Comprehensive Integrated Format for Systematic ... - Jaypee Journals

JRAS

JRAS

10.5005/jp-journals-10064-0027

Short Communication

Comprehensive Integrated Format for Systematic Documentation of Cancer Management through Ayurveda Interventions 1

Manohar S Gundeti, 2Thrigulla Sakethram, 3R Govind Reddy, 4Sneha S Marlewar, 5Laxman Bhurke, 6Amrish Dedge Elavana Remya, 8Azeem Ahmad, 9Shruti Khanduri, 10Sulochana Bhat, 11Narayanam Srikanth

7

ABSTRACT Introduction: There is an upsurge in use of complementary alternative medicines including Ayurveda among cancer patients. A systematic review of published data has shown that evidence for effectiveness of Ayurveda as add-on to conventional cancer treatment is substantial in comparison to standalone. However, there is a need for robust documentation of the cancer case management involving Ayurvedic interventions. National Cancer Institute Best Case Series program aims at systematic documentation of management using unconventional therapies for cancer for identification of novel therapies. However, a comprehensive integrated case format needs to be evolved at this juncture. Aim: To develop comprehensively integrated case record format for systematic documentation of cancer management through Ayurveda interventions. Results: Raja Ramdeo Anandilal Podar Central Ayurveda Research Institute (RRAP-CARIC) under Central Council for Research in Ayurvedic Sciences (CCRAS) has developed Cancer Case Record Format (CCRF), a comprehensive integrated format for systematic documentation including demography, definitive diagnosis, clinical examination, treatment and disease response, etc. of cancer patients after wide consultation process and pretesting on more than 500 cancer patients. Clinical significance: This may be well utilized as a tool for uniform documentation by students, scientists, researchers, and physicians. Keywords: Ayurveda, Cancer, Cancer case record format, National cancer institute best case series, Systematic documentation.

Research Officer (Ayurveda), 3Research Officer (Scientist-III) Assistant Director (Scientist-III) Incharge, 11Deputy Director General 1,2,4-9 10

1,3-8,10

Raja Ramdeo Anandilal Podar Central Ayurveda Research Institute for Cancer, Mumbai, Maharashtra, India 2 National Institute for Indian Medical Heritage, Hyderabad Telangana, India 9,11

Central Council for Research in Ayurvedic Sciences, New Delhi, India Corresponding Author: Manohar S Gundeti, Research Officer (Ayurveda), Raja Ramdeo Anandilal Podar Central Ayurveda Research Institute for Cancer, Mumbai, Maharashtra, India e-mail: [email protected]

How to cite this article: Gundeti MS, Sakethram T, Reddy RG, Marlewar SS, Bhurke L, Dedge A, Remya E, Ahmad A, Khanduri S, Bhat S, Srikanth N. Comprehensive Integrated Format for Systematic Documentation of Cancer Management through Ayurveda Interventions. J Res Ayurvedic Sci 2017;1(4):263-282. Source of support: Nil Conflict of interest: None

INTRODUCTION Cancer is a major cause of morbidity and mortality in the world. The International Agency for Research on Cancer GLOBOCON project has predicted that India’s cancer burden will nearly double in the next 20 years, from slightly over a million new cases in 2012 to more than 1.7 million by 2035.1 The burden of cancer in India is intimately linked to the country’s major socioeconomic inequalities in access to health care and other areas.2 However, the affordable and equitable cancer care for all is India’s greatest public health challenge.3 Management of cancer includes surgery, radiation therapy, chemotherapy, and biological therapy, resulting in cure of >50% patients diagnosed with cancer. There are many reasons why people living with cancer use complementary alternative medicine (CAM), viz., financial, to improve quality of life, faith, as last resort, etc.4 The findings of a study in 2012 suggest that, on average, half of all cancer patients use CAM and that this proportion has increased over the past years.5 Many randomized controlled trials and case–control studies have generated reasonably good evidence for Ayurveda and plant-based interventions as add-on concomitant to conventional cancer treatment to combat its toxicities, particularly radiation mucositis and chemotherapy-induced nausea and vomiting, and overall fatigue.6

PROCESS OF CCRF DEVELOPMENT It is very important to note that in Indian scenario, great amount of data pertaining to cancer management through Ayurveda either as stand-alone treatment or as add-on concomitant treatment is available in unpublished form with individual Ayurveda practitioners and certain institutions dedicated to this purpose. It is high time that

