Palliative care in women's cancer care: Global challenges and advances

Abstract

Women's cancer rates are increasing in low‐ and middle‐income countries, with presentations that are often far advanced requiring intense symptom management, thus advancing the urgent need to address palliative care. Most resource settings have some options available to assist women with advanced gynecologic cancer, and a combination of leveraging these and expanding on emerging models for palliative care could lessen suffering and improve care for women with gynecologic cancers globally. Providing palliative care for women with cancer is constrained by resources (human and physical), lack of equipment, lack of access, and policy absence or barriers. There is important work to be done in advocating for appropriate infrastructure development and legislation to assure that these options are available to women and their families. Access to adequate opioid and other pain relief options for cancer‐related pain is a particular concern given that availability, cost, and legislative prohibitions create barriers that cause suffering for patients and grief for their families who are unable to address their suffering. All of these require ongoing advocacy for continual advances to improve access and infrastructure for palliative care.

Dignity and loss of dignity: Experiences of older women living with incurable cancer at home

“…They described loss of dignity when feeling neglected, invaded in their personal lives and offended by HCPs. These findings are also supported by several studies of women sensing insecurity and experiencing violation in their everyday lives (Aabom et al, 2005;Cain & Denny, 2018;Poulose et al, 2013). The findings resonate with the theoretical perspective of suffering related to care as proposed by Eriksson (1994).…”

Healthcare professionals’ perceptions of dignity-preserving care for older home-dwelling women with incurable cancer in Norway

“…Previous research from Norway and Scotland has revealed that healthcare services do not meet the demands of care of older home-dwelling cancer patients, implying a risk of hindering older people's access to proper end-of-life care (Fjose et al, 2018;Miller & Nevadunsky, 2018). Another risk relates to older people being considered as one group without appreciation of gender differences related to life-threatening illnesses (Cain & Denny, 2018;Rochon et al, 2020). Whereas dignity in care has been discussed from the perspective of HCPs in general (Baillie et al, 2008;Barclay, 2016;Johnston et al, 2012), we found that GPs, CCs and HCPNs emphasized sources of dignity differently.…”

“…Breast, colorectal and lung cancers accounted for the top three of women's cancers, with breast cancer representing the leading cause of death (Bray et al, 2018). Providing palliative care for women with cancer seems to be hampered by lack of both human and physical resources as well as policy absence or barriers (Cain & Denny, 2018). Palliative care is a widely used term within cancer care, and may be provided to the patient at any point from diagnosis to end-of -life.…”

“…This article has its focus on older women nearing end-of-life, and we have therefore used the term end-of-life care throughout this article. Against this background, high quality end-of-life care for the rising number of older women with incurable cancer is now of great importance and should warrant sufficient healthcare resources, proper alleviation of symptoms, and respectful and supportive care (Cain & Denny, 2018;Rochon et al, 2020). This presupposes increasing demands on healthcare services and a multidisciplinary collaboration among healthcare professionals (HCPs) with complementary competencies to fulfil the complex needs of patients with incurable cancer (Johansen & Ervik, 2018).Figure 1 Despite the diversity in the term "older age" due to genetic inheritance and the environments in which older people live, we here define "old" from the age of 65 years in this study (WHO, 2020).…”

“…The biological, hormonal and social differences between men and women should be incorporated when developing personalized therapeutic cancer treatment as well as palliative symptomatic treatment (Bartz et al, 2020;Kim et al, 2018). Cain and Denny (2018) suggest that this would contribute to more efficient symptom alleviation and better quality of life for women with incurable cancer. A number of studies have reported that women experience pain, anxiety, depression and loneliness more frequently than men (Dahlberg et al, 2015;Fillingim, 2017;Jaworska & Ryan, 2018;Wright et al, 2019).…”