopsy as appropriate. Despite many operational, procedural and importation of donated equipment challenges, the feasibility study demonstrated that asymptomatic subjects will enroll, all procedures including biopsies can be done in rural settings, and all required information can be acquired and transferred into electronic databases for subsequent analysis and interpretation. The feasibility study highlighted the importance of rural village leaders and the preparatory work with them by the research team to ensure participation.

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Almost one year of interactive Zoom-enabled regular meetings between the Canadian and Indian teams (MNJIO, Pain Relief & Palliative Care Society, Panineeya Institute for Dental Sciences and the Government Dental College) preceded the initial pre-feasibility (February 2nd) and feasibility (IRB –approved protocol –directed) study on March 4th. The e-learning modules cover a wide range of fundamental concepts in Medical Physics, Radiobiology and clinical basics of Radiation Oncology, informing decision making and determining treatment planning. The program has grown since its start, with the addition of modules that are specific to the needs of the program in Hyderabad, sensitive to the local academic environment and clinical demands. Our team continues to adapt to novel communication methods, using new platform like Whatsapp and Facebook groups, in order to bring the experts and students closer although the distance and time change remains a challenge. The local champions are progressively incorporating their views and knowledge in the modules.

Evaluation of oral cancer screening by blue light

The pilot study to determine the incremental value of blue-light, intra-oral examination compared to standard, white-light examination is being planned for September– December 2018.

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