Skip to main content
SpringerLink
Log in

Palliative Care

  • Chapter
  • First Online:
Gynecologic Oncology

  • 2323 Accesses

Abstract

Women with gynecological cancers deserve to have their pain and symptoms managed throughout the course of their illness. This chapter discusses the essentials of pain and symptom management that a physician needs to provide quality primary palliative care for these patients. The first half of this chapter discusses opioids, their conversion, and non-opioid pain management, such as anti-inflammatories and neuropathic pain agents. The rest of the chapter discusses the management of common symptoms, such as depression, constipation, nausea and vomiting, bowel obstruction, ascites, and dyspnea. The discussion emphasizes a practical and systematic approach to symptom management. For example, the recommendation of an antidepressant is based on matching the beneficial side effects to the patients’ other problems. The relative advantages and disadvantages of laxatives are presented to aid in the selection of a laxative the patient will take. Treatment suggestions are offered for refractory constipation. Structured approaches are provided for the management of nausea, vomiting and dyspnea. Treatment options for bowel obstructions and ascites are given in the context of their pathophysiology and based on risks and benefits.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. WHO Definition of Palliative Care. http://www.who.int/cancer/palliative/definition/en/. Accessed 5 June 2014.

  2. Pantilet S, Anderson W, Gonzales M, et al. Hospital-based palliative medicine: a practical, evidence-based approach. Copyright © 2015 by John Wiley & Sons, Inc. Pre-publication.

    Google Scholar 

  3. Ferris and Pirrello. Improving equianalgesic dosing for chronic pain management. American Association for Cancer Education Annual Meeting Presentation, Cincinnati, OH, Sept 2005.

    Google Scholar 

  4. Attal N, Cruccu G, Baron R, Haanpää M, et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010;17(9):1113–e88.

    Article  CAS  PubMed  Google Scholar 

  5. Chase DM, Monk BJ, et al. Supportive care for women with gynecologic cancers. Expert Rev Anticancer Ther. 2008;8(2):227–41.

    Article  PubMed  Google Scholar 

  6. Kirkova J, Davis MP, et al. Cancer symptom assessment instruments: a systematic review. J Clin Oncol. 2006;24:1459–73.

    Article  PubMed  Google Scholar 

  7. Chochinov HM, Wilson KG, et al. Are you depressed? screening for depression in the terminally ill. Am J Psychiatry. 1997;154:674–6.

    CAS  PubMed  Google Scholar 

  8. Li M, Fitzgerald P, Rodin G. Evidence-based treatment of depression in patients with cancer. J Clin Oncol. 2012;30:1187–96.

    Article  PubMed  Google Scholar 

  9. Gao K, Sheehan DV, Calabrese JR. Atypical antipsychotics in primary general anxiety disorders or comorbid with mood disorders. Expert Rev Neurother. 2009;9(8):1147–58.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  10. Tarumi Y, Wilson MP, Szafran O, Spooner GR. Randomized, double-blind, placebo-controlled trial of oral docusate in the management of constipation in hospice patients. J Pain Symptom Manage. 2013;45(1):2–13.

    Article  PubMed  Google Scholar 

  11. Thomas J, Karver S, Cooney GA, Chamberlain BH, et al. Methylnaltrexone for opioid-induced constipation in advanced illness. N Engl J Med. 2008;358(22):2332–43.

    Article  CAS  PubMed  Google Scholar 

  12. Pothuri B, Montemarano M, Gerardi M, Shike M, et al. Percutaneous endoscopic gastrostomy tube placement in patients with malignant bowel obstruction due to ovarian carcinoma. Gynecol Oncol. 2005;96(2):330–4.

    Article  PubMed  Google Scholar 

  13. Matulonis UA, Seiden MV, Roche M, Krasner C, et al. Long-acting octreotide for the treatment and symptomatic relief of bowel obstruction in advanced ovarian cancer. J Pain Symptom Manage. 2005;30(6):563–9.

    Article  CAS  PubMed  Google Scholar 

  14. Ripamonti CI, Easson AM, Gerdes H. Management of malignant bowel obstruction. Eur J Cancer. 2008;44(8):1105–15.

    Article  PubMed  Google Scholar 

  15. Ripamonti C, Twycross R, Baines M, Bozzetti F, et al. Clinical-practice recommendations for the management of bowel obstruction in patients with end-stage cancer. Support Care Cancer. 2001;9(4):223–33.

    Article  CAS  PubMed  Google Scholar 

  16. de Bree E, Koops W, Kröger R, van Ruth S, et al. Peritoneal carcinomatosis from colorectal or appendiceal origin: correlation of preoperative CT with intraoperative findings and evaluation of interobserver agreement. J Surg Oncol. 2004;86(2):64–73.

    Article  PubMed  Google Scholar 

  17. Jacquet P, Jelinek JS, Steves MA, Sugarbaker PH. Evaluation of computed tomography in patients with peritoneal carcinomatosis. Cancer. 1993;72(5):1631–6.

    Article  CAS  PubMed  Google Scholar 

  18. Rath KS, Loseth D, Muscarella P, Phillips GS, et al. Outcomes following percutaneous upper gastrointestinal decompressive tube placement for malignant bowel obstruction in ovarian cancer. Gynecol Oncol. 2013;129(1):103–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Harding V, Fenu E, Medani H, Shaboodien R, et al. Safety, cost-effectiveness and feasibility of daycase paracentesis in the management of malignant ascites with a focus on ovarian cancer. Br J Cancer. 2012;107(6):925–30.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Fleming ND, Alvarez-Secord A, Von Gruenigen V, Miller MJ, Abernethy AP. Indwelling catheters for the management of refractory malignant ascites: a systematic literature overview and retrospective chart review. J Pain Symptom Manage. 2009;38(3):341–9.

    Article  PubMed  Google Scholar 

  21. Becker G, Galandi D, Blum HE. Malignant ascites: systematic review and guideline for treatment. Eur J Cancer. 2006;42(5):589–97.

    Article  PubMed  Google Scholar 

  22. Woopen H, Sehouli J. Current and future options in the treatment of malignant ascites in ovarian cancer. Anticancer Res. 2009;29(8):3353–9.

    PubMed  Google Scholar 

  23. Runyon BA. Management of adult patients with ascites due to cirrhosis: update. 2012. http://www.aasld.org/practiceguidelines/Documents/ascitesupdate2013.pdf. Accessed 11/12/13.

  24. Sangisetty SL, Miner TJ. Malignant ascites: a review of prognostic factors, pathophysiology and therapeutic measures. World J Gastrointest Surg. 2012;4(4):87–95.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Numnum TM, Rocconi RP, Whitworth J, Barnes MN. The use of bevacizumab to palliate symptomatic ascites in patients with refractory ovarian carcinoma. Gynecol Oncol. 2006;102(3):425–8.

    Article  CAS  PubMed  Google Scholar 

  26. Hamilton CA, Maxwell GL, Chernofsky MR, Bernstein SA, Farley JH, Rose GS. Intraperitoneal bevacizumab for the palliation of malignant ascites in refractory ovarian cancer. Gynecol Oncol. 2008;111(3):530–2.

    Article  CAS  PubMed  Google Scholar 

  27. Stewