Page 0095

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

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