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

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.

Body image and the level of stress in cervical cancer patients

“…The data collection tool uses a questionnaire body image and Depression Anxiety Stress Scale (DASS). The result of Body image is categorized as good (mean ≥) and poor (mean <23) while DASS is categorized as normal (0-14), mild (15)(16)(17)(18), moderate (19)(20)(21)(22)(23)(24)(25), severe (26)(27)(28)(29)(30)(31)(32)(33) and extreme severe (≥ 34). Body image questionnaire is valid (0,353-0,754) and reliable (Cronbach's alpha 0.483).…”

“…Most patients may feel some combination of moderate or severe physical, psychological, social, and spiritual suffering. 15 he prevalence of depression and anxiety was 52.2% and 65.6% in cervical cancer patients. 16 The research aimed to find out the correlation between body images and stress levels in cervical cancer patients who receive chemotherapy at the Gynecology Centers of Dr. Kariadi General Hospital Medical Centre Semarang.…”

The state of gynecologic radiation therapy in low- and middle-income countries

“…There are scarce data on the proportion of patients treated with curative versus palliative intent in low- and middle-income countries. Recent work by Krakauer et al80 has looked at the global need for palliative care for patients with cervical cancer, and provided a quantitative estimate of the need for palliation in this population. The authors estimated that one million women with cervical cancer had moderate or severe pain, 85% of whom were in low- and middle-income countries.…”

Frequency and duration of suffering of cervical cancer patients and caregivers: Results from an international Delphi study

“…A global dataset on the annual need of palliative care service for cervical cancer was created, including all four categories of sufferings-physical, psychological, social and spiritual. The results have been published elsewhere [22].…”