DISEASE-SPECIFIC CANCER CONTROL
94 CANCER CONTROL 2014
the applicability of palliative care early in the course of illness,
in conjunction with other therapies that are intended to
prolong life.26
Need for evidenced-based strategies for AIDS-KS
management in Zimbabwe
As summarized, available data provide evidence that:
‰ KS is the most commonly reported cancer in Zimbabwe,
despite increased availability of ART for the treatment of
HIV-1 infection;
‰ since advanced AIDS-KS is often refractory to ART alone
and optimal treatment usually requires combination ART
and chemotherapy, earlier diagnosis of KS by primary care
providers could improve treatment outcomes and provide
cost savings;
‰ infectious complications are a common cause of morbidity
and mortality during treatment of AIDS-KS in Zimbabwe
and better strategies are needed to prevent, diagnose and
treat infections in people with AIDS-KS;
‰ data on how best to incorporate palliative care approaches
at the time of AIDS-KS diagnosis to improve overall
treatment of AIDS-KS are lacking;
‰ access to effective AIDS-KS treatment in community
settings is limited.
Therefore, in order to provide effective medical care to
people with AIDS-KS, alternative strategies for the
sustainable delivery of AIDS-KS care in Zimbabwe and other
African settings must be developed. Effective and efficient
management of AIDS-KS in resource-constrained settings will
require the integration of KS screening, diagnosis, tumour
staging and treatment into primary care settings. Efforts must
be made to diagnose KS in community care settings at early
stages when it is most likely to respond to ART alone and
thereby reduce the need for expensive and potentially toxic
chemotherapy. Current international guidelines for the
management of HIV infection contain few recommendations
for the management of AIDS-KS (Table 1). If AIDS-KS is to be
effectively managed in primary care settings, evidence-based
recommendations for screening, diagnosis, staging and
treatment must be developed. It was with this background in
mind that the SIKO study was designed.
SIKO interventions
SIKO was designed to address the issues described above in
primary care delivery in Zimbabwe. The study comprises
three interventions:
‰ KS Standardized Evaluation (KS-SE). Since early KS
diagnosis is highly dependent on detection of suspected
SIKO Standardized Palliative Care Checklist
(TO BE COMPLETED FOR EVERY PATIENT WITH KS
COMPLETE A NEW FORM FOR EACH VISIT DATE)
Page 1 of 2
Clinic Name: Visit Date:
Patient Name: OI Clinic No.:
Baseline Follow-up visit number #:
1. MODIFIED APCA PALLIATIVE OUTCOMES SCALE (POS) QUESTIONS
RESPONSE OPTIONS SELECT ONE
Q1. Please rate your pain from
0=no pain to 5=worst pain
during the last 3 days
0 = No pain at all
1 = Slight pain
2 = Moderate pain
3 = Severe pain (interferes with activities of daily life)
4 = Very severe pain
5 = Overwhelming (the worst pain you can imagine)
Q1.1. How long have you had the
pain?
0 = Days
1 = Weeks
2 = Months
3 = Years
4 = Not applicable, no pain
Q1.2. What is the nature of pain?
1 = Neuropathic (burning, shooting, numb, radiating, lancinating,
electrical, 'pins and needles')
2 = Not Neuropathic
3 = Not applicable, no pain
Q1.3. What aggravates the pain?
0 = Nothing
1 = Sleep or resting in certain positions
2 = Movement
3 = Not applicable, no pain
Q1.4. What relieves the pain?
0 = Nothing
1 = Sleep or resting in certain positions
2 = Movement
3 = Not applicable, no pain
Q2. Have any other symptoms
(e.g. nausea, coughing or
constipation) been affecting
you in the last 3 days?
0 = No symptoms at all
1 = Slight symptoms
2 = Moderate symptoms
3 = Severe symptoms (interferes with activities of daily life)
4 = Very severe symptoms
5 = Overwhelming. The worst symptoms you can imagine
Q3. Have you been feeling
worried about your illness in
the past 3 days?
0 = Not at all worried
1 = Worried very occasionally
2 = Worried some of time
3 = Worried a lot of the time
4 = Worried most of the time
5 = Worried all of the time
Q4. Over the past 3 days have
you been able to share how
you are feeling with your
family or friends?
0 = Not at all
1 = Only once
2 = Occasionally
3 = Fairly frequently
4 = Often
5 = Yes, I've talked freely
Q5. Over the past 3 days have
you felt that life was
worthwhile?
0 = Not at all
1 = Not very often
2 = Occasionally
3 = Some of the time
4 = Most of the time
5 = Yes, all the time
Q6. Over the past 3 days have
you felt at peace?
0 = Not at all
1 = Not very often
2 = Occasionally
3 = Some of the time
4 = Most of the time
5 = Yes, all the time
Q7. Have you had enough help
and advice for your family to
plan for the future?
0 = None
1 = Very little
2 = For a few things
3 = For several things
4 = For most things
5 = As much as wanted
Q8. How much information have
you and your family been
given about your disease?
0 = None
1 = Very little
2 = Some
3 = Quite a lot
4 = A great deal
5 = As much as wanted
SIKO Standardized Palliative Care Checklist
(TO BE COMPLETED FOR EVERY PATIENT WITH KS
COMPLETE A NEW FORM FOR EACH VISIT DATE)
Page 2 of 2
2.0 LOCATION: Mark location(s) of pain on the body diagrams.
2.1 SHORTNESS OF BREATH ASSESSMENT
Select One Description Score
No breathlessness at all 0
Mild shortness of breath 1
Moderate shortness of breath or breathing difficulty 2
Severe shortness of breath or very hard breathing 3
Extremely
severe
(unable
to sleep or do anything) 4
2.2. COUGH ASSESSMENT
Select One Description Score
No cough 0
Mild cough 1
Moderate cough 2
Severe cough 3
2.3 LYMPHEDEMA ASSESSMENT
Select One Description Score
No lymphedema 0
Mild
lymphedema 1
Moderate
lymphedema 2
Severe
lymphedema 3
2.4 CONSTIPATION ASSESSMENT
Select One Description Score
No Constipation 0
Mild
Constipation 1
Moderate
Constipation 2
Severe
Constipation 3
2.5. DIARRHEA ASSESSMENT
Select One Description Score
No Diarrhea 0
Mild
Diarrhea 1
Moderate
Diarrhea 2
Severe
Diarrhea 3
2.6 NAUSEA/VOMITING ASSESSMENT
Select One Description Score
No nausea 0
Mild
nausea 1
Moderate
nausea 2
Severe
nausea 3
Vomiting 4
2.7 SORE MOUTH Yes No
2.8 OTHER SYMPTOMS (describe):
Figure 2: The SIKO standardized palliative are checklist