Palliative care in gynaecological oncology

Women with a gynaecological malignancy often suffer significant symptom burden, both physically and psychologically, throughout the course of their disease. Despite advances in treatment, up to 25% of women diagnosed with a gynaecological malignancy will die from recurrent disease. Early palliative care involvement can provide a holistic approach to care with the benefit of improving symptom control and quality of life for both the patient and carer as well as lowering resource utilisation at the end of life. Palliative care can be offered alongside curative or life prolonging treatment as well as at end of life. This article reviews the management of common physical symptoms and complications experienced by patients with advanced gynaecological malignancy.     

Palliative care in gynaecological oncology

Women with a gynaecological malignancy often suffer significant symptom burden, both physically and psychologically, throughout the course of their disease. Despite advances in treatment, up to 25% of women diagnosed with a gynaecological malignancy will die from recurrent disease. Early palliative care involvement provides a holistic approach to care with the benefit of improving symptom control and quality of life for the patient and their carers, as well as lowering resource utilisation at the end of life. Palliative care can be offered alongside curative or life prolonging treatment as well as at end of life. This article reviews the management of common physical symptoms and complications experienced by patients with advanced gynaecological malignancy.     

Single-fraction palliative pelvic radiation therapy in gynecologic oncology: 1,000 rads

The management of the patient with advanced gynecologic malignancies presents multiple problems for the gynecologic and radiation oncologists involved in their care. When palliative management only is indicated, conventional treatment protocols occupy a significant portion of the patient's remaining life span, oftentimes with associated morbidity. Single-fraction external radiation therapy, consisting of 1,000 rads to the whole pelvis, was used in 30 patients with advanced gynecologic malignancies to palliate locally advanced pelvic disease. Alleviation of symptoms and maintenance of a reasonable quality of life were obtained in all patients. No untoward acute side effects were observed. Thirteen patients are alive from 2 to 19 months after treatment, with a mean overall survival after treatment of 8.4 months. It is concluded that this regimen should be considered as the palliative therapy of choice for certain patients with advanced gynecologic malignancies.     

Palliative care in gynaecological oncology

Gynaecological malignancy accounts for significant patient morbidity and mortality. Clinical aims focus upon palliative management and supportive care when potentially curative treatment options are exhausted. Patients with recurrent, advancing or terminal disease may suffer severe and distressing physical and psychological effects associated with both cancer diagnosis and treatments. It is of paramount importance that patients, families and carers are provided with the assistance they need to have as high a quality of life as possible.This review focuses upon the provision of relief from pain and other distressing symptoms commonly associated with gynaecological malignancy. In addition, we highlight some of the important aspects of psychosocial care.     

Palliative care in gynaecological oncology

Gynaecological malignancy accounts for significant patient morbidity and mortality. Clinical aims focus upon palliative management and supportive care when potentially curative treatment options are exhausted. Patients with recurrent, advancing or terminal disease may suffer severe and distressing physical and psychological effects associated with both cancer diagnosis and treatments. It is of paramount importance that patients, families and carers are provided with the assistance they need to have as high a quality of life as possible.This review focuses upon the provision of relief from pain and other distressing symptoms commonly associated with gynaecological malignancy. In addition, we highlight some of the important aspects of psychosocial care.     

Quality of Life in Progressive Ovarian Cancer

When ovarian cancer progresses, goals change from cure to prolongation of life with the best possible quality for the patient. Criteria for futility must be established to guide the transition from active to palliative management. Pain control can be achieved by following established WHO guidelines. Continued education of the medical community, legislators, and the public is needed to assure pain control for the cancer patient. Limited surgery or radiation can be used to control symptoms from locally progressive disease. Other symptoms to be actively controlled include nausea and vomiting, nutrition, hydration, and fatigue. Support services, including home services, psychological counseling, and nutritional support need funding for both home and hospital settings. Quality of life assessment must be as specific as possible and address the patient's concerns by self-assessment techniques. Funding must be provided to develop specific quality of life tools and to then apply them clinically, both as part of research protocols and to assess success of palliative care.     

