6^th World congress on Hospice and Palliative care May 13-14, 2019 Holiday Inn Singapore Atrium | Singapore

Biography:

A Guillaume Pollet is a Specialized Breast Cancer Surgeon with Expertise in Oncoplasty and Global Care (Oncofertility) and Former G&O. His professional activity disrupts the conventional treatment after being educated in the Institute Curie, Paris, one of the most prestigious, innovative and precursor Cancer Center in the world. He is currently an Executive MBA at INSEAD Business School, Singapore

Abstract:

Innovation? It's not that we need new ideas, but we must stop having old ideas-Edwin Land, inventor of the Polaroid. The medical world is facing a crucial period. The increase in the world population and its aging will generate a massive influx of patients. Cancer is one of the leading causes of death in the world. Access and reimbursement of treatments, as well as associated care, are costly priorities. No country in the world will be able to pay these costs if nothing changes. The current model of care must be redesigned. The concept of real-world evidence allows for a new form of scientific validation, associated with the standard of reference of randomized clinical trials, allowing the use of new treatments. Innovation in the detection and treatment of cancers affect all stages. The arrival of new players (start-ups, institutions, and companies) and new technologies (AI, digital health, VR, block chain, etc.) brings a different vision. The different contexts of the actors make it possible to accelerate this evolution. To be effective, it must be accompanied by the regulators, with a change of policy centered on a treatment of great value and responsible care. Expansion of insurance coverage and lower prices will not be enough. This requires that traditional actors adapt, relearn their job by integrating these advances. The range of possibilities is vast, the goals can be achieved if an environment works for everyone. Innovations are a catalyst for economic progress and social transformation if properly integrated.

Biography:

Neeraj Jain is Associate Professor in radiation oncology at Sri Guru Ram Das University of Health Sciences Amritsar. He is eminent Radiation Oncologist and participated in numerous national and international conferences and presented papers. He is Senior Vice President of North Zone Association of Radiation Oncologists of India and Vice Chairman of Indian College of Radiation Oncologists (ICRO).

Abstract:

India is a developing country. The present population is 1.35 billion. 1.4 million new cancer patients are diagnosed every year. A total of 2.25 million cases are prevalent at a given time. Mortality from cancer is as high as 1.2 million. Cervix and breast are leading cancers among females and head, neck and lung are leading cancers among males. Due to poverty and illustration there is lack of awareness which leads to presentation at advanced or metastatic stage. The treatment in most of cases is palliative though now the awareness about cancer has increased and urban population is very conscious about the disease. Financial constraints are other issue for a radical and effective treatment. Lack of health insurance leads to a financial burden on effected family and despite being in a curable stage the patient fails to get required treatment. Central and state governments have started funding programs for diagnosis and treatment, but still costlier target therapies are beyond reach of majority of the patients. More and more funds are being allocated under National Cancer Control Program with sole aim of early detection and cure. Pharma companies are also running patient assistance programs and costly medicines are given as free cycles after patient purchases initial cycles. So, over all scenarios is positive.

Biography:

Nitosh Kumar Brahma a life Fellow of The Institution of Engineers, India. He is actively engaged as Convener of WBSC/IEI, Chemical Engineering Division and as Visiting Professor of Institute of Genetic Engineering (IGE) Badu, Madhamgram. He completed his double Graduation with Distinction; BSc ÇU, B Tech, M Tech, TUB and Doctoral work in Max-Planck Germany 1968-1986. He published more than 100 articles related to Genetic Engineering, Chemical and Bio-Chemical Process Technology. He is the author of three books entitled Introduction to Chemical Science and Engineering, Molecular and Engineering Concepts of Microbiology and Bacterial adherence.