Journal of Research in Ayurvedic Sciences, October-December 2017;1(4):263-282

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Manohar S Gundeti et al

we undertake systematic documentation of this valuable data in retrospective manner to fetch potential leads for managing cancer. In this context, it is pertinent to note that “Office of Cancer Complementary and Alternative Medicine (OCCAM) at the NCI, USA has initiated NCI BCS Program for evaluating patient data from CAM practitioners in cancer for identification of novel CAM therapies.7 However, a retrospective review of case reports of four practitioners from India who used Ayurvedic and Homeopathic therapies to cancer concluded that the challenge for submitters rests in their ability to supply sufficient documentation for the NCI-BCS program.8 On this background, it would be better to record cases through a comprehensively integrated case record format on regular basis and after a certain degree of compilation of concrete, interpretable data, one can communicate to NCI-BCS or other research agency. This forms the basis of design and pilot implementation of CCRF at RRAP-CARIC, Mumbai. The CCRF has been evolved as a comprehensive case template by incorporating the suggestions received from the Ayurveda and modern medical experts, research officers involved in this field from time to time, and currently it is “CCRF Version 5.0.” The CCRF has been divided into six components, viz., (1) demography, (2) consent, (3) definitive diagnosis of cancer, (4) case record form, (5) adjunct formats, and (6) follow-up notes. 1. Demography: Registration number, address, photograph, date of birth, age, birthplace, sex, marital status, religion, nationality, education, occupation, identification mark, anthropometric measurements. 2. Consent: Informed written consent in local language and English. 3. Definitive Diagnosis of Cancer: Conventional with registration details, Ayurvedic diagnosis as vis-à-vis and Svantantra vyadhi, present status (stage), purpose of visit. 4. Case Record Form: Clinical assessment at baseline, onset-duration-progress, examination of involved systems, comorbid conditions, past history, environmental/occupational history, habits, family history of cancer, family tree, general examination including ashtavidha parikshana, ECOG score, etiopathology (Ayurvedic aspect), nidanapanchaka, chikitsa, concomitant medicines, lab investigations. 5. Adjunct formats: (1) Determination of Prakriti, (2) Assessment of Saara, Satva, etc. (3) Performance status—ECOG and Karnofsky score, (4) FACT-G (Version 4) Functional Assessment of Chronic Illness therapy—General, (5) European Organization for Research and Treatment of Cancer (EORTC) disease-specific quality of life (QOL) questionnaire, (6) Conventional treatment details, and (7) Other treatment details.

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6. Follow-up notes: Treatment history and disease response; summary chart. The format has been utilized by RRAP-CARIC from last 4 years and around 500 cases have been recorded so far. Further, an electronic version of the same has been developed for retrospective and prospective recording. The data generated are being subjected to data analysis and will be published in due course of time. However, the CCRF is being published here with an intention that it may be well utilized for the documentation of cancer management through Ayurveda by all stakeholders and encourage researchers to pool data in large numbers for statistical validity. Further, it is also requested to share valuable feedback after utilization of the format by users with the authors for further modifications and refining the document.

ACKNOWLEDGMENTS Authors would like to thank Dr Shweta Deshpande and Dr Aarti Jadhav for their assistance in developing the case format. Authors also express thanks to DG, CCRAS for encouragement and support.

REFERENCES 1. Ferlay, J.; Soerjomataram, I.; Ervik, M.; Dikshit, R.; Eser, S.; Mathers, C.; Rebelo, M.; Parkin, DM.; Forman, D.; Bray, F. GLOBOCAN 2012 v1.0, cancer incidence and mortality worldwide: IARC Cancer Base No.11. Lyon: International Agency for Research on Cancer; 2013. Available from: http:// globocan.iarc.fr. 2. Mallath MK, Taylor DG, Badwe RA, Rath GK, Shanta V, Pramesh CS, Digumarti R, Sebastian P, Borthakur BB, Kalwar A, et al. The growing burden of cancer in India: epidemiology and social context. Lancet Oncol 2014 May;15(6):e205-e212. 3. Pramesh CS, Badwe RA, Borthakur BB, Chandra M, Raj EH, Kannan T, Kalwar A, Kapoor S, Malhotra H, Nayak S, et al. Delivery of affordable and equitable cancer care in India. Lancet Oncol 2014 May;15(6):e223-e233. 4. Pal SK. Use of alternative cancer medicine in India. Lancet Oncol 2002 Jul;3(7):394-395. 5. Horneber M, Bueschel G, Dennert G, Less D, Ritter E, Zwahlen M. How many cancer patients use complementary and alternative medicine: a systematic review and metaanalysis. Integr Cancer Ther 2012 Sep;11(3):187-203. 6. Gundeti MS, Srikanth N, Dedge A, Khanduri S, Dave P, Tripathi AK, Sakethram T, Govind Reddy R. Ayurveda and plant-based interventions for cancer management: a systematic review. J Drug Res Ayurvedic Sci 2017 Apr-Jun;2(2):74-90. 7. National Cancer Institute, Division of Cancer Treatment and Diagnosis. NCI best case series protocol. Bethesda (MD): NCI; 2013. [cited 2018 Jan 31]. Available from: https://cam.cancer. gov/indentifying_novel_cam_therapies/best_case_protocol. htm. 8. Olaku O, Zia F, Santana JM, White JD. The National Cancer Institute best case series program: a summary of cases of cancer patients treated with unconventional therapies in India. Integr Cancer Ther 2013 Sep;12(5):385-392.

