Sushma Bhatnagar

Purpose: Metastatic spinal cord compression (MSCC) is a debilitating complication of advanced malignancies, associated with immense physical and emotional distress. The aim of this study was to assess the trajectory of emotional well-being (primary outcome) and quality of life (QoL), functional status, and pain (secondary outcomes) over 30 days. Methods: 106 MSCC patients were included in this prospective observational study. Assessments were done using the Hospital Anxiety and Depression Scale (HADS) for emotional well-being, EORTC QLQ-C30 for QoL, Karnofsky Performance Status (KPS) for functional status, and the numeric rating scale (NRS) for pain. These were conducted at baseline ( T ₀ ), day 10 ( T ₁₀ ), and day 30 ( T ₃₀ ). Results: The mean age of the participants was 54.1 years. A V-shaped pattern was observed in emotional well-being; improvement in HADS was noted from T ₀ to T ₁₀ ( P < 0.001), but they worsened by T ₃₀ ( P < 0.01). Global health and functional domains of QoL ( P < 0.05) showed improvement, but these gains plateaued as fatigue and financial distress increased. Baseline correlation weakened over time between QoL and functional domains. At T ₃₀ , the only domain that remained significantly associated with QoL was emotional functioning, underscoring its strong link to overall QoL. The pain decreased significantly by day 10. Conclusion: MSCC affects the emotional well-being and QoL. Initial improvements in psychological symptoms is followed by an eventual decline. There is a paradox wherein, despite objective health deterioration there is subjective improvement in well-being. Hence, a multidisciplinary approach, involving psychological and rehabilitative support, becomes crucial for optimal patient-centred care.

Background and Aims: Frailty increases vulnerability to stressors, negatively impacting cancer outcomes. We evaluated the association between pre-operative frailty and post-operative outcomes in Indian patients undergoing major abdominal cancer surgery and explored ultrasound-based sarcopenia markers for frailty screening. Methods: Frailty was assessed using the Fried Frailty Phenotype. The primary outcome was hospital length of stay (LOS); secondary outcomes included severe complications (Clavien–Dindo III/IV), intensive care unit stay, and 30- and 90-day mortality. Pre-operative ultrasound-guided quadriceps thickness and rectus femoris cross-sectional area (CSA) were measured, and their cut-off values were derived via receiver operating characteristic (ROC) curves as screening parameters for pre-operative frailty. Results: Among 142 patients, 68 (47.8%) were frail. Frail patients had longer hospital stays {median 9 vs. 6 days; relative risk (RR) 1.20 [95% confidence interval (CI) 1.02 to 1.41]}; P = 0.031. On multivariate analysis, frailty {RR 1.16 [95% CI 1.03 to 1.31]}; P = 0.012 and American Society of Anesthesiologists physical status (ASA-PS) > III {RR 1.35 [95% CI 1.10 to 1.65]}; P = 0.004 independently predicted prolonged LOS. ROC analysis showed poor predictive ability of ultrasonography: {area under curve 0.591 [95% CI 0.497 to 0.685]}; P = 0.061 for body mass index-normalised quadriceps thickness; {0.613 [95% CI 0.519 to 0.707]}; P = 0.020 for rectus femoris CSA, which improved to {0.721 [95% CI 0.636 to 0.806]} with pre-operative anaemia. The diagnostic accuracy was 65.5% and 64.3%, respectively; the sensitivity/specificity for quadriceps was 78%/54%, and for rectus femoris, CSA was 50%/78%. DeLong’s test showed no significant difference ( P = 0.6). Conclusion: Frailty prolongs hospital stay but not complications or mortality. Ultrasound alone poorly predicts frailty. Combining pre-operative anaemia improves the predictive value of rectus femoris ultrasound assessment.

Purpose Breast cancer is the most common malignancy among women in India, with patients often experiencing high symptom burden and compromised quality of life (QoL). Despite evidence supporting early supportive care integration, significant implementation gaps persist in low- and middle-income countries (LMICs). This study addresses the lack of feasible intervention models for resource-constrained settings and inadequate characterization of mechanisms through which early supportive care improves outcomes—particularly symptom-specific contributions and financial burden reduction. Methods This single-centre, randomised controlled trial at All India Institute of Medical Sciences, New Delhi, randomised 110 newly diagnosed adult female breast cancer patients (1:1) into intervention (early supportive care plus standard care) or control (standard care only) groups. Supportive care included symptom management, psychosocial counselling, and educational support. Outcomes were assessed at baseline and 3 months using EORTC QLQ-C30 and Edmonton Symptom Assessment Scale (ESAS). Statistical analyses included t-tests, multivariate regression, and mediation modelling. Results Both groups showed significant QoL improvement, but greater symptom reduction occurred in the intervention group (mean ± SD ESAS reduction: 30.69 ± 15.51 vs. 22.9 ± 15.99; p = 0.014). Fatigue and pain were significantly lower in the supportive care group (Cohen’s d = 0.55 [95% CI:0.17,0.94] and 0.38 [95% CI:0.00,0.75], respectively). Financial burden significantly reduced (p = 0.001), with higher patient and caregiver satisfaction (p = 0.032). Mediation analysis confirmed pain reduction as a key QoL predictor (p < 0.001). Conclusions Early supportive care integration significantly reduces symptom burden, enhances psychological well-being, and lowers financial stress, supporting its inclusion as standard adjunct cancer care in developing countries, providing actionable evidence for policymakers in LMICs.

In India, where cancer incidence is rising, and healthcare infrastructure in tertiary care centers is strained, the outcomes of cancer patients requiring intensive care unit (ICU) care remain poorly understood. We aim to describe demographic, clinical, and survival data and to identify factors associated with mortality in non-elective medical admissions of critically ill cancer patients to ICU in a tertiary care hospital. Retrospective observational study of non-elective medical admissions of critically ill adult cancer patients to the ICU with a diagnosis of solid organ or hematological malignancies between 1st January 2018 and 31st December 2022. Data regarding patient and neoplasm characteristics, ICU admission features, and outcomes were collected from medical records and ICU charts. A total of 204 non-elective medical admissions of critically ill cancer patients to the ICU were analyzed. Hematological malignancies were documented in 53.9% patients. The main causes of admission to the ICU were febrile neutropenia (34.3%), respiratory failure (31.8%), sepsis (9.8%), and shock (7.8%). The mean length of ICU stay was 5.62 ± 5.67 days. Intensive care unit mortality was 52.94%. The most common cause of mortality was septic shock (53.7%). The need for invasive mechanical ventilation (IMV) [adjusted odds ratio (OR) 0.113; 95% confidence interval (CI) 15.98 (4.22–60.56), p < 0.001], use of vasopressors (adjusted OR 12.59; 95% CI: 3.45–45.94, p < 0.001), need for dialysis (adjusted OR 17.99; 95% CI: 1.97–164.45, p = 0.01), and tracheostomy (adjusted OR 0.15; 95% CI: 0.03–0.7, p = 0.016), were independent risk factors associated with higher ICU mortality. An increasing number of cancer patients require intensive care, and our study suggests that many of these patients have a reasonable chance of surviving their ICU stay. The in-ICU mortality of 52.94% was observed at our tertiary care center in India. Independent predictors of mortality included age, type of malignancy, treatment intent, need for early IMV, vasopressors, and dialysis in the ICU. Sandill S, Mishra S, Garg R, Gupta N, Bharti SJ, Kumar V, et al. Outcomes of Cancer Patients Requiring Non-elective Medical Admission to the Intensive Care Unit of a Tertiary Care Center in India: A 5-year Retrospective Study. Indian J Crit Care Med 2026;30(1):13–18.

Objectives: Burnout is a significant occupational hazard among palliative care physicians, driven by the emotionally demanding and high-stress nature of their work. Despite its implications for physician well-being and patient care, limited data are available on burnout within Indian palliative care settings. This study aimed to assess the prevalence of burnout and explore associated demographic and occupational factors among palliative care physicians across India. Materials and Methods: A cross-sectional survey was conducted among 68 palliative care physicians across India using a non-probabilistic convenience sampling approach. Participants completed a semi-structured socio-demographic questionnaire along with the Copenhagen Burnout Inventory (CBI), which measures burnout across three domains: personal, work-related and client-related. Given the non-normal distribution of data, non-parametric statistical tests were employed for analysis. Results: The majority of physicians (85.3%) reported low overall burnout, whereas 10.3% experienced moderate burnout and 4.4% reported high burnout, based on established CBI cut-off scores. Notably, higher work-related and client-related burnout scores were observed among junior physicians and those practising in mixed-care settings. Engagement in regular physical activity was significantly associated with reduced overall burnout ( P = 0.039), indicating its potential protective effect. Conclusion: Although most palliative care physicians in India demonstrated low levels of burnout, a significant minority exhibited moderate to high burnout–particularly in domains related to work and patient care. These findings highlight the need for targeted interventions aimed at improving institutional support, encouraging physical well-being and optimising work environments to mitigate burnout and enhance the sustainability of palliative care practice.

