A review of patients with advanced cervical cancer presenting to palliative care services at Queen Elizabeth Central Hospital in Blantyre, Malawi|
Bates, M.J. & Mijoya, A.
Cervical cancer is the commonest cancer affecting women in Malawi,
which has the highest rate of this disease in the world. Most cases are
diagnosed at an advanced stage.
To describe the symptom burden, palliative care interventions, and
outcomes of cervical cancer patients who entered care at Tiyanjane Clinic
in Blantyre, Malawi, between January and December 2012.
We reviewed the case files of 72 patients presenting to our hospital-based
palliative care service over one year.
The mean age was 49.5 years. Twenty-six patients (36%) were HIVpositive
and the majority of these (n = 22; 85%) were on antiretroviral
medication at presentation to palliative care. Pain (n = 66; 92%), vaginal
discharge (n = 44; 61%), and unpleasant odour (n = 37; 51%) were
commonly reported. Over a third of patients (n = 26; 36%) reported pain
in two or more sites. Fourteen patients (19%) reported vaginal bleeding.
Spousal breakdown (through widowhood or divorce) was noted in over
half (n = 41; 57%) of all cases. Pain relief was provided to 69 (96%)
of the patients (morphine to 40 patients; 56%). Common interventions
provided included metronidazole tablets (used vaginally), sanitary items,
and counselling. At the end of the study period, 18 patients (25%) were
still under the care of palliative services.
Access to medications such as morphine, metronidazole and tranexamic
acid can improve quality of life, even when radiotherapy is limited.
Health care teams require necessary skills and training, including how to
perform a comprehensive assessment, with an emphasis on the provision
of psychosexual counselling, to assist with the complexity of symptoms
occurring in this vulnerable group.