title: Retrospective review of symptoms and palliative care interventions in women with advanced cervical cancer.
abstract: OBJECTIVE
  The objective of this study was to delineate and measure the symptom distress experienced by patients with advanced cervical cancer at the time of palliative care (PC) referral.
  
  
  METHODS
  A total of 156 patients with advanced cervical cancer were referred to PC from 2010 to 2012. Of these, 88 patients had completed the Edmonton Symptom Assessment System (ESAS) and were included in the analysis.
  
  
  RESULTS
  The mean age was 45years (25-76), 47% were white, 18% were African American, and 33% were Hispanic. Fifty-one percent were married, 64% had no advance directives, and 75% had recurrent disease. Clinically significant symptoms recorded by patient reported outcome measurement (defined as ESAS scores ≥4) were pain (81%), anorexia (72%), a poor feeling of well-being (70%), fatigue (69%), and insomnia (54%). The chief complaint recorded for the visit was pain in 94% of patients. According to the PC specialists' assessment, pain (96%), emotional distress (77%), and constipation (50%) were predominant symptoms. Various PC interventions including opioids, laxatives, and expressive supportive counseling were provided. Clinically significant symptoms including nausea, depression, anxiety, and feeling of well-being were significantly improved at follow-up visits.
  
  
  CONCLUSIONS
  More than half of patients with advanced cervical cancer were significantly burdened with pain, anorexia, a poor feeling of well-being, fatigue, insomnia, and constipation at the time of PC referral. This research is an integral step towards developing a standardized tool for assessing symptoms in women diagnosed with cervical cancer and thus maximizing effectiveness of patient centered care.
authors.affiliation: Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Yu Jung
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Mark F
authors.initials: MF
authors.lastname: Munsell
authors.affiliation: Division of Hematology-Oncology, Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Republic of Korea.
authors.forename: Ji Chan
authors.initials: JC
authors.lastname: Park
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Larissa A
authors.initials: LA
authors.lastname: Meyer
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Charlotte C
authors.initials: CC
authors.lastname: Sun
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Alaina J
authors.initials: AJ
authors.lastname: Brown
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Diane C
authors.initials: DC
authors.lastname: Bodurka
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Janet L
authors.initials: JL
authors.lastname: Williams
authors.affiliation: Division of Gynecologic Oncology St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
authors.forename: Dana M
authors.initials: DM
authors.lastname: Chase
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
authors.affiliation: Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. Electronic address: lramonde@mdanderson.org.
authors.forename: Lois M
authors.initials: LM
authors.lastname: Ramondetta
mesh_terms: D000328:Adult; D000368:Aged; D000855:Anorexia / Q000209:etiology / Q000628:therapy; D001007:Anxiety / Q000188:drug therapy / Q000209:etiology; D003248:Constipation / Q000188:drug therapy / Q000209:etiology; D003863:Depression / Q000209:etiology / Q000628:therapy; D005221:Fatigue / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009325:Nausea / Q000188:drug therapy / Q000209:etiology; D010146:Pain / Q000188:drug therapy / Q000209:etiology; D010166:Palliative Care; D012189:Retrospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy / Q000209:etiology; D013315:Stress, Psychological / Q000209:etiology / Q000628:therapy; D063189:Symptom Assessment / Q000379:methods*; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000523:psychology / Q000628:therapy*
keywords: Advanced cervical cancer; Palliative care intervention; Symptom