JRAS Comprehensive Integrated Format for Systematic Documentation of Cancer Management

Cancer Case Record Form 5.0 R.R.A. Podar Central Ayurveda Research Institute for Cancer (CCRAS) (Ministry of AYUSH, Government of India) Podar Medical Campus, Dr A.B. Road, Worli, Mumbai-18 022-24947259, 24947822 (Fax), email- [email protected]

CONFIDENTIAL 1. Demography: OPD Reg No:

Date and time:

Case recorded by:

Name:

Dr. Incharge

Permanent address:

Photograph

Local address in Mumbai: Habitat: Urban/Semi urban/Rural

Date of birth:

Age:

Birthplace:

Gender: M/F/T

Marital status:

Religion:

Mother tongue:

Nationality:

Aadhaar no.:

Education:

Occupation (Past):

(Present):

Socioeconomic status: APL/BPL

Identification mark:

Name of relative and address: Contact No. (Patient):

Contact No. (Relative):

Email:

Height:

Weight:

BMI:

Hip:

Waist:

Anguli:

Aayam:

Waist Hip Ratio

Chest: Vistara:

Referred by: Address, phone, email, fax:

2. Consent:

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Written informed Consent I the undersigned

, being the patient/parent/guardian of , do hereby consent for following, 1. To provide personal and health-related information to facilitate evaluation. 2. To subject myself/my child/my ward to physical examination by appropriate hospital personnel to facilitate evaluation. 3. For use of all or part of my/my child’s/my ward’s case record, including investigations reports, to be used for research purpose, without disclosing my/my child’s/my ward’s identity. 4. To subject myself/my child/my ward to Ayurvedic treatment modalities, viz. Medicines, Panchakarma procedures, Ksharasutra, etc., whichever required and as prescribed by physician. 5. I hereby nominate who is (relationship) to consent on my behalf in the event of myself being medically incapacitated to give consent during the course of my treatment in this hospital. I hereby consent to the above on my free will and accord, knowing fully well all possible consequences which have been explained to me in language that I understand. Date: Signature: (1) Patient/Guardian/Parent (2) Witness (3) Dr Incharge Name:

3. Diagnosis: Definitive diagnosis of cancer (Conventional): Case registration no.: New (with date): Metastasis (with date): System involved:

Recurrence (with date): Origin of cancer (Primary): Organ involved:

Ayurvedic diagnosis: as vis-à-vis: Srotas involved: Organ involved: Metastasis:

Present status (stage/treatment): Precancerous Newly diagnosed Ongoing RT Completed CAM *CAM: Complimentary Alternative Medicine

as svatantra vyadhi:

Origin of cancer (Primary):

Due for radiotherapy (RT) Post-CT

Due for chemotherapy (CT) Postsurgery

Due for surgery

Ongoing CT

Post-RT

Ongoing CAM*

Purpose of visit: 1 Concomitant to conventional* treatment for reducing toxicity of CT/RT 2 Concomitant to conventional curative treatment 3 Concomitant to conventional palliative treatment 4 Completed conventional treatment and intention of nonrecurrence of cancer *Conventional—Allopathy

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5

Left out from conventional system and hence this treatment only

6 7 8

As a proper treatment of cancer through only Ayurveda Primary prevention Any other (Specify)


4. Clinical Assessment: 4.1 4.2 4.3 4.4 4.5

History informed by: Patient/Other (Please specify) Presenting complaints with duration: History of diagnosis and treatment of cancer till date: (Onset duration progress in flow diagram) Other treatment: (Ayurveda/Homeopathy/Other): Examination of involved system/organ/site (Specific findings with diagram if possible)


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4.6 Comorbid conditions: (age at onset/duration/medication) Sl. no. 1

Disease spectrum Metabolic syndrome

2

GIT pathology

3

Infections

4

Cardiac and respiratory

5

Endocrine

6

Nervous system

7

Psychiatric

Condition Diabetes mellitus Hypertension Obesity Dyslipidemia Fatty liver Cirrhosis IBS Gastritis Constipation Ulcer—peptic/duodenal IBD Tuberculosis Hepatitis HIV H. Pylori HPV Oral candidiasis Recurrent URTI IHD CAD MI Asthma COPD Thyroid Adrenal Pituitary Gonads Hypothalamus CVA Epilepsy Headache Bipolar Anxiety PTSD Phobias Conversion

Age of onset

Medication

Remark

4.7 History of use of Ayurvedic medicines/Panchakarma procedures in past for other than cancer: Yes/No. If yes, details—source, frequency, and duration, for which condition? 4.8 Significant past history: (hospitalization/surgery, etc.) 4.9 Birth/immunization history: 4.10 Environment/occupational history: 4.11 Habits: NO/if YES: Sl. no. 1 2 3 4 5 6 7 8 9

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Habit Tobacco chewing Smoking (beedi/cigarette/chilim) Gutkha/paan masala Paan/betel nut Masheri/snuff Alcohol Drugs Use of electronic gadgets Other

Quantity (with unit)

Duration

Age when started

Quit (Y/N)

Age when quit


4.12 Family history: Sl. no.

Relationship

Diseases

(Cancer site if cancer)

Age at onset of disease

Duration

*Status (value from 1 to 5)

*Status values: 1. Alive; 2. Alive with disease; 3. Died of disease; 4. Died of other causes; 5. Unknown

