Limited knowledge and access to palliative care among women with cervical cancer: an opportunity for integrating oncology and palliative care in Zimbabwe

Abstract

Background: Cervical cancer is mostly diagnosed at advanced stages among the majority of women in low-income settings, with palliative care being the only feasible form of care. This study was aimed at investigating palliative care knowledge and access among women with cervical cancer in Harare, Zimbabwe. Methods: Sequential mixed methods design was used, consisting of two surveys and a qualitative inquiry. A census of 134 women diagnosed with cervical cancer who visited two cancer treating health facilities and one palliative care provider in Harare between January and April, 2018 were enrolled in the study. Seventy-eight health workers were also enrolled in a census in the respective facilities for a survey. Validated structured questionnaires in electronic format were used for both surveys. Descriptive statistics were generated from the surveys after conducting univariate analysis using STATA. Qualitative study used interview/discussion guides for data collection. Thematic analysis was conducted for qualitative data. Results: Mean ages of patients and health workers in the surveys were 52 years (SD = 12) and 37 years (SD = 10,respectively. Thirty-two percent of women with cervical cancer reported knowledge of where to seek palliative care. Sixty-eight percent of women with cervical cancer had received treatment, yet only 13% reported receiving palliative care. Few women with cervical cancer associated treatment with pain (13%) and side effects (32%). More women associated cervical cancer with bad smells (81%) and death (84%). Only one of the health workers reported referring patients for palliative care. Seventy-six percent of health workers reported that the majority of patients with cervical cancer sourced their own analgesics from private pharmacies. Qualitative findings revealed a limited or lack of cervical cancer knowledge among nurses especially in primary health care, the existence of stigma among women with cervical cancer and limited implementation of palliative policy. Conclusions: This study revealed limited knowledge and access to palliative care in a low-income setting due to multifaceted barriers. These challenges are not unique to the developing world and they present an opportunity for lowincome countries to start considering and strategizing the integration of oncology and palliative care models in line with international recommendations.

Gaps and opportunities for cervical cancer prevention, diagnosis, treatment and care: evidence from midterm review of the Zimbabwe cervical Cancer prevention and control strategy (2016–2020)

“…Palliative care is not covered in detail in the strategy although advanced cervical cancer burden is high in the country [ 1 , 3 ]. One recent study by Tapera et al [ 21 ] showed that only 13% of women with advanced cervical cancer had access to palliative care in Harare and this finding supports what was reported in our review. There is need for the government to strengthen the integration of palliative care into the health delivery system in line with international recommendations [ 19 , 21 ].…”

Gaps and opportunities for cervical cancer prevention, diagnosis, treatment and care: evidence from midterm review of the Zimbabwe Cervical Cancer Prevention and Control strategy (2016-2020).

“…One recent study by Tapera et al [21] showed that only 13% of women with advanced cervical cancer had access to palliative care in Harare and this nding supports what was reported in our review. There is need for the government to strengthen the integration of palliative care into the health delivery system in line with international recommendations [18,21].…”

Snapshot of symptoms of advanced cervical cancer patients referred to the palliative care service in a cancer center in Mexico

“…Squamous cell carcinoma is the most frequent histology (79%), 86% had locally advanced disease or advanced disease when first seen at the INCan; therefore, most of them had received concurrent chemoradiotherapy (76%) following international guidelines and institutional protocols 7,18 . Anti‐tumor treatments in patients with CC have an important negative impact on quality of life 15,16 . In addition, 55% of the patients included in this review had the presence of ureteral stents and nephrostomies, the presence of fistulae, or lower lymphedema (Table 2), all of which have a negative impact on the patient's quality of life 16 …”

“…Anti‐tumor treatments in patients with CC have an important negative impact on quality of life 15,16 . In addition, 55% of the patients included in this review had the presence of ureteral stents and nephrostomies, the presence of fistulae, or lower lymphedema (Table 2), all of which have a negative impact on the patient's quality of life 16 …”

“…The American Society of Clinical Oncology has recommended the inclusion of palliative care (PC) in cancer treatment and has issued specific recommendations for women with advanced CC with or without access to tumor‐directed therapy 14,15 . Nevertheless, there are few reports of PC in advanced CC, 16‐19 particularly in Latin America 20 …”