Abstract:

Benign tumors that are not identified as malignant and the malignant tumor which is identified as cancer must follow two different human physiological and immunological consequences. We all carry cancer cells and or generate cancer cells continuously during our growths and metabolic processes and by environmental impacts, like temperature, humidity, smokes, dust and UV of sunrays. The concept of BNT (Bio nanotube of Escherichia coli K-12) is one such concept to optimize the delivery system of chemotherapeutic drugs and to sustain the body immune system/bidirectional immune response (i.e. to kill cancer malignant cells through chemotherapeutic drugs, immobilized in BNT and at the same time helps to normalize the body immune system, since BNT is genetically engineered E. coli cell, there extracted surface antigen fimbriae (pili), are the expressed cloned gene of cancer cell. BNT carrying cancer chemotherapeutic drug immobilized, is specific to the cancer cell and the necessitate body immune response responsible to sustain the body immune response. The main danger in chemotherapy is the damage of patient's immune system during and after administration, responsible to prevent the growth of opportunistic bacterial growths, increasing in case of immune suppression, susceptible to the body. BNT has initiated the concept for anticancer drug from the studies of anti-adherent activities of microbes in Balb/C mice to prevent fatal diarrhea. The immune response in this case was unique to observe the difference in mortality of mice against inoculums of donor fatal diarrhea causing bacteria and a group with BNT injected peritoneal survived against fatal diarrhea causing bacteria infected to mice and increased up to 108 ells/0.2 ml.

Biography:

Tarang Krishna is a distinguished and acclaimed Physician who has made immense contribution in the field of cancer treatment. He is a well-known and a fabled personality in healthcare, he has successfully treated thousands of patients over a span of 18 years. He has completed his MD and thereafter went on to do his PhD from University of London. He has been appreciated and awarded several times by the Government of India as well as by International Organizations.

Abstract:

Non-Hodgkin’s Lymphoma is one of the most common cancers worldwide. It primarily affects adults above the age of 50 years but it is not uncommon in children. Non-Hodgkin’s Lymphoma is the cancer pertaining to lymphocytes, one of the types of leucocytes. As the lymphocytes multiply abnormally, of thymus, spleen, bone marrow and the lymph nodes present in the body tend to get affected. It has been associated with various risk factors like autoimmune disorders, smoking, immunosuppressive treatments and frequent infections. The recommended treatment for Non-Hodgkin’s Lymphoma is an integrated chemotherapy and immunotherapy treatment. This treatment has considerable side effects like severe hair fall, allergic reactions; decrease in blood count especially the neutrophils that protect the body from infections. Other alternatives include radiotherapy, bone marrow transplant and radio immunotherapy. Many studies have been conducted in relation to the treatment of Non-Hodgkin’s Lymphoma with immunotherapy but the possibility of emergence of alternate effects has also not been entirely ruled out. This case report aims to establish the efficacy of oral immunotherapy treatment in a patient of Non- Hodgkin’s Lymphoma in terms of the following: Relieving the patient of his presenting complaints, removing the evidence of the disease completely from the body without any side effects, ruling out relapse of the disease and ensuring a normal life to the patient.

Biography:

Aalapti Singh is currently pursuing her Doctoral Research in the area of Psycho-oncology in India. She is interested in the areas of distress screening and management among oncology staff to help reduce burnout.

Abstract:

The International Agency for Research on Cancer (IARC) in the GLOBOCAN 2018 report suggests that the global cancer burden has risen to 18.1 million cases and 9.6 million cancer deaths. This calls for an exponential increasing demand for treatment both physical and emotional. In this course, we must not forget to treat the cancer of our minds in the disease’s course from diagnosis to survivorship/palliative care. Psycho-oncology is a practice of going beyond traditional medical treatment and serves lifestyle, psychological and social aspects of cancer. It addresses two major dimensions: (1) psychological responses of patients (families and caregivers) to cancer at all stages of the disease; (2) psychosocial factors influencing the disease process. Cancer-related distress is defined as a multifactorial unpleasant emotional experience of a psychological (cognitive, behavioral, emotional), social and/or spiritual nature that may interfere with the ability to cope effectively with cancer, its physical symptoms and treatment. It expands through a continuum from normal sadness to existential crisis, thereby endorsed as the sixth vital sign. Evidence shows, 60% to 80% cancer patients (including families/caregivers) report distress, whereas only a meagre 20% receive help. Hence, distress screening is crucial in identifying individuals to be referred for help. Psycho-oncological interventions have proven to reduce distress, enhance quality of life and increase participation in medical treatment. The most unattended group is the oncology personnel (doctors-surgical, medical, radiation oncologists; nursing staff and other related specialists), who deal with death on a daily basis. Staff burnout is at a tipping point due to extreme stress. Distress screening for them is a necessity, with strengthening practices like open discussions, cut-off time, experience sharing and a conducive working environment should be implemented. Cancer is undoubtedly a disease of the body and mind, likewise. The mind aspect of it needs equal attention and effort, as the physical part.