4.13 Family tree:

5. General Examination Including Ashtavidha Parikshana 5.1 General condition: Good/Fair/Poor/Moribund 5.2 Performance status: (ECOG/WHO/Zubrod score): 5.3 Karnofsky score: 5.4 Aakruti: Lean/obese lost weight?—Yes/No gain weight?—Yes/No Change in weight kg/time/duration 5.5 Built: Average/emaciated/well-built/tall/dwarf 5.6 Nutrition: Well-nourished/moderately nourished/malnourished 5.7 Gait/general appearance 5.8 Drik (Eyes) 5.9 Shabda/voice: 5.10 Change in symmetry of face/body parts: 5.11 Pallor- Yes/No Cyanosis- Yes/No Edema - Yes/No Clubbing- Yes/No Jaundice- Yes/No Icterus- Yes/No 5.11 Lymphadenopathy: Location- Number Size- Mobility Consistency 5.12 Samhanana (compactness of organs): 5.13 Saaratva (excellence of tissue elements) 5.14 Satva (mental status) 5.15 Saatmya (homologation): Allergy: 5.16 Prakriti (body constitution) 5.17 Systemic examination: 5.17a Respiratory system: RR /min, Air entry Breath sounds 5.17b Cardiovascular system: HR /min, S1 S2 Additional sounds Nadi/Pulse: Blood pressure: 5.17c Gastrointestinal system: P/A L S K Kshudha (Appetite): Pachana (Digestion): Abhyavarana: (quantity/frequency/liking for taste and type food) Mala (Stool): (color/consistency/quantity/frequency/straining) Stoma if any: Status with contents: 5.17d Nervous system: Higher mental functions/Satva Reflexes- Power- Sensations Nidra (Sleep): (duration/daytime sleep) Swapna (Dreams): 5.17e Musculoskeletal system: Joints- Vyayamshakti (Exercise tolerance capacity/Stamina) 5.17f Genitourinary system: Local examination of genitals wherever required and findings Mutra (Urine): (color/consistency/frequency/straining) Libido: Menstrual history: Status: Premenarche/premenopausal/perimenopausal/postmenopausal LMP: Menstrual cycle: Regular/irregular Menstrual flow: Normal/light/heavy Journal of Research in Ayurvedic Sciences, October-December 2017;1(4):263-282

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Menstrual abnormalities: Obstetric history: Breast examination: Mass/secretion Contraceptive history: 5.17g Any other findings:

White discharge P/V: Breast feeding: Rt

Lt

6. Etiopathology 6.1 Diet (type/quantity/salt intake/foods like abhishyandi, viruddha, adhyashana, etc.) 6.2 Lifestyle (including daily routine, exercise, job, habits)—Sedentary/active/alcohol, smoking, narcotics, other recreational drugs (individual/combined use) 6.3 Mental status (stress levels, personality)

7. Nidana Panchaka 7.1 Agni: 7.2 Vyadhi Adhisthana: 7.3 Udbhavasthana: Amashaya Pakvashaya 7.4 Rogamarga: Bahya Abhyantara 7.5 Doshavastha (Kriya kala): Sanchaya Prakopa Vyaktavastha Bhedavastha 7.6 Rogaprabhava: Ashukari Chirakari 7.7 Avastha: Ama Nirama 7.8 Roga pariksha (Examination of stages of disease): 7.9 Nidana (Etiology): 7.10 Purva Roopa (Prodromal symptoms): 7.11 Rupa (Signs and symptoms): 7.12 Upashaya/Anupashaya: 7.13 Samprapti (Pathogenesis): 7.14 Samprapti Ghataka: 7.15 Dosha: 7.15a Anubandha Dosha: 7.15b Anubandhya Dosha: 7.15c Avaraka Dosha: If yes, then specify: _ 7.16 Dhatu: 7.17 Mala: 7.18 Srotas:

Madhyama Prasaram

Sthanasanshrayam

8. Chikitsa: Chikitsa siddhanta (Treatment Principle) 8.1 Shodhana (Panchakarma): 8.2 Shaman (Aushadhi): 8.3 Sattwavajaya (Counseling) 8.4 Yoga/Pranayama 8.5 Pathyapathya: 8.6 Concomitant Medication: Chemotherapy

Radiotherapy

Other

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Type/Drugs/Cycles Starting date Ending date Type/sittings Starting date Ending date

Drugs with details (Toxicity) (CTCAE criteria) Details (Toxicity) (CTCAE criteria)


9. Lab Investigations: Sl. no.

Investigations

Date

Result

ANNEXURE-1 DETERMINATION OF PRAKRITI

1. Physiological Status (PHS) 1.01 Status of Appetite: (AD) a. Good appetite b. Stable appetite with usually moderate desire to eat c. Variable appetite 1.02 Dietary/Eating habits (DH) a. Enjoys eating, ready to eat mostly and hates to miss food b. Regular food habits, but can spend hours without food c. Desirous to take food, eats less at a time, needs mid-meals snacks 1.03 Bowel Habits (BH) a. Regular, once-a-day, stool well formed, if constipated it is mild (Respond to medium strength laxative) b. Regular and frequent, stool semisolid or loose rarely constipated (Respond to mild laxatives sometimes even milk, fig, raisins, etc.) c. Variation seen, mostly constipated (strong purgatives are needed) 1.04 Sleeping pattern (SH) a. Sleeps easily but light b. Sleeps easily and sound (heavily) c. Trouble to get sleep, light sleeper/variable sleep pattern 1.05 Morning feelings, after leaving the bed (MF) a. Do not feel fresh b. Feel fresh. Feel well even with less sleep c. Feel fresh but not good when less hours of sleep have 1.06 Dreams (DM) a. Cool and peaceful dreams, not bothers to remember b. Passionate dreams, sees heat, light and remembers well c. Plenty of dreams, mostly related to motion, usually forget 1.07 Physical working capacity/physical strength a. Starts with speed and gets exhausted easily b. Loves hard work, has moderate capacity c. Good stamina but slow and not interested for physical work 1.08 Performance of activities a. Quickly with a lot of initiative b. Moderately with medium initiative c. Slow, steady, and balance activities 1.09 Talking a. Very fast missing words b. Sharp, provocative, and clear-cut c. Slow, clear, and stable 1.10 Walking a. Very quick with swift movement b. Normal and rhythm c. Slow and steady Journal of Research in Ayurvedic Sciences, October-December 2017;1(4):263-282

