Palliative Care — A Shifting Paradigm — NEJM

"....Despite the increasing availability of palliative care services in U.S. hospitals and the body of evidence showing the great distress to patients caused by symptoms of the illness,3 the burdens on family caregivers,4 and the overuse of costly, ineffective therapies during advanced chronic illness,5 the use of palliative care services by physicians for their patients remains low. Physicians tend to perceive palliative care as the alternative to life-prolonging or curative care — what we do when there is nothing more that we can do — rather than as a simultaneously delivered adjunct to disease-focused treatment.6...."

Menopausal symptoms in women undergoing chemotherapy-induced and natural menopause: a prospective controlled study - abstract

CONCLUSIONS: Women undergoing chemotherapy-induced menopause may experience worse symptoms than women undergoing natural menopause.

Review Symptom research in gynecologic oncology: A review of available measurement tools (abstract)

 define: heterogeneity - diverse and not comparable

 Results

Nine studies examined symptom assessment, quality-of-life assessment, or symptom indexes for various gynecologic cancers. Studies varied in design, patient profiles, symptoms assessed, and outcomes measured. Meta-analysis was not performed due to heterogeneity in the studies.

Conclusion

Although pain is well-studied and well-characterized, other disease-specific and general systemic symptoms of gynecologic cancers need better understanding and assessment. Accordingly, assessment of symptoms throughout the course of disease is crucial for treatment decisions and outcomes monitoring for patients with gynecologic cancer. This is especially true for survivors of gynecologic cancer, for patients whose treatment was unsuccessful, or for choosing between treatments with comparable survival outcomes. However, measurement and assessment of cancer-related symptoms is challenging because of the complex interaction between disease progression, multi-modality treatments, and symptoms. In this review, we evaluate the currently available symptom assessment tools for gynecologic cancers, along with quality-of-life assessment tools that include symptom items, and we give recommendations for further research.