Augmented Package of Palliative Care for Women With Cervical Cancer: Responding to Refractory Suffering

Abstract

The essential package of palliative care for cervical cancer (EPPCCC), described elsewhere, is designed to be safe and effective for preventing and relieving most suffering associated with cervical cancer and universally accessible. However, it appears that women with cervical cancer, more frequently than patients with other cancers, experience various types of suffering that are refractory to basic palliative care such as what can be provided with the EPPCCC. In particular, relief of refractory pain, vomiting because of bowel obstruction, bleeding, and psychosocial suffering may require additional expertise, medicines, or equipment. Therefore, we convened a group of experienced experts in all aspects of care for women with cervical cancer, and from countries of all income levels, to create an augmented package of palliative care for cervical cancer with which even suffering refractory to the EPPCCC often can be relieved. The package consists of medicines, radiotherapy, surgical procedures, and psycho-oncologic therapies that require advanced or specialized training. Each item in this package should be made accessible whenever the necessary resources and expertise are available.

Access to Palliative Care in Patients with Advanced Cancer of the Uterine Cervix in the Low- and Middle-Income Countries: A Systematic Review

“…Available evidence from diverse resource settings suggest that women with cancer of the cervix frequently suffer from severe complex refractory symptoms not readily relieved by basic PC (41). Addressing these symptoms require more advanced procedures such as palliative external beam radiotherapy to control vaginal bleeding and discharge, advanced medical therapies, nerve block for intractable neuropathic pelvic pain, surgical procedures for bowel obstruction, and psycho-oncology to manage severe or refractory anxiety and depression (41). Identifying needs of patients and their families, communication, assessment and treatment of pain and other symptoms, and referral for management of complex distressing symptoms is recognised as a basic requirement even at lower levels of care (40,42).…”

T cell immunotherapy for cervical cancer: challenges and opportunities

“…For advanced cervical cancer, many studies have turned to palliative treatment to reduce the pain of patients, and to improve the quality of life of patients such as palliative surgery, analgesia drugs, or neurosurgery to prevent pain ( 6 ).Advanced cervical cancer can only be treated with chemotherapy or radiotherapy, but the prognosis is poor with the median survival rate of 16.8 months. For these patients, more effective treatment is urgently needed ( 7 ).…”

Cervical Cancer: 90-70-90 and Palliative Care

“…Krakauer et al, 2 - 4 using a mixture of tools, including a modified Delphi process, calculate the level of suffering. One could question the methodologies used: Was the focus group large enough?…”

“…The second 3 and third 4 papers follow with both essential and an augmented packages of palliative components that should be provided. Importantly, the essential package is not a poor person's palliative care for those who cannot afford it.…”

“…The WHO team then goes on to propose an augmented package that offers modes of care beyond the essential package with evidence provided for many therapies. 4 Surgery is commonly available throughout the world, but oncological surgery is often complex and requires great expertise. Correctly, it is pointed out that a colostomy may circumvent issues of a rectal-vaginal fistula rather than attempting surgery within the tumor bed.…”