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1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18

Nature of thirst (TN) a. Excessive and frequent, difficult to tolerate b. Less thirst, easy to tolerate c. Moderate and variable thirst Status of perspiration (SP) a. Scanty even in hot climate but odorless b. Profuse with strong odor c. Moderate perspiration, consistent to climate, with pleasant smell Sexual qualities (SQ) a. Variable, strong desire, overindulgence, and gets exhausted b. Moderate with dominating behavior c. Usually low and steady desire, with good stamina Quantity of seminal discharge a. Scanty and comparatively thin in consistency b. Moderate and normal c. Plenty and thick Fertility or productivity a. Comparatively lesser b. Less c. Capable of producing good no. of offspring Longevity or average age a. Short life span b. Moderate life span c. Long life span Resistance to diseases (RD) a. Usually poor. Frequently fall ill b. Medium c. Good. Able to tolerate seasonal variation, food etc. well Climatic preferences (CP) a. Prefers warm, avoids cold climate b. Likes cold, but intolerant to warm/hot c. Likes normal climate and prefers warm in comparison to cold

2. Mental/Psychological Status: 2.01 2.02 2.03 2.04

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Mental reactions (MR)/personality traits: a. Very sensitive, reacts quickly b. Gets irritated easily and sustains it c. Cool, calm, avoids confrontations Memory status (MS) a. Remembers easily and tends to forget easily b. Takes time to grasp, but retains for long c. Remembers easily and tends to retain Leadership quality (LQ) a. Do not like to lead and happy as a follower b. Requires commanding status. c. Avoid leading Decision making capacity (DMC) a. Takes immediate decision without thinking much b. Takes decision after properly analyzing the facts c. Avoid taking decision. Usually keeps them pending


2.05 Concentration power (CP) a. Very easy to concentrate on a work, but not for long duration b. Difficult to concentrate on a work c. Retains concentration for a long period 2.06 Attitude toward problems or difficulties a. Lot of worrying, instability in reaction b. Angry, over awed, easily provoked, and highly irritable c. Peaceful, slow, steady, and balance 2.07 Nature a. Easily irritable, irritating to others, exaggerating, anxious materialistic liking b. Polite but hot-tempered, proud, brave, bold, less but good friendship c. Polite, decent, not greedy, appreciating, have good and long-lasting friendship 2.08 Liking about taste (TL) a. Sweet, salt, and sour b. Sweet, bitter, and astringent c. Pungent, astringent, and bitter

3. Physical Features (PF) 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08

Body frame (BF) a. Thin body frame, unusually long/short b. Medium frame c. Broad, large frame Body weight (BW) a. Moderate/average weight b. Underweight or tendency of fluctuation c. Overweight or with a tendency to gain weight Distribution of body fat (DBF) a. Unequal/on specific areas b. Evenly distribution c. Scanty deposition of body fat Nature/Texture of skin a. Delicate, irritable skin, gets wrinkles easily b. Dry, rough, cracked, or having a tendency of cracking c. Smooth, firm, soft, clear with good luster, not prone to disorders Complexion/skin color (SC) a. Extremely fair/pinkish b. Fair, reddish, burns easily c. Comparatively dull or darkish, tans easily Body hair (BH) a. Dry, rough, coarse, lusterless, and curly b. Soft, scanty, straight, fine textured c. Thick, shiny, moderate Forehead (FH) a. Large b. Medium c. Small Eyes (EF) a. Rolling, restless, small, dull, and lusterless b. Sharp, medium-sized with sclera of reddish tinge c. Large calm stable eyes with milky white sclera


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3.09 3.10 3.11 3.12 3.13

Teeth (TE) a. Teeth are of average size, yellowish, prone to cavities b. Dry, cracked, irregular dull white c. Large, even, gleaming white Tongue (TO) a. Thin tongue, with blackish spots, often coated with thin adherent coating b. Medium, reddish, occasionally coated with yellow or red coating c. Thick usually clear, rarely coated, coating is usually thick white Lips (LP) a. Soft, moist, and reddish b. Dry, thin, and blackish c. Thick and glossy Blood vessels (BV) a. Prominent b. Less prominent c. Not visible Scalp hair (SH) a. Dark in shade, coarse, rough, easily prone to dandruff, and split ends b. Thin, delicate, straight, light colored, turn gray at an early age c. Strong, thick, dark, slightly wavy with good luster, oiliness is usually one of the chief complaints 3.14 Joints (JT) a. Crackling joints, hyper mobile in nature b. Comparatively normal but have soft and loose ligaments c. Well lubricated, strongly built joints which are well organized, well covered 3.15 Voice (VR) a. Rough, unclear voice, which turns hoarse or cracks on strain b. Concise, sharp voice, intense in nature, and high pitched c. Deep, pleasant, resonant voice which is melodious, resonating, but lower in pitch and intensity 3.16 Nail (NL) a. Hard, brittle, rough and differ in size from one another, bluish/grayish in contour b. Soft, strong, well formed, lustrous, pink in color c. Strong, large, thick symmetrical, and somewhat pale in color 3.17 Body temperature a. Feels slightly cold on touch b. Feels slightly warm on touch c. Normal 3.18 Shape of palms and feet a. Short and broad b. Medium and slim c. Long and broad 3.19 Face a. Small and broad with uneven features b. Medium and oval with sharply defined features c. Round, bubbly, and attractive with balance features

