1. Title of best practice : Holistic Cancer Care, Education & Research
2. Objectives of the best practice: Holistic Cancer Care, Education & Research
To sensitize and generate awareness on cancer among all stake holders as a part of primary prevention.
To screen cancers leading to early diagnosis and help addicts to quit habits as part of secondary prevention.
To initiate early treatment for diagnosed cancer cases as part of secondary prevention
To start rehabilitation and palliative care as part of tertiary prevention.
To impart excellence in education, training and research in cancer for undergraduate and postgraduate students .
To provide subsidized /free cancer treatment to poor and needy patients under Ayushman Bharat/MJPJAY health insurance scheme
To provide Registry for cancer cases in rural area
3. The context:
a)Emergence of cancer on community health concern
Chronic non-communicable diseases are at present the leading cause of death. The lifestyle and behavioral pattern of people are changing rapidly, being favorable to onset of chronic diseases.
The impact of chronic diseases on the lives of people is serious when measured in terms of loss of life, disablement, family hardship, poverty as well as economic loss to country.
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b)Need for sensitization& awareness
High levels of smokeless tobacco use was identified as major risk factor in this area. Lack of awareness, availability of medication, trained manpower, lack of evidence based approach to treatment etc. were some
of the gaps identified
Commonest cancer reported in this region is head and neck cancer and risk factor is tobacco abuse.
.
Awareness for warning signs/symptoms will help in early diagnosis and treatment. Most of the cases reported are in advanced stages.
Awareness among females about warning signs for Ca cervix and Ca breast will help in early diagnosis and treatment as they are the second & third common site for cancer in this area
c) Need for enhancement of curricular & co-curricular teaching learning activities
There is need of trained human resource in medical as well as paramedical staff for early detection & prom treatment
In this background, Pravara Institute of Medical Sciences provides holistic cancer care including promotive, preventive, curative, rehabilitative and
palliative care with compassion under one roof
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The Institute has always taken a people centric approach.
4. Practice:
a) Awareness programs
Awareness programs are organized on cancer and substance abuse for students from 8th to 12th standard in near by schools/junior colleges by Radiation Oncology Department.
Awareness program for breast and cervical cancer among women is started in memory of late. Smt. Sindhutai Vikhe Patil.
Radiation Oncology department also conducts cancer awareness programs for patients and relatives in day care ward for Breast Self Examination and Self Oral Examination.
Health talks on Radio on Myths and facts about cancer and cancer education is being given on KVK Pravara Community Radio in local language catering villages from five talukas in the are
Women empowerment cell organized cancer awareness for all female employees of PIMS DU
SSEP college of Nursing conducted cancer awareness rally in the village. They have also developed educational material in local language
Rural Dental College released pamphlets about oral cancer and self oral examination on World Cancer Day
Rural Dental College organizes camps for early detection of oral cancer and premalignant lesions for nonteaching staff of PMT
Under Tabacco Research & Cessation Centre short films by CHRE to create awareness were showcased to a wide audience to promote health and prevent tobacco use. NSS volunteers were used to spread awareness.
Awareness campaigns among doctors, nurses and hospital ancillary staff were conducted to spread awareness about cessation of tobacco and services available at institute
Developing IEC material for OPDs were taken up by the students
School for Public health and Social Medicine and Women empowerment cell organized seminar on “ Prevention and control of cancer among women -Role of ASHAs”
School for Public health and Social Medicine and Department of Radiation Oncology observed “World breast cancer awareness month” in October 2022 through its Rural and Tribal Health Centers
b) Screening Programs
Institute is actively involved in various cancer detection camps organized
by Pravara Rural hospital
Screening camps for early detection of oral cancer at school for parents
was organized by Rural Dental College.
.
World rose day celebration dedicated to cancer patients was organized on
22/9/2021 by Rural Dental College.
Under Tobacco Research & Cessation Centre Separate OPD with trained
doctors, nursing staff, research associates individual and group counselling
room was set up. Cotinin diagnostic kits, carbon monoxide breath
analyzers are made available in OPD. Free medications including nicotine
replacement therapy is provided by institute.
c) Diagnosis, Palliative care & Rehabilitation.
Pathology department has state of art digital pathology laboratory having facilities like digital scanner, high speed internet line, video conferencing ,large screen ultra HD TV and audio system .By using the scanner ,histopathology glass slide is converted to digital format and stored on the
server, which can be assessed by International faculty as a part of second
opinion.
Guest lectures were organized by Medical Education Unit for faculty & student on cancer screening disparities and outcome in South Asian Indian female by international faculty.
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Guest lecture on cancer screening: Indian scenario for students & faculty
Pravara pain clinic was started in March 2023 for palliative care in cancer patients.