COVID-associated mucormycosis (CAM) is a severe fungal infection with lasting physical and psychological effects. This prospective cohort of 53 CAM patients evaluated symptom burden, depression (PHQ-9), anxiety (GAD-7), and quality of life (WHOQOL-BREF) at baseline, 6 months and 1 year. Facial pain (89%) and headache (87%) were the most common symptoms; depression improved significantly (PHQ-9: 9.7 to 5.4; p < 0.001), while anxiety initially declined but rose again at 1 year. Quality of life improved in physical and psychological domains, whereas social and environmental aspects remained unchanged. Persistent challenges such as dysphagia (33%), voice changes (27%) and appearance concerns (27%) underscore the need for integrated long-term mental health and rehabilitation strategies in CAM care.

Background and Aims: Traditional airway assessment methods likely miss findings, resulting in unanticipated difficult airways. Surgeons routinely do computed tomography (CT) scans of head and neck cancer patients to determine the extent and resectability of the disease. We used these images for 3-dimensional CT (3D CT) reconstruction to provide additional airway-related information to the anaesthesiologist and studied its impact on airway management. Methods: We randomly allocated 60 patients into two groups to formulate the airway management plan: Group A (Conventional airway assessment) and Group B (Conventional airway assessment along with 3D CT findings). A CT reporting format was prepared based on a literature review after discussion with radiologists and airway experts. In the case of luminal obstruction, a virtual endoscopy video was also created. These findings were shown to the anaesthesiologist managing the airway, and any change in the primary plan was noted. The primary outcome was the total time required for successful airway management. Secondary outcomes included the number of attempts, number of alternative techniques, other manoeuvres required, incidence of failed intubation, and any complications. Data were analysed using the SPSS statistics software. Results: The airway management time between both groups was comparable, with a median difference of 0 [95% confidence interval (CI): −14, 20; P = 0.752]. Among the manoeuvres used, optimal external laryngeal manipulation (OELM) was required more in Group A ( P = 0.007). Both groups had no difference in the number of attempts ( P > 0.99), number of alternative techniques ( P = 0.052), and complications ( P > 0.99). There was a significant change in the endotracheal tube size after CT findings were shown ( P < 0.001). It aided in selecting the preferred side of the nostril for nasotracheal intubation (kappa = 0.545, showing moderate agreement between before and after CT groups). As per the feedback from anaesthesiologists who rated 3D CT on a Likert scale, it was considered beneficial for airway assessment. Conclusion: 3D CT reconstruction and virtual endoscopy can be a valuable method of airway assessment.

Introduction: Despite the disproportionate burden of cancer morbidity and mortality in low- and middle-income countries (LMICs), little is known about patients’ care experiences in these settings. This study assesses which aspects of physician communication and care coordination most influence patients’ overall experience with care, and factors associated with patient experience ratings, to inform quality improvement and improve cancer care experiences in LMICs. Methods: In a cross-sectional study of 1933 patients with advanced cancer recruited at 10 major public hospitals in seven LMICs in Asia, patients rated their experience with physician communication, care coordination and overall. Results: Physician communication mattered most in patients’ assessment of overall experience with care. Patient use of traditional medicine was associated with poorer physician communication ratings (β: −1.38, 95% CI: −2.11 to 0.65), while outpatient care (0.91, 95% CI: 0.24 to 1.57) was associated with higher ratings. Patients who were unsure (−0.77, 95% CI: −1.43 to –0.10) of their cancer stage (relative to aware of late-stage), or indicated financial difficulty (sufficient money to cover their daily needs fairly well (−0.77, 95% CI: −1.50 to –0.04) or poorly (−1.20, 95% CI: −2.30 to –0.09) relative to very well) rated care coordination lower. Patient experience ratings differed by minority group status and cancer severity understanding. Respondents identifying as ethnic minorities who were unsure of their cancer stage rated physician communication significantly higher (1.64, 95% CI: 0.71 to 2.58) than non-minorities aware of their advanced cancer. Non-minorities unsure of their cancer stage rated care coordination significantly lower (−1.00, 95% CI: −1.64 to –0.36) than non-minority patients aware of their cancer stage. Conclusions: This study provides new understanding of care priorities among patients with advanced cancer in LMICs. Our findings highlight the importance patients attribute to physician communication and considerations for improving patient-centred communication to support equitable and culturally appropriate care. This study also underscores the need for future work navigating prognostic discussions in LMICs.