4. Social or Economical Status 4.1 Economy a. Getting less outcome with hard work b. Getting good outcome with moderate efforts c. Enjoys lavishly and royal life

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JRAS Comprehensive Integrated Format for Systematic Documentation of Cancer Management SCORE SHEET FOR DETERMINATION OF PRAKRITI Sl. no. 1.

Observation code 1.01

a P

Options b K

c V

2.

1.02

P

K

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3.

1.03

K

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4.

1.04

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5.

1.05

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6.

1.06

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7.

1.07

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8.

1.08

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9.

1.09

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10.

1.10

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11.

1.11

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12.

1.12

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13.

1.13

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14.

1.14

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15.

1.15

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16.

1.16

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17.

1.17

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18.

1.18

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19.

2.01

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20.

2.02

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21.

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22.

2.04

V

P

K

23.

2.05

P

V

K

24.

2.06

V

P

K

25.

2.07

V

P

K

26.

2.08

V

P

K

27.

3.01

V

P

K

28.

3.02

P

V

K

29.

3.03

K

P

V

30.

3.04

P

V

K

31.

3.05

K

P

V

32.

3.06

V

P

K

33.

3.07

K

P

V

34.

3.08

V

P

K

35.

3.09

P

V

K

36.

3.10

V

P

K

37.

3.11

P

V

K

38.

3.12

V

P

K

39.

3.13

V

P

K

40.

3.14

V

P

K

41.

3.15

V

P

K

42.

3.16

V

P

K

43.

3.17

V

P

K

44.

3.18

V

P

K

45.

3.19

V

P

K

46.

4.01

V

P

K

Identified area (V/P/K)

INDIVIDUAL SCORE OF VPK

V

P

K

PERCENTAGE OF VPK

V=

P=

K=

TYPE OF PRAKRITI V: Vata; P: Pitta; K: Kapha


275


ANNEXURE-2 Assessment of Saara: RASA/TWAKA SAARA • Snigdha evam prassanna tvacha (soft, oily, and glowing skin) • Alpa evam komal loma (sparse and silky hair on the skin) RAKTA SAARA • Snigdha evam raktavarna (oily and reddish hue) of Akshi (palpebral conjunctiva) Jivha (tongue) Nakha (nails) Panitala (palms) MAMSA SAARA • Sthira, Pushta evam Guru (stable, well built, and bulky) muscles of Greeva (sternocleidomastoids) Bahu (biceps) Adho shakha (gastrocnemius) MEDA SAARA • Snigdha (oily) Kesha (scalp hair) Oshtha (lips) Nakha (nails) ASTHI SAARA • Sthool (prominent) Sandhi (joints) Chibuka (chin) Jatru (collar bones) MAJJA SAARA • Snigdha Varna (oily complexion) • Snigdha Svara (soft voice) SHUKRA SAARA • Kshirapoorna lochana (milky white and lustrous eyes) • Saumya prekshana (pleasing personality) • Mahasphika (heavy built in the region of the hip) • Sama Samhita (well-built body)

Type of Saara: Rasa/Twaka Saara Mamsa Saara Asthi Saara Shukra Saara

(1) (3) (5) (7)

Rakta Saara Meda Saara Majja Saara

Assessment of Samhanana • Pravara (Compact body), defined as Body mass index (BMI) in the range of 18.5-to-24.9 kg/m2 (i.e., normal range)

276

(2) (4) (6)


• Madhyama (Medium body), defined as Body mass index (BMI) in the range of 16.6-to-18.4 kg/m2 (i.e., underweight) and 25-to-29.9 kg/m2 (i.e., overweight) • Avara (Flaccid body), defined as Body mass index (BMI) ≤16.5 kg/m2 (i.e., starvation) and ≥30 kg/m2 (i.e., obesity).