Biography:

Amabelle Trina Gerona is working as Medical Oncology Fellow at St. Luke’s Medical Center, Philippines

Abstract:

Introduction: There is no standard sequence in giving treatment for metastatic breast cancer. Eribulin mesylate has been approved for heavily pretreated patients in the second line setting.

Method: Case series from a single institution in the Philippines including all metastatic breast cancer patients given Eribulin in both out-patient and in-patient services in St. Luke’s Medical Center Quezon City from 2013-2016.

Results: Thirty-four patients were given Eribulin from January 2013-December 2017 in our institution for Metastatic Breast Cancer. Median age was 59.1 (37-84). Hormone receptor status were mostly: triple negative 12 (35.29%) and ER (+) PR (+) Her2 (-) with 9 (26.47%). Most 24 (70.59%) had received prior one line of treatment while 6 (17.64%) had received prior two lines of treatment. There were 3 out of 34 patients who had ER (+) PR (+) Her2 (-) subtype, one patient had 2 months response while two patients had 3 months response to Eribulin. Hormone receptor subtype ER (+) PR (+) Her2 (+) had 3/34 patients which response to Eribulin in 2, 3, 3 months while triple negative subtype, had the most number of patient 12/34 had one patient with 5 and 12 months each response, two patients with 0.5, 3 and 4 months each response, four patients with 2 months response, and four patients with 2 months response each with Eribulin. Common adverse events to Eribulin were neutropenia 17 (50%) and fatigue 15 (44.11%). Reasons for discontinuation of Eribulin were due either to adverse events 7 (25.92%) or disease progression 24 (70.59%).

Conclusion: Eribulin mesylate in our institution was used mostly as a second line setting and was used not only in triple negative breast cancer but as well as other breast subtypes as well. Most common metastatic site were lung and liver. Most patients had stable disease. One patient had achieved complete response when Eribulin was used as second line metastatic setting. Most common cause of discontinuation were due to progressive disease, while only modest had discontinuation due to adverse effects

Biography:

Hemish Kania is working as surgical Oncology Fellow at Dr. B. Borooah Cancer Institute, India.

Abstract:

Aim: To report our early experience in chemo port insertion without image guidance by surgeons.

Methods: This was a cross-sectional study conducted in a tertiary center with 19 chemo port insertions done from November 2017 to May 2018. The chemo ports were inserted at the operation theater unit. All the chemo ports had right Internal Jugular Vein (IJV) as the entry site. Other entry sites included the left IJV, subclavian veins and the inferior vena cava were not used. Immediate and early complications were recorded. None of the port insertions were performed under image guidance with the aid of ultrasound and fluoroscopy.

Results: The technical success rate was 100%. In terms of immediate complications, there were only two cases of arterial puncture that resolved with local compression. No pneumothorax or air embolism was documented. No case of early complications was recorded. The most common early complication was catheter blockage (2/19; 10.52%), followed by catheter-related infection (2/19; 10.52%). No incidence of catheter malposition, venous thrombosis and catheter dislodgement or leak was recorded. A total of 1 (5.26%) chemo ports had to be removed within 30 days; most of them were due to infections that failed to respond to systemic antibiotic therapy. In terms of place of procedure, there were no significant differences in complication rates between the chemo port catheter placements via. image guidance in comparison to the one done without image guidance.

Conclusion: Chemo port insertion without image guidance by surgeons gives low periprocedural complication rates in comparison to chemo port insertion done by image guidance. Using right IJV as the entry site, the image guidance gives good success rate with least complication. The advantage of doing it without image guidance is that it saves a lot of time. Also, it can be done under local anesthesia. It doesn’t require any radiological assistance during the procedure. And it requires lesser number of skilled personals in terms of manpower. To our best knowledge, this is the first publication of chemo port insertion without image guidance.

