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Palliative care for women with cervical cancer: a public health imperative

Author: Tapati Dutta, PhD Student, Indiana University Bloomington
31 January 2017

Cervical cancer is the most common cancer affecting women in sub-Saharan Africa. January being Cervical Cancer Awareness Month, Tapati Dutta, a socio-behavioral scientist in community health, highlights sub-Saharan Africa's struggle with the disease.

This is part 1 of a 2 part series on cervical cancer in sub-Saharan Africa for Cervical Cancer Awareness Month.

There has been compelling literature which shows that for the majority of women who get infected with the human papillomavirus (HPV) infection, causal to cervical cancer, their bodies clear off the infection spontaneously. However, for many women the infection persists, and progresses to internal and external precancerous lesions, which, if left untreated, could develop into cervical cancer.

The stages of disease progression upon detection determines the treatment options for a woman with cervical cancer. Typically, it is treated through surgery or radiotherapy, where there is access to essential life saving technologies, with or without chemotherapy. However, in most cases, being asymptomatic in nature, cervical cancer mostly gets diagnosed at an advanced stage. Contingent to being diagnosed in the later stages, palliative care often becomes the only resort for intervention, while at some point, hospice care might also be offered.

Prolonging life and increasing its quality

As per the World Health Organization (1990), palliative care visualises dying as part of the normal life cycle, does not quicken or delay death, provides relief from pain and other upsetting symptoms. It includes the psychological, social, and spiritual aspects of care, offers a support system to help ill people live as actively as they can until death, and offers a support system to help family members cope during the sick person’s illness and in their own grief and mourning. Hospice, similarly, is a special care that treats the person rather than the disease and focuses on quality rather than length of life. Most of the time, it is rendered at home.

Acknowledging the value of palliative care for women affected by cervical cancer, Dr. Yvonne Karamagi, Director Clinical Services at Mildmay, Uganda, reiterates the value of early integration of palliative care in the treatment of women with advanced cancer of the cervix. She mentioned that “this would not just prolong life but would help improve quality of life too.”

“Though the understanding on palliative care and hospice is gradually increasing, the most important barrier to its early integration is a lack of proper understanding and scope of ‘palliative care’”, said Dr. (Prof.) David Serwadda, Professor and the Director of the Institute of Public Health at Makerere University in Kampala.

The predominant common perception, about palliative care among cancer survivors and their families continues to be synonymous with end-of-life care. According to African Palliative Care Association (APCA) Executive Director, Dr Emmanuel Luyirika, primary palliative care and specialty primary care services palliative care are both holistic approaches, "which encompass all aspects of the person and her caregivers or family members.” 

Summing up, the public health imperative of palliative care to address the high disease burden of cervical cancer in sub-Saharan Africa, needs to be recognized by a broad spectrum of stakeholders - service providers, policy makers, affected persons and their families. Alongside, care providers need to be trained on how to perform a comprehensive assessment, with an emphasis on the provision of psychosexual counselling.    

Resources to address palliative care misconceptions

The African Palliative Care Association (APCA), has published a Palliative Care for Women Living with HIV and Cervical Cancer (2013), with support from the Open Society Initiative for Southern Africa (OSISA). This resources provides basic Information for women in communities and is a valuable resource for community level care givers and family members who support the women living with HIV (WLHIV) and cervical cancer and are in need of palliative care.

The resource, is available both in hard copy and digitally in English, Portuguese and French. It is a basic guide on the role of palliative care among WLHIV and cervical cancer, to survivors, their families and care providers while also serves as an effective sensitization tool for the communities at large. 

Tapati Dutta, is a socio-behavioral scientist in community health and currently in her second year doctoral studies at the School of Public Health, Indiana University Bloomington, majoring in Health Behavior and Health Policy. Her research emphasis on multi-level community engagement in cervical cancer prevention policies, addressing vaccine confidence challenges, particularly in resource-limited country settings; focusing on both, community perspective of this engagement as well as the indicators of engagement that are policy artefacts.

This article was originally published on the Africa edition of ehospice.

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