Palliative and hospice care in gynecologic cancer: A review

Despite the increasing availability of palliative care, oncology providers often misunderstand and underutilize these resources. The goals of palliative care are relief of suffering and provision of the best possible quality of life for both the patient and her family, regardless of where she is in the natural history of her disease. Lack of understanding and awareness of the services provided by palliative care physicians underlie barriers to referral. Oncologic providers spend a significant amount of time palliating the symptoms of cancer and its treatment; involvement of specialty palliative care providers can assist in managing the complex patient. Patients with gynecologic malignancies remain an ideal population for palliative care intervention. This review of the literature explores the current state of palliative care in the treatment of gynecologic cancers and its implications for the quality and cost of this treatment.     

Effectiveness of the Online Daily Diary (ONDIARY) program on family caregivers of advanced cancer patients: A home-based palliative care trial

ObjectivesThere are many effective palliative care programs for patients with advanced cancer. However, little is known about effective programs for family caregivers of patients with advanced cancer, especially in home-based palliative care settings. This study aimed to determine the effect of the Online Daily Diary (ONDIARY) program on the quality of life (QOL) of family caregivers of patients with advanced cancer in home-based palliative care settings.MethodsThis study used a quasi-experimental design with a control group. The sample comprised 60 family caregivers (intervention group n = 30, control group n = 30) of patients with advanced cancer receiving home-based palliative care. The intervention group was assigned to the ONDIARY program in addition to usual care, and the control group was assigned to usual care. Group allocation was not randomized. The ONDIARY program is a 7-day online diary intervention program that aims to enhance emotional competence. Outcome measures were feasibility assessment, and primary and secondary outcome assessment. Primary and secondary outcome measures were the Caregiver Quality of Life Index-Cancer (CQOLC) and the six-item Kessler Psychological Distress Scale (K6). Repeated measures analysis of variance was performed on each measure, with group and group × time interactions.ResultsThere was a significant group × time interaction in CQOLC scores (F = 9.324, P = 0.003). The CQOLC scores of family caregivers in the intervention group were maintained after the intervention, whereas those in the control group declined. There was no significant difference in K6 scores between the two groups.ConclusionThe results suggest that the ONDIARY program in addition to usual care has potential to be effective in preventing decline and maintaining QOL of family caregivers of patients with advanced cancer in home-based palliative care settings.     

Acute and chronic pain management in palliative care

Every palliative care patient should have the expectation that acute and chronic pain management will be an integral part of their overall care. However, in all too many instances, the pain of cancer is often grossly under-treated. This issue is of concern because more than 80% of patients with cancer pain can find adequate relief through the use of simple pharmacological methods. It is even more troubling to note that women and minority groups have their cancer pain under-treated more frequently. Physicians with the basic skills of assessment and treatment will be able to control the symptoms in the majority of cancer pain patients. However, there are still some patients who may require other modalities to control their moderate to severe pain. A thorough understanding of all pain management options will help the gynaecological oncologist to maintain an acceptable quality of life for their patients throughout the therapeutic and palliative phases of care.     

The overactive bladder: an overview for primary care health providers.

The overactive bladder, with symptoms of frequency, urgency and urge incontinence, substantially affects the life styles of millions of people throughout the world. The symptoms are associated with significant social, psychological, occupational, domestic, physical, and sexual problems. Despite the considerable impact of the condition on quality of life, sufferers are often reluctant to discuss their problem with family members or health care professionals. This state of affairs is unfortunate, for much can be done to alleviate the symptoms of this distressing condition. It is therefore of utmost importance that medical education about symptoms of the overactive bladder and other related problems be improved, to help health care professionals identify and treat patients who will benefit from therapy. This article reviews current thinking regarding definition, epidemiology, quality of life effects, evaluation and management. Emphasis is placed on knowledge particularly useful in primary care, especially, noninvasive modalities of therapy.     

卵巢癌患者生活质量研究进展

卵巢癌临床症状相对隐蔽,大多数患者在被确诊时已处于卵巢癌晚期。但随着治疗方案的进步,不少患者可以得到长期生存。因此,对于卵巢癌患者,尤其是晚期复发性卵巢癌患者,改善其生活质量与延长其生存期同等重要。大量研究证实卵巢癌患者在躯体、心理、社会和性等方面受到较为严重的损害,为改善患者生活质量,除需对患者进行贯穿始终的心理调节外,还需根据卵巢癌患者所处的不同时期针对性地进行生活质量的改善。对于初治卵巢癌患者,应审慎选择治疗方案,针对性处理治疗相关不良反应或并发症,督促患者加强体育锻炼;对于无瘤生存期患者,应注重帮助患者恢复工作、社会能力,增强生存信心;对于带瘤生存期患者,应进行症状管理、家庭支持等。     

Palliativmedizinische Maßnahmen bei gynäkologischen Malignomen und Mammakarzinomen gemäß S3-Leitlinie

Palliative care plays an important role in the care of patients with advanced gynecological tumors and breast cancer. In addition to an empathic and honest communication, adequate pain and symptom control of the patients is essential. Randomized studies have shown that early integration of palliative care into the oncological treatment of patients with advanced cancer not only improves the quality of life but can also improve survival. Overall, palliative care is helpful for most patients with advanced gynecological tumors and breast cancer and should be provided early and as a low threshold offer.     

