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• W2081790547 abstract "Some very specific difficulties arise in the care of patients with advanced gynecologic cancers. Initial treatment for these tumors is often radical and associated with a large number of distressing side effects from which the patient takes some time to recover physically and longer to recover emotionally; she then faces the realization that these treatments, which aimed at cure, were futile. As the disease progresses towards her death, thoughts such as “What did I go through all that for?” often occur. It is almost impossible to say precisely when patients become “terminally ill.” The patient and her family should not be deprived of the benefits of palliative care because she is not “actively dying.” It can be helpful to think of the patient's disease progression, and hence her needs, as following the trajectory outlined in Figure 1. Although many problems are common in advanced gynecologic malignancy, some specific issues relate more closely with different primary sites. The mutilation of radical vulvectomy for carcinoma of the vulva is very difficult for a woman to adapt to psychologically.19 Those who have positive nodes at the time of radical vulvectomy have a poor prognosis and, in addition to the trauma of the treatment, will have to face death. Local recurrence with fungating tumor and concomitant problems of smell, exudate, and pain are accompanied by a high risk of hemorrhage, either through neovascularization in the recurrent tumor or erosion of an artery such as the femoral artery by inguinal recurrence. Patients with cervical carcinoma tend to be in a younger age group. They may feel stigmatized19 through the association of this malignancy with sexual activity. Any perceived failure of cervical cytology and screening gives rise to anger in the patient and her family. Noncompliance with cervical screening in the past may leave the woman feeling very guilty and angry with herself when she is diagnosed with advanced cervical disease. Disease recurrence tends to occur locally causing pain, fistulas, and fungation of tumor at the top of the vagina. Extension of the tumor posteriorly to invade the presacral plexus causes severe pain, as does bone involvement in the lower lumbar region and sacrum. Development of leg weakness may herald spinal cord compression, 31 and some patients may develop hypercalcemia. Ovarian carcinoma is also a disease of younger women, with all the social ramifications of a young mother's death. The association of ovarian cancer and breast cancer in some families makes a comprehensive family tree essential93; other women in the family who are at high risk may require genetic counseling. Transcoelomic spread of tumor predisposes women with ovarian cancer to a particularly high risk of bowel obstruction and ascites relatively early in the disease. Advanced carcinoma of the endometrium is relatively uncommon, tending to occur in older women. Local complications relate to tumor in the pelvis10 and the problems of bleeding." @default.
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• W2081790547 date "1999-02-01" @default.
• W2081790547 modified "2023-10-17" @default.
• W2081790547 title "END-OF-LIFE CARE IN PATIENTS DYING OF GYNECOLOGIC CANCER" @default.
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• W2081790547 doi "https://doi.org/10.1016/s0889-8588(05)70155-6" @default.
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