Biography:

Armheel Klein Baldonado is currently the Chief Resident of Radiation Oncology at a Training Institution in the Philippines.

Abstract:

The objective of this case report is to present a case of leptomeningeal metastasis at the time of diagnosis of the primary high-grade glioma in a child and to describe the course of diagnosis, treatment and outcome. A 13-year old girl presented with signs and symptoms including headache with associated projectile vomiting, which persisted for a month and was accompanied with diplopia and ataxia. MRI was done revealing a mass on the left temporal lobe, which was compatible with diffuse meningitis and an alternative diagnosis of a high-grade neoplasm with leptomeningeal metastasis. She underwent left temporal parietal craniotomy with excision of the tumor and revealed a histopathologic diagnosis of high-grade gliomas consistent with glioblastoma. Patient underwent adjuvant Craniospinal Irradiation (CSI). Additional chemotherapy was then initiated with Temozolamide for 6 cycles due to the residual glioblastoma with leptomeningeal metastasis. A repeat craniospinal MRI was done after the last cycle of chemotherapy, which revealed an apparent complete resolution of the previously noted contrast-enhancing residual mass. Leptomeningeal metastasis from GBM in the pediatric age group is not a common occurrence. The evaluation of leptomeningeal dissemination of tumor is based on the several criteria: presence of clinical signs and/or symptoms, evaluation of lumbar CFS cytology and craniospinal CT scan or MRI. Current treatment for pediatric GBM typically includes initial surgery followed by radiation and chemotherapy. There is no specific recommendation for CSI for primary disseminated GBM. The efficacy of Temozolamide remains controversial but a beneficial effect is not disproven.

Biography:

Shreya Kar is an Industrious Researcher with the President’s Graduate Fellowship at the National University of Singapore (NUS). She has published six research articles in peer-reviewed journals. She is the student Ambassador currently at EACR and PSS. She has completed her master’s degree in Biotechnology from Calcutta University, India with a Gold medal

Abstract:

Tumor-associated Macrophages (TAMs) choreograph various aspects of the tumor microenvironment. Annexin A1 (ANXA1) is an anti-inflammatory protein is highly expressed in metastatic breast cancer. Gene Expression Omnibus (GEO) and array express was used to assess the association between TAMs and breast cancer in the patients. MMTV-Wnt1 mouse model was used for in vivo study. Microarray Affymetrix was done to find the signaling mechanism involved. LC-MS was done to find the array of secreted protein by the breast cancer cells. Clinically, we found that M2 TAMs were highly enriched in Claudin-low breast cancer subtype and was strongly associated with ANXA1 gene expression, which was validated in our mouse model. Additionally, macrophages were skewed to a more M2 TAM-like phenotype upon co-culture with breast cancer cells, with enhanced migratory and invasive properties and phagocytic potential, which was reduced in the ANXAI-/- macrophages. TAMs isolated from the breast tumors of wild type and ANXA1 knockout mice wherein 4T1 had been injected orthotopically, showed higher percentage of M2 macrophages in the wild type as compared to the ANXA1 KO. We have found a novel signaling loop connecting RANTES-Annexin A1-stat3-Arginase 1 using our Affymetrix and LC-MS data, which has been also validated in our ex vivo and in vivo model. This study demonstrates a novel role of ANXA1 in regulating the dynamic process of macrophage polarization in the breast tumor microenvironment and future studies include abrogating this process using a novel stat3 inhibitor.

Biography:

