[Palliative treatment in gynecologic cancer].
BACKGROUND
Data on the need for palliative care related to disease groups are very limited.


METHODS
A retrospective analysis was performed on the hospital records of 228 patients who died from gynaecologic cancer during the 1988-1997 period.


RESULTS
76% of deaths took place in hospital; 12% at home. Median terminal hospital stay was 13 days. Symptoms from intestinal obstruction were dominating in 30% of cases and most frequently seen in patients with ovarian cancer. Palliative intestinal surgery was performed in 38% of patients with ovarian cancer, median survival being 5 months (range 10 days-7 years), perioperative mortality (within 30 days) 13%. Cachexia dominated in 27% and was more often present when death occurred at home. Assistance from a gastroenterologic surgeon, urologist, haematologist or anaesthesiologist was needed in 32% of cases. One in two patients received parenteral pain relief in the terminal phase, for a median period of five days. Palliative radiotherapy was given 21% of the patients, most often in cervical and endometrial cancer, and chemotherapy or hormonal therapy was used in 36%. Minor interventions like laparocentesis, pleurocentesis, tumour resections, and various forms of urinary deviations were frequent.


CONCLUSIONS
Hospital deaths are more common among patients suffering from gynaecologic cancer than among cancer patients in general (55% in Norway), and the need for multimodal hospital service is large. We see substantial benefits in the Norwegian model in which a gynaecologist experienced in oncology has comprehensive responsibility for the treatment, supported by other specialists and the primary health service.
Onsrud
M
M
Gynekologisk avdeling Regionsykehuset i Trondheim 7006 Trondheim. mathiaso@frisurf.no
Hagen
B
B
Heimstad
R
R
D000328:Adult; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D007902:Length of Stay; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D010051:Ovarian Neoplasms / Q000150:complications / Q000401:mortality / Q000451:nursing / Q000628:therapy*; D010166:Palliative Care / Q000379:methods; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods; D014594:Uterine Neoplasms / Q000150:complications / Q000401:mortality / Q000451:nursing / Q000628:therapy*; D014846:Vulvar Neoplasms / Q000150:complications / Q000401:mortality / Q000451:nursing / Q000628:therapy*