title: A review of patients with advanced cervical cancer presenting to palliative care services at Queen Elizabeth Central Hospital in Blantyre, Malawi.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  We reviewed the case files of 72 patients presenting to our hospital-based palliative care service over one year.
  
  
  RESULTS
  The mean age was 49.5 years. Twenty-six patients (36%) were HIV-positive 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: M J
authors.initials: MJ
authors.lastname: Bates
authors.affiliation: Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
authors.forename: A
authors.initials: A
authors.lastname: Mijoya
mesh_terms: D000328:Adult; D017677:Age Distribution; D019380:Anti-HIV Agents / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology / Q000523:psychology; D059408:Pain Management / Q000379:methods*; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data*; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012944:Social Support; D012959:Socioeconomic Factors; D014148:Tranexamic Acid / Q000627:therapeutic use; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D014592:Uterine Hemorrhage / Q000209:etiology / Q000628:therapy
chemical_list: D019380:Anti-HIV Agents; D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid