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Cervical Cancer-Associated Suffering: Estimating the Palliative Care Needs of a Highly Vulnerable Population

Krakauer EL 1 , Kwete X 2 , Kane K 3 , Afshan G 4 , Bazzett-Matabele L 5 , Bien-Aimé DDR 6 Show all authors , Byrne-Martelli S 1 , Connor S 7 , Correa R 8 , Devi CRB 9 , Diop M 10 , Gafer N 11 , Goodman A 12 , Grover S 13 , Hasenburg A 14 , Irwin K 15 , Thanh Khanh Q 16 , Kumar S 17 , Nevzorova D 18 , Truong QXN 19 , Rajagopal MR 20 , Randall T 12 , Rassouli M 21 , Sessa C 22 , Spence D 23 , Torode JS 24 , Trimble T 25 , Varghese C 26 , Fidarova E 26

Affiliations 

  • 1 Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA
  • 2 Harvard School of Public Health, Boston, MA
  • 3 Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Department of Medicine, Harvard Medical School, Boston, MA
  • 4 Department of Anaesthesiology, Aga Khan University Medical College, Karachi, Pakistan
  • 5 Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana
  • 6 Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
  • 7 Worldwide Hospice Palliative Care Alliance, Fairfax, VA
  • 8 Clínica Las Condes, Las Condes, Chile
  • 9 Normah Medical Specialist Centre, Sarawak, Malaysia
  • 10 Cancer Institute of Cheikh Anta Diop University, Dakar, Senegal
  • 11 Radiation and Isotope Centre, Khartoum, Oncology Hospital, Sudan
  • 12 Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA
  • 13 Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
  • 14 Department of Gynecology and Obstetrics, Johannes Gutenberg University Medical Center, Mainz, Germany
  • 15 Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA
  • 16 Ho Chi Minh City Oncology Hospital, Ho Chi Minh City, Vietnam
  • 17 Institute of Palliative Medicine, Medical College, Kerala, India
  • 18 Federal Center for Palliative Care, Sechenov 1st Moscow State Medical University, Moscow, Russian Federation
  • 19 College of Public Health Science, Chulalongkorn University, Bangkok, Thailand
  • 20 Pallium India, Trivandrum, India
  • 21 Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • 22 Department of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
  • 23 Hope Institute Hospital, Kingston, Jamaica
  • 24 Union for International Cancer Control, Geneva, Switzerland
  • 25 National Cancer Institute, Bethesda, MD
  • 26 Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
JCO Glob Oncol, 2021 Jun;7:862-872.
PMID: 34115522 DOI: 10.1200/GO.21.00025

Abstract

PURPOSE: To enable design of optimum palliative care for women with cervical cancer, we studied the most common types of suffering and their severity, prevalence, and duration.

METHODS: We first reviewed the literature on the major types, severity, prevalence, and duration of suffering associated with cervical cancer. We then conducted a modified Delphi process with experts in cervical cancer care to supplement the literature. For each type of suffering, we distinguished between decedents (those who die from cervical cancer in a given year) and nondecedents (those who have cervical cancer in a given year but do not die). By applying the suffering prevalence and duration estimates to the number of decedents, nondecedents, and family caregivers in 2017, we were able to estimate their palliative care needs and the intensity of palliative care needed to respond adequately to this suffering.

RESULTS: There is a high prevalence among decedents of moderate or severe pain (84%), vaginal discharge (66%), vaginal bleeding (61%), and loss of faith (31%). Among both decedents and nondecedents, there is a high prevalence of clinically significant anxiety (63% and 50%, respectively), depressed mood (52% and 38%, respectively), and sexual dysfunction (87% and 83%, respectively). Moderate or severe financial distress is prevalent among decedents, nondecedents, and family caregivers (84%, 74%, and 66%, respectively). More than 40% of decedents and nondecedents are abandoned by their intimate partners. Most patients experience some combination of moderate or severe physical, psychological, social, and spiritual suffering. In total, 258,649 decedents and 2,558,857 nondecedents needed palliative care in 2017, approximately 85% of whom were in low- and middle-income countries where palliative care is rarely accessible.

CONCLUSION: Among women with advanced cervical cancer, suffering is highly prevalent and often severe and multifaceted.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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