Michaela Bercovitch is the director of the Oncological Hospice in Sheba hospital, Tel Hashomer, Israel and a lecturer at Tel Aviv University Sackler School of Medicine. Dr. Bercovitch was born in Romania, Bucharest, where she graduated from medical school as MD in Pediatrics. In 1987 she emigrated to Israel and after two years training in Internal Medicine and Geriatrics she continued her medical practice in the Oncological Hospice. In 1998 she initiated a 2 year comprehensive postgraduate course of Palliative Medicine for doctors. She is involved in the education of medical students, nurses and doctors across Israel. Her research fields include pain control, impact of high dose opioids on patients’ survival, development of clinical auditing tools and a hospice oriented clinical database. She is the author of the chapter discussing treatment of pain with TENS (Oxford Textbook of Palliative Medicine), and other chapters addressing euthanasia, non-pharmacological treatments for chronic pain, the role of the physician near death, and the effect of patient-setting on the work of the team. Dr. Bercovitch was a member of the Directory of European Association for Palliative Care (2007-2016); Served as the Chairperson of Israeli Palliative Medicine Society (2002- 2016) focusing on the recognition of Palliative Medicine as a sub-specialty and its inclusion as a government-funded treatment. Along the years she has actively participated in the conception and promulgation of the first Israeli law regarding the dying patient.

Abstract:

Since ancient times, the obligation of the physician was to relieve suffering. Despite this fact, little attention was given to the problem of suffering and dying in medical education, research or practice. In the 21st century life expectancy is increasing, more people live with serious effects of chronic illnesses and they must deal with many complex issues: relief of symptoms, effect of the illness on roles and relationships, restoring or maintaining quality of life. Each of these issues creates expectations, needs, hopes and fears, which must be addressed in order for the ill person to adapt and continue living and presents a set of public health challenges requiring the attention of policy makers. Traditionally end of life care in the form of palliative care has been offered mostly to cancer patients. For some years this kind of care has been offered for a wider range of serious illnesses and was integrated more broadly across care services. Hospice was created as a coordinated program providing palliative care to terminally ill patients and supportive services to patients, families, 24 hours a day seven days a week. Services are comprehensive, case managed based on physical, social, spiritual and emotional needs during the dying process by medically directed interdisciplinary team consisting of patients, families, health care professionals and volunteers (WHO). Hospice treatment is the most personalized way to care, by recognizing a patient not only like a body part, but as a unique being, with soul and psyche. Each patient means a new book to be read and understood by the team. Hospice program is limited for those patients diagnosed with terminal illness with a limited life spam and it is not a must in health care system. Hospice is a choice and any individual has the right, in conformity with the law, to decide how to be treated when facing a terminal illness. Those patients refusing to accept the imminence of death and want to continue to fight they are not eligible for hospice. Those prefer to concentrate on living as comfortably as they can until their last day prefer the hospice care.

Biography:

Dr fatungase oluwabunmi motunrayo is a consultant Anesthetist of over 10 years experience as a fellow of the National Postgraduate Medical College(FMCA) , Nigeria. She is a fellow of the West African College of surgeons (FWACS) and a Fellow of the International College of Surgeons (FICS). She is a senior lecturer at the Obafemi Awolowo College of Health Sciences , Ogun State Nigeria. She is the current Head, department of Anaesthesia and intensive care and the coordinator of the palliative care unit. Her area of interest are regional anesthesia, pediatric anesthesia , pain management and palliative care.

Abstract:

REFERRAL PATTERN AT A YOUNG PALLIATIVE CARE UNIT IN SOUTHWEST: Studies have shown that palliative care referral is not done as often and as early as required. In order to identify the potential barriers to appropriate referrals and awareness of palliative care service in a young growing unit. The current referral pattern would need to be audited for efficient palliative care services METHODS:  A retrospective cross-sectional study was carried out reviewing all the in-patients from the medical information’s department and palliative care unit records. The data was collected from the June1st 2016 up to October 30^th 2018.Data was entered using the SPSS statistical package version 20 [Chicago IL]. Results are presented in prose, tables and figures.
RESULTS :  There were a total of 10,186  in-patient admissions during the 29 months review period. The number of patients diagnosed as having different forms of cancer were 309, out of which only forty two [42; 13.6%]  cancer patients were referred to be seen by the palliative care unit of the hospital.  General surgeons referred the most; 21[50%], then Gynecologist 14[33.3%], Internal medicine 3[7.1%], hematology 2[4.8%], while orthopedics and pediatric referrals were 1[2.4%] each.  It should be noted that 100% of cases referred were cancer patients.CONCLUSION:  In view of the referral pattern documented in our facility, most clinicians will benefit from education on who needs palliative care how early such patient should be referred to palliative care specialistforbetter quality of life.