Dietary advice to cancer patients by dietician is given
Regular dental and physiotherapy referral is being done
Cancer rehabilitation is done by physiotherapy including therapy to address the effect of cancer like fatigue, pain, loss of conditioning, loss of strength,
balance problem and cognitive impairment
All the constituent units of Pravara Institute are involved in giving comprehensive care with emphasis on prevention , promotion ,diagnosis ,treatment & rehabilitation
Evidence of success:
a) Awareness programs
Under “Awareness and attitude on substance use among the school going students from 8th to 12th standard of Loni & Pravaranagar” a total of 5150 students from various schools were benefited
Under Tabacco Research & Cessation Centre 5000 beneficiaries have been sensitized
Women Empowerment cell 650 female employees were sensitized regarding cancer
Cancer education is being given on KVK Pravara Community Radio in local language catering villages from five talukas in the area
Short films by CHRE to create awareness were showcased to a wide audience to promote health and prevent tobacco use. NSS volunteers were used to spread awareness.
b) Screening & treatment
In cancer awareness and screening camp 125 high risk women were screened for breast cancer
In last five years 24087 samples were received for histopathology 2336 turn out to be malignant. Most common malignancies on histopathology were carcinoma breast and carcinoma cervix .Leukemia were 130 cases in last five years.
In last five years 3792 patients of cancer received treatment at Pravara Rural Hospital. Majority of the cases were from Medicine followed by Obs/Gyn
department. Commonest site was head neck face followed by breast & cervix
cancer.
Since, the establishment of the department of Radiation oncology in 1996 thousands of cancer patients have been treated with radiotherapy, brachytherapy and chemotherapy as well as palliative care to terminally ill
patients.
Average 25 -45 patients are treated daily on Linear Accelerator unit and 1-2 patients on Brachytherapy unit.
About 4-12 patients are provided day care facility for chemotherapy & supportive care
Around 25 -40 patients are admitted in male & female wards for indoor care
Department of oral & maxillofacial surgery operated total 222 oral cancers and 67 premalignant lesions.
Under Pravara Pain Clinic Non –Interventional approach Around 150 patients received patch treatment as palliative care While in. Interventional approach 40 patients received palliative care for their pain relief.
c)Teaching & learning activities
We have enough clinical material to train five MD Radiation Oncology students, PhD in Radiation Oncology, Five students of BSC RTT, Two Medical Physicist interns & four Medical Physics externship students.
Department of Radiation oncology conducts value added program for Nursing student.”Chemotherapy Drug Administration and Various precautions” for 50 students for three months per year. Trained students are getting selected in renowned centres like Tata Memorial Hospital.
d) Research
Under Tabacco Research & Cessation Centre twelve student research fellowships of six months have successfully completed.
Innovative topics like use of social media in tobacco cessation, integrating cessation with ANC care, Tele– Counselling, prevention of loss to followup. Etc.
Clinical trial of effectiveness of Nicotine Inclusive Tobacco Cessation Therapy among Tuberculosis patients was successfully completed
An operational research project has also been sanctioned by state NTEP cell to train Community Medical Officer in Counseling and referral of TB patients who use tobacco.
Agreement of Co-operation between The Hebrew University of Jerusalem & Pravara Institute of Medical sciences Deemed to be University is signed for
1.Exchange of faculty members
2.Exchange of students
3.Joint research projects
4.Joint conference
5.Exchange of research material
“Immunohistochemical Analysis of tumor associated macrophage receptor
proteins in oral potential malignant disorders & oral squamous cell
carcinoma” is the ongoing research project between PIMS (DU) and
Hadassah Medical Centre ,The Hebrew University of Jerusalem ,Israel.
e) Cancer Registry
Department of Radiation Oncology has successfully uploaded details of 4053 patients on “Hospital Based Cancer Registries Data Management Software” The information aids efforts towards cancer prevention and
control in the country
Multi-disciplinary Cancer care and treatment are available under one roof in Rural area
Problems encountered and resources required
This is rural tertiary care center where we encounter patients who are
economically backward, illiterate and unaware of the disease, complications,
prognosis, extent and the modality for diagnosis & treatment.
In spite of regular awareness programs 60 to 65 % of cases are reporting in
advanced stages of cancer.
Around 10-15 % of patients are treatment defaulters and they fail to report
on time for chemotherapy.
Negligence and hesitation of female patients for screening and availing
treatment facilities.
Extra workload for faculty for conducting these activities along with patient
care.
Uniqueness :
Comprehensive cancer care is being provided in rural area with emphasis on
prevention, early diagnosis, treatment & palliative care.
Providing quality education to postgraduate, undergraduate, paramedical
staff in cancer care.