Treatment preferences in recurrent ovarian cancer

OBJECTIVES: In the case of recurrent ovarian cancer, salvage therapy represents the potential to trade off between quality and quantity of life. Patient and physician face a choice between chemotherapy directed at slowing disease progression and supportive or palliative care that focuses on symptom management. To date, no studies have investigated the effects of best supportive care on ovarian cancer patients' quality of life and length of life as compared to salvage therapy. In other cancers, both quantity and quality of life considerations have been shown to affect treatment preferences. METHODS: Using a decision board, we assessed preferences for salvage therapy or palliative care in the case of recurrent ovarian cancer among 81 ovarian cancer patients receiving first-line chemotherapy and 75 Noncancer Controls. RESULTS: Compared to Noncancer Controls, ovarian cancer patients overwhelmingly preferred salvage therapy; quantity of life was of primary importance. In both groups, preference was not related to age, marital status, number of children, or employment status. On average, patients indicated they would switch from salvage therapy to palliative care when the median survival associated with salvage therapy was reduced to 5 months. Noncancer Controls would switch significantly sooner, when the median increment in survival period was reduced to 8 months. Switchpoint was not associated with life satisfaction, quality of life, or psychological or spiritual well-being in either group. CONCLUSIONS: The majority of women, independent of a cancer diagnosis, indicated a desire for continuing aggressive treatment, despite poor outcomes. Quality of life was of secondary importance, especially among ovarian cancer patients.     

Life quality of post-myocardial infarction patients: influence of personal variables on coping

Coping in terms of physical, social, and psychological well-being and health-seeking behavior were studied by a self-reported questionnaire in 233 outpatients with myocardial infarction below 70 years of age. For most of these patients, physical limitations or discomfort were not significant, but the impacts on their emotion and social life were rather severe. As to social maladjustment, 70.3% of the patients were experiencing a deteriorated sexual life, 63.9% had not returned to their prior work status, 55.6% had decreased social participation and 45.7% had less interest in leisure activities. Physical morbidity was not the only determinant of maladaptation. Sex, educational level, existence of combined chronic disease, the time interval, and premorbid occupational characteristics all appear to be salient factors for coping. Those patients with a lower educational level were prone to the prominent threat of the disease (perceived lack of control and predictability), had higher scores of psychiatric symptoms, reported more physical symptoms, had a lower rate of work resumption and showed poorer medical compliance. Such data indicates that differences in disease-perception may be the mediators of socioenvironmental and illness-related influences. The rate of work resumption was also directly proportional to the patients' socioeconomic status and the degree of premorbid work responsibility and psychological demand reported by patients. Poorer outcomes of coping were also related to time interval since first heart attack and combined diabetes mellitus. Recovery from myocardial infarction is more than just a medical problem. Biomedical and psychosocial variables interact at many levels in the recovery process. It is of considerable practical importance to recognize the patients' coping ability, in order to obtain effective comprehensive care.     

Irritable Bowel Syndrome in Women

Irritable bowel syndrome is a gastrointestinal disorder characterized by abdominal pain and changes in bowel habits. It adversely affects the quality of life for women who have it and is a significant health care burden. The syndrome results from the interaction of many factors that are not clearly understood, including stress, environment (internal and external), and biological mechanisms. It affects women more than men, and clear biological, psychological, and physical differences exist between the sexes, creating the need for a specialized approach to management in women. The objective of this article is to explore the pathophysiology of irritable bowel syndrome and how it relates specifically to women and to apply these differences to the diagnosis and treatment of irritable bowel syndrome in women.     

The utilization of palliative care in gynecologic oncology patients near the end of life

Background

Palliative and supportive care services provide excellent care to patients near the end of life. It is estimated that enrollment in such services can reduce end-of-life costs; however, there is limited data available regarding the impact of palliative services in end-of-life care in gynecologic oncology patients. We examined the use of palliative services in gynecologic oncology patients during the last six months of life.

