In gynecologic oncology, every clinical intervention has two distinct aims. One is to produce objective improvement in the patient's medical condition and second aim, regardless of whether medical improvement is possible, is to produce amelioration of the patient's subjective symptoms. Helping the patient get better and feel better. Communication skills are essential for both. While there has been a dramatic improvement in the cure rate of gynecological malignancies and women survive longer than 5 years, with what is commonly considered a "chronic" cancer. In each phase of the illness -- diagnosis, surgery and chemotherapy with curative intent, remission and survivorship, relapse and sequential chemotherapy, bowel obstruction and end of life; quality of life (QOL) is one of the most important considerations. There has recently been a large increase in studies reporting the assessment of QOL; that has changed the field from descriptive reporting to quantitative science. History and development of QOL evaluation and various approaches to QOL assessment (psychometric based and utility based) are also discussed. It describes strategies for meaningful interpretation of QOL profiles. We hope the science of the study of QOL will be the foundation and confirmation of many of the anticipated advances for patients.Read More

Epithelial ovarian cancer is the most lethal gynecologic malignancy in adult women. Exploratory laparotomy is required for histologic confirmation, staging and tumor debulking and should be performed by a surgeon trained in these aspects of ovarian cancer management. Because of the propensity of epithelial ovarian cancer to spread beyond the confines of the ovary, the majority of patients will require postoperative chemotherapy in an attempt to eradicate residual tissue. With advanced-stage disease (stages III and IV), postoperative combination chemotherapy with a taxane and platinum combination is the standard of care. Such treatment is capable of inducing responses in >70% of patients with residual epithelial ovarian cancer and is also capable of prolonging both disease-free and overall survival. Ongoing efforts to identify anti-angiogenesis compound to incorporate agents with novel mechanisms of action are also discussed. Role of radiotherapy and other modalities are explored. Ultimately, it is hoped, a combination of these approaches will result in an improvement in the survival of patients with this devastating disease.Read More

Unrelieved pain is the greatest fear among patients with a life-limiting disease. Physicians should consider the legal ramifications of inadequate pain management and understand the liability risks associated with both inadequate treatment and treatment in excess. As the fifth vital sign, pain should be assessed as frequently as the other vital signs and the findings should be well documented, for easy reference by all members of the healthcare team. This review discusses the etiology of pain at the end of life and issues in effective pain management; assessment of pain accurately through use of clinical tools and other strategies, including the use of an interpreter; and select appropriate pharmacologic and/or non-pharmacologic therapies to manage pain in patients during the end-of-life period.Read More

Symptom management is an essential element in any care setting, requiring diligent ongoing assessment and evaluation of interactions. Side effects related to treatment of symptoms must be understood and treated. The goals of symptom management for patients near the end of life are to control symptoms, promote meaningful interactions between patients and families, and facilitate peaceful deaths. Optimum treatment of symptoms involves comprehensive assessment and use of drug and non-drug interventions. It is essential that healthcare providers in all settings become prepared to provide quality care at the end of life. The physical comfort measures must continue, including frequent repositioning and oral hygiene. Emotional support of the family is imperative. This document discusses the symptoms: Fatigue and Weakness; Dyspnea; Constipation; Nausea and Vomiting.Read More

The purpose of this document is the best management of symptoms in end-of-life situations. Before initiating a symptom management approach, pharmacologic or non-pharmacologic, clinicians should allow patients time to express their thoughts and concerns. This simple step has led to better outcomes and when carried out in a supportive environment, has been almost as effective as more advanced techniques. Continual reassessment of symptoms is necessary to ensure adequate management of symptoms. It may be helpful for patients or a family member to keep a pain or symptom diary to note which measures have or have not provided relief and the duration of relief. This information will help clinicians deter­mine the efficacy of specific therapeutic options and modify the treatment plan as necessary. The discussion of interventions in this document focuses on the care of adults. This document discusses the symptoms: Anorexia and Cachexia, Diarrhea; Sleep Disturbances; and Delirium.Read More

This course is designed to bridge the gap in knowledge of palliative care by providing an overview of the concept of palliative care and a discussion of the benefits and barriers to optimum palliative care at the end of life. Before initiating a symptom management approach, pharmacologic or non-pharmacologic, clinicians should allow patients time to express their thoughts and concerns. This simple step has led to better outcomes and when carried out in a supportive environment, has been almost as effective as more advanced techniques. Continual reassessment of symptoms is necessary to ensure adequate management of symptoms. It may be helpful for patients or a family member to keep a pain or symptom diary to note which measures have or have not provided relief and the duration of relief. This information will help clinicians deter­mine the efficacy of specific therapeutic options and modify the treatment plan as necessary. The discussion of interventions in this document focuses on the care of adults. The issue of physician-assisted-suicide or euthanasia is likely to remain high on the medico-legal or ethical agendas of many countries in coming years. One reason, according to some experts, is a growing insistence among patients in many countries on having the final say – in all senses of the word “final” – about their medical treatment. Another reason is that people are living longer and because of medical advances increasing numbers are surviving with debilitating conditions, such as cancer and heart disease. The evidence of more than a dozen years’ experience in Oregon and two years’ data from Washington state suggests that legalized physician-assisted death provides an appropriate and ethically acceptable choice to patients who wish it and who qualify under the statutory guidelines. Along with science, empathy – the humanistic dimension – remains critical. This document discusses the symptoms: Psychosocial Care; Anxiety; Depression, Spiritual Needs; Imminent Death and Physician-Assisted Suicide.Read More