Type of Samhanana Pravara (1)

Madhyama (2)

Avara(3)

Assessment of Satmya 1. Ahara satmya (Change in food habits) • Most of the edibles are suitable (3) • Few edibles are not suitable (2) • Very few edibles are suitable (1) 2. Desha satmya (Change in place) • Is never troublesome (3) • Is sometimes troublesome (2) • Is always troublesome (1) 3. Kala Satmya (Change in season) • Is never troublesome (3) • Is sometimes troublesome (2) • Is always troublesome (1)  Pravara Satmya (Ahara + Desh + Kala)  Madhyama Satmya (Ahara + Desh + Kala)  Avara Satmya (Ahara + Desh + Kala)

=9 = 6–8 = 3–5

Type of Satmya Pravara Satmya (1)

Madhyama Satmya (2)

Avara Satmya (3)

Assessment of Satva In the recent past, any event of crisis like loss of a family member/close friend loss of money/loss in business severe deterioration in health of self or a loved one • Was well tolerated (Pravara Satva) • Could be tolerated with some support from the family and/or friends (Madhyama Satva) • Was inconsolable (Avara Satva)

Type of Satva Pravara Satva (1)

Madhyama Satva (2)

Avara Satva (3)

Assessment of Ahara Shakti: 1. How many major meals do you have in a day? • If ≥3, then score =3 • If 2, then score =2 • If 1, then score =1 2. How do you feel after having the meal? • If delighted, then score =3 • If comfortable, then score =2 • If not comfortable, then score = 1 Journal of Research in Ayurvedic Sciences, October-December 2017;1(4):263-282

277


If sum of 1 and 2 is • = 6, then Pravara Ahara Shakti • = 4–5 ,then Madhyama Ahara shakti • = 2–3, then Avara Ahara shakti

Type of Ahara Shakti: Pravara Ahara Shakti (1) Avara Ahara Shakti (3)

Madhyama Ahara Shakti (2)

Assessment of Vyayama Shakti: 1. Can you climb up stairs to the next floor of the house? Or Can you walk 100 yards? (a) If yes, without any difficulty, then score = 3 (b) If yes, but with a little difficulty, then score = 2 (c) If it is not possible to climb up, then score = 1 2. Daily routine activities like  Bathing  Dressing  Cooking  Mopping  Professional activity • Are never troublesome, then score = 3 • Are sometimes troublesome, then score = 2 • Are always troublesome, then score = 1 The Sum total of above two questions assesses Vyayama Shakti as follows: • if total score = 6, then Pravara Vyama Shakti • if total score = 4–5, then Madhyama Vyama Shakti • if total score = 2–3, then Avara Vyama Shakti

Type of Vyayama Shakti: Pravara Vyayama Shakti Madhyama Vyayama Shakti Avara Vyayama Shakti

(1) (2) (3) Srotasa examination:

Sl. no. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.

278

Srotas Pranavaha Udakavaha Annavaha Rasavaha Raktavaha Mamsavaha Medovaha Asthivaha Majjavaha Shukravaha Purishavaha Srotas Mutravaha Svedavaha Artavavaha Stanyavaha Manovaha

Normal (1)

Atipravritti (2)

Abnormalities Sanga (3) Siragranthi (4)

Vimargagamana (5)

Any other information


ANNEXURE-3 Performance Status: (ECOG/WHO/Zubrod score) • 0—Fully active, able to carry out all predisease performance without restriction. • 1—Restricted in physically strenuous activity, but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work, etc. • 2—Ambulatory and capable of all self-care, but unable to carry our any work activities; up and about more than 50% of waking hour. • 3—Capable of only limited self-care, confined to bed or chair; requires assistance more than 50% of waking hours. • 4—Completely disabled, cannot carry on any self-care; totally confined to bed or chair. • 5—Dead.

Karnofsky Score • • • • • • • • • • •

100%—normal, no complaints, no signs of disease 90%—capable of normal activity, few symptoms or signs of disease 80%—normal activity with some difficulty, some symptoms or signs 70%—caring for self, not capable of normal activity or work 60%—requiring some help, can take care of most personal requirements 50%—requires help often, requires frequent medical care 40%—disabled, requires special care and help 30%—severely disabled, hospital admission indicated but no risk of death 20%—very ill, urgently requiring admission, requires supportive measures or treatment 10%—moribund, rapidly progressive fatal disease processes 0%—death.

ANNEXURE-4 FACT-G (Version 4) Functional Assessment of Chronic Illness Therapy—General Below is a list of statements that other people with your illness have said are important. Please circle or mark one number per line to indicate your response as it applies to the past 7 days. PHYSICAL WELL-BEING GP1 GP2 GP3 GP4 GP5 GP6 GP7

I have a lack of energy I have nausea Because of my physical condition, I have trouble meeting the needs of my family I have pain I am bothered by side effects of treatment I feel ill I am forced to spend time in bed

Not at all 0 0 0

A little bit 1 1 1

Some-what 2 2 2

Quite a bit 3 3 3

Very much 4 4 4

0 0 0 0

1 1 1 1

2 2 2 2

3 3 3 3

4 4 4 4

SOCIAL/FAMILY WELL-BEING Not at all A little bit Some-what I feel close to my friends 0 1 2 I get emotional support from my family 0 1 2 I get support from my friends 0 1 2 My family has accepted my illness 0 1 2 I am satisfied with family communication about my illness 0 1 2 I feel close to my partner (or the person who is my main 0 1 2 support) Q1 Regardless of your current level of sexual activity, please answer the following question. If you prefer not to answer it, please mark this box and go to the next section. GS7 I am satisfied with my sex life 0 1 2 Please circle or mark one number per line to indicate your response as it applies to the past 7 days. GS1 GS2 GS3 GS4 GS5 GS6