Methods

After IRB approval, a retrospective chart review of patients with a diagnosis of a gynecologic malignancy who died between June 2007 and June 2010 was performed. Abstracted data included demographics, admission and procedural history, use of anti-cancer therapy, and palliative care utilization during the last six months of life.

Results

268 patients were identified. Most patients were white (76.9%) and had ovarian cancer (56.7%). During the last six months of life, 155 (57.8%) patients underwent anti-cancer therapy with chemotherapy, 19 (7.1%) patients were treated with radiation therapy, and 17 patients (6.3%) underwent treatment with both. 218 patients (81.3%) had at least one admission during this time (range 0-14). The most common reason for admission was gastrointestinal complaints (37.1%), followed by admissions for procedures (18.3%). The median time between the last admission and death was 32 days. 157 patients (58.6%) underwent at least one procedure during the last six months of life (range 0-11). The most common procedure performed was paracentesis (22.6%). 198 (73.9%) patients died at home or in a palliative care unit. 189 (70.5%) patients were referred to hospice or palliative care. 3.2% underwent a procedure or treatment with chemotherapy or radiation after hospice enrollment. The median time between hospice enrollment and death was 22 days. 55% of patients were enrolled in hospice less than 30 days before death. Of the 79 patients not referred to hospice, only 16.5% had documentation of refusing hospice services.

Conclusions

During the last six months of life, the majority of gynecologic oncology patients receive anticancer therapy and many have repeated hospital admissions. While the majority of patients are referred for palliative care, it appears that most patients spend less than 30 days on hospice. Earlier referral could decrease the number of hospital admissions and procedures while providing invaluable support during this end of life transition.     

Palliative and end-of-life care for patients with ovarian cancer

Palliative care improves the quality of life of patients and their families through the prevention and treatment of distressing symptoms while addressing the psychological, social, and spiritual aspects of patient care. Emerging paradigms of delivery promote early involvement in the disease trajectory and specialty approaches to care. Interdisciplinary assessment and shared decision making are important components. Throughout the disease course, aggressive symptom management can improve patients' quality of life and their ability to tolerate and continue treatment. End-of-life care focuses on comfort, control, meaning, and support that become particularly intense when death is imminent.     

Patterns of palliative care referral in ovarian cancer: A single institution 5 year retrospective analysis

Background

The American Society of Clinical Oncology recommends that patients with advanced cancer receive dedicated palliative care services early in their disease course. This investigation serves to understand how palliative care services are utilized for ovarian cancer patients in a tertiary referral center.

A paradigm of integrative care: healing with curing throughout life, "being with" and "doing to".

We are presenting an integrative paradigm of care. We will review the basis for its evolution from prior series and parallel models. In this paradigm, healing and palliation (when indicated) are introduced in parallel with curative measures as soon as any diagnosis, especially a critical one, is made. Frequently palliative measures address patient symptoms, such as pain, anxiety, delirium, or depression, and are geared towards comfort care at the end of life. Our view of healing care is that it actively addresses the cognitive, emotional and spiritual needs of the patient and family, and includes the elements of palliative care as a complement. Because a loss is often experienced in many conditions, even in the absence of death, bereavement is represented in our model as an ongoing, continual process throughout a disease process. While we will be drawing mainly from experiences with children, the proposed model is applicable to all ages. In order to implement this model most effectively, it will be important to shift from our mindset of "doing to" to one that includes "being with" our patients and their families. The uniqueness of this paradigm, in contrast to other models, is its comprehensiveness and universality. It is appropriate for patients of any age, at any stage of their disease or illness, regardless of the severity or duration of their condition.     

Palliativmedizin – weit mehr als nur Schmerztherapie

The WHO definition of palliative care clearly states that it is more than just pain therapy with a “humanistic touch”. The widespread misunderstanding of palliative medicine as a “pain therapy for dying (cancer) patients” has been disproved by clinical reality. The principles of palliative medicine are increasingly being applied to non-oncological patient groups, especially neurological patients. It is now generally accepted that palliative care is care for, but not just at the end of life. Palliative psychosocial and spiritual support play at least as important a role within palliative care as medical symptom control (pain, internal medicine and neuropsychiatric symptoms). The goal of palliative care, as Cicely Saunders said, is “to provide space” in order to allow patients to live fully until they die.