Outpatient Department

The Pulmonary Medicine Service   runs an Outpatient Department ( Chest Physician OPD) Monday through Friday ( excluding Wednesdays) between 8 AM and 4 pm.

The Services include respiratory evaluation of cancer patients referred from Oncology Units at Tata Memorial Hospital.

The spectrum of services includes

• Assessment of cancer patients with respiratory symptoms.
• Diagnosis and management of respiratory comorbidities like Asthma, COPD, ILD, sleep apnea, infections, undiagnosed effusions and pulmonary rehabilitation to improve quality of life.
• Pre-operative evaluation of cancer patients for respiratory co-morbidities and optimization of therapy to improve performance status.
• Undiagnosed pulmonary pathologies that are referred to Tata Memorial Hospital for presumed malignancy. This group includes infectious, autoimmune,other disorders that may mimic cancer and in the Indian scenario tuberculosis often forms a bulk of these mimics.
• Evaluation of incidentally detected radiological pleuro-pulmonary lesions in cancer patients
• Assessment, diagnostic workup and treatment of pulmonary infections in the immune-compromised cancer patients with hematological malignancies, patients on chemotherapy and post bone marrow transplant cases
• Diagnosis and management of pulmonary toxicities during the course of cancer treatment that includes chemotherapy, radiotherapy, immunotherapy and targeted therapy
• Assessment and management of post –operative pleuro-pulmonary infections

Inpatient services

The Pulmonary Medicine Service attends to the need for respiratory opinion and assistance in management of admitted patients referred from across all oncology departments at Tata Memorial Hospital including the intensive care units.

• Respiratory distress and respiratory failure in critically ill cancer patients
• Respiratory infections including pneumonias, lung abscess, empyema, opportunistic infections
• Post –op respiratory distress and infections

Procedures

• Endo-bronchial ultrasound TBNA with ROSE for staging of lung cancer, diagnosis of mediastinal lymphadenopathy in cancer and suspected cancer patients in conjunction with thoracic surgical and interventional radiology departments.
• Fiber optic bronchoscopy including broncho-alveolar lavage, biopsy: endo-bronchial and trans-bronchial lung biopsy.
• Medical Thoracoscopy for diagnosis of undiagnosed pleural effusions and thoracoscopic pleurodesis.
• Bronchoscopic cryotherapy and biopsy.
• Other pleural interventions: chest tube insertions, indwelling pleural catheter etc.

Cancer incidence is increasing with globally 18.1 million new cases and 9.6 million cancer deaths in 2018. The approach to diagnosis and treatment of cancer and management of pulmonary complications of lung and other cancers or their therapies is a specialized area requiring training, experience and expertise. Current postgraduate training though concise, provides limited exposure to diagnostic and interventional procedures required in these patients as well as exposure to the above mentioned specialized issues of cancer management. Structured, University approved training programmes to address this is lacking in India even in Cancer Institutes in Pulmonology. As one of the largest cancer centres in Asia with almost 72,000 new cancer patient registrations every year, Tata Memorial Hospital is ideally poised to reach out to the multitudes of young Chest Physicians passing out every year and training them in the above. To address this, we felt that there is a need to develop a formal , University approved, structured training fellowship programme for a sound theoretical and practical exposure to various facets of Oncology and its related procedures. A two   year duration of training was hence considered necessary to do justice to the Fellowship mission.

The Department of Pulmonary Medicine along with the Thoracic Disease Management Group ( DMG)    has thus initiated a Two year Fellowship in Pulmonary Oncology for Chest Physicians certified through Homi Bhabha National Institute (HBNI) that will begin from August 2019.

The aim of this fellowship is to provide a structured curriculum and training to pulmonologists to enable them to manage pulmonary diseases, complications, co-morbidities and toxicities prevalent in the cancer patient cohort. The planned curriculum also includes training in bronchoscopy, EBUS, pleural procedures including pleuroscopy and care of critically ill cancer patients. Further details of the Fellowship are available on our webpage.

The Department also has two Senior Registrar ( SR)  posts of one year tenure. The Pulmonary Oncology Fellow post as well as the one year SR posts are all recognized towards the one   year PG bond of the Government of Maharashtra. ( Government Resolution )

As an academic initiative of the Thoracic DMG, the Department of Pulmonary Medicine   has also initiated the fortnightly Chest Radiology as well as the monthly Chest Radiology Pathology meetings which are an academic feast and is open to participation across all specialities. It has participation also by   invited external eminent experts in the field of Chest Radiology and Chest Pathology and serves as a teaching platform for all faculty and residents alike. These meetings have multi- disciplinary participation and discussions on   complex respiratory radiology, pathology and clinical presentations.

Research Interests

• COPD and lung cancer.
• ILD and Lung Cancer
• Pre-operative respiratory optimization for cancer surgery and its impact on peri-operative respiratory events
• EBUS in lung cancer staging in the Indian perspective
• Pulmonary rehabilitation and its impact on QALY in cancer patients with respiratory co-morbidities
• Pulmonary infections in patients with cancer and on cancer therapy
• Diagnosis management and prevention of  drug induced pulmonary toxicity
• Broncho-alveolar lavage and its yield in diagnosis of infections in immune suppressed hosts
• Obstructive Sleep Apnea in treated oral cancer patients

Chest Physician OPD

• This is located in the Golden Jubilee Building 3rd Floor Room No. GJB-304 ( the entrance is through the door opposite the GJB 3rd floor lift).
• OPD timings: Monday to Friday ( excluding Wednesdays) 8 am to 4 pm
• Consultations are available for both private as well as general category patients in the same OPD
• A prior appointment is necessary for consulting us, both for first time and follow up visits.
• Consultations include referrals from within our institution from the various oncology departments. If you wish to consult us, please request your treating doctor at Tata Memorial Hospital to make a formal referral.
• If you are diagnosed as having cancer, you will need to see the appropriate oncology department who would refer you to us for a respiratory consult, if required.
• Appointments may be taken personally by contacting our secretary at the OPD Counter between 8 am to 4 pm.
• Telephonic appointments for Tata Hospital referred new and   follow-up patients are possible, please contact the appointment desk on 022-24177000 Extension 4872 for an appointment between 9 am to 3 pm quoting your TMH File number. Since the waiting list for a new or follow-up appointment may range from 1 to 2 weeks, we recommend that you take a telephonic appointment at least 2 weeks   prior to the desired date.
• In case you are unable to keep your appointment, kindly call up the above number to cancel the appointment so that another needy patient is not deprived of a consultation.
• Typical waiting time for an appointment for a first consult and follow up consult may be 7 to 10   working days. Consultations without a prior appointment are possible subject to unforeseen cancellations of prior appointments, availability of time slots and any emergency reason for consultation and patients may drop in around 12 pm for any chance appointments.
• Patients are requested to please get any prior consultation details, X-rays, CT scans,CDs and investigations for review at the time of the OPD visit. This enables us to get a comprehensive view on sequence of medical events that is often a pre-requisite for better understanding and prompt diagnosis of your condition.