Quite a bit 3 3 3 3 3 3

Very much 4 4 4 4 4 4

3

4

279

Manohar S Gundeti et al EMOTIONAL WELL-BEING GE1 GE2 GE3 GE4 GE5 GE6

I feel sad I am satisfied with how I am coping with my illness I am losing hope in the fight against my illness I feel nervous I worry about dying I worry that my condition will get worse

Not at all 0 0 0 0 0 0

A little bit 1 1 1 1 1 1

Some-what 2 2 2 2 2 2

Quite a bit 3 3 3 3 3 3

Very much 4 4 4 4 4 4

FUNCTIONAL WELL-BEING GF1 GF2 GF3 GF4 GF5 GF6 GF7

I am able to work (include work at home) My work (include work at home) is fulfilling I am able to enjoy life I have accepted my illness I am sleeping well I am enjoying the things I usually do for fun I am content with the quality of my life right now

Not at all 0 0 0 0 0 0 0

A little bit 1 1 1 1 1 1 1

Some-what 2 2 2 2 2 2 2

Quite a bit 3 3 3 3 3 3 3

Very much 4 4 4 4 4 4 4

ANNEXURE-5 European Organization for Research and Treatment of Cancer (EORTC) Disease Specific QOL (Source: http://www.eortc.org/)

ANNEXURE-6 Conventional Treatment Details 1. SurgeryDetails of procedure

Date

Place

2. ChemotherapyChemotherapy Type/Drugs

Date/Cycles Starting date Ending date

Toxicity (CTCAE criteria)

Date/Sittings

Toxicity (CTCAE criteria)

3. RadiationRadiation type

ANNEXURE-7 Other Treatment Details 1. ProcedureType of procedure

Source

Date

details

2. MedicinesMedicine names

280

Source

Cycles

Starting date

Ending date

Toxicity if any (CTCAE criteria)


Follow-up: Clinical findings

Date

Treatment Toxicity if any (CTCAE criteria)

Summary Chart: Name:

Age/Gender: Baseline

1 2 3 4 5 6 7 8 9

Diagnosis: F/u1

F/u2

F/u3

Date Main complaints Weight/BMI TNM score ECOG score Karnofsky score FACT-G Disease specific QoL score Laboratory findings Imaging


281


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euksgj ,l- xqaMsVh] 2f=xqyk lkdsrjke] 3vkj xksfoan jsìh] 4Lusgk ,l- ekysZokj] 5y{e.k HkqdsZ vejh'k nsMxs] 7,ykokuk jsE;k] 8vthe vgen] 9Jqfr [kaMwM+h] 10lqykspuk Hkê] 11ukjk;.ke Jhdkar

6

ikÜoZHkwfe% dSalj jksfx;ksa esa vk;qosZn lesr iwjd ,oa oSdfYid fpfdRlk ¼lh,,e½ ds mi;ksx esa o`)h gqbZ gSA çdkf'kr vkadM+ksa dh O;ofLFkr leh{kk ls irk pyk gS fd çpfyr dSalj mipkj ds iwjd :i esa vk;qosZn dh mi;qärk dsoy vk;qosZn }kjk fpfdRlk dh rqyuk esa vf/kd gSA gkykafd vk;qosZn }kjk dSalj ds çca/ku lEca/kh Bksl nLrkostksa dh vko';drk gSA us'kuy dSalj baLVhV~;wV csLV dsl lhfjt ¼,ulhvkbZchlh,l½ dk;ZØe dk mís'; ufou fpfdRlk dh igpku ds fy, vikjEifjd mipkj }kjk dSalj çca/ku dk O;ofLFkr çys[ku djuk gSA gkykafd bl le; vk;qosZn }kjk dSalj çca/ku ds fy, ,d O;kid ,dh—r fpfdRlk çi=d çk:i fodflr fd;k tkuk vko';d gSA y{;& vk;qosZn ds ek/;e ls dSalj çca/ku ds O;ofLFkr çys[ku ds fy, O;kid ,dh—r fpfdRlk çi=d ¼dsl fjd‚MZ½ çk:i dk fodkl djukA ifj.kke& jktk jkenso vkuanhyky iksnkj dsaæh; vk;qosZnh; dSalj vuqla/kku laLFkku ¼vkjvkj,ihlh,vkjvkbZlh½] dsaæh; vk;qosZnh; foKku vuqla/kku ifj"kn~ ¼lhlhvkj,,l½ }kjk O;ofLFkr çys[ku ds fy, foLr`r ijke'kZ çfØ;k ds ckn dSalj ds jksfx;ksa ds tulkaf[;dh] fuf'pr funku] uSnkfud ijh{kk] mipkj vkSj jksx dh çfrfØ;k vkfn lfgr ,d ^O;kid ,dh—r fpfdRlk çi=d çk:i ¼lhlhvkj,Q½ fodflr fd;k x;k ,oe dSalj ds ikap lkS ls vf/kd jksfx;ksa es fpfdRlh; ijh{k.k gsrq ç;ksx fd;k x;kA uSnkfud egRo & ;g Nk=ksa] oSKkfudksa] 'kks/kdrkZvksa vkSj fpfdRldksa }kjk leku nLrkost fuekZ.k ds fy, ,d midj.k ds :i es ç;ksx fd;k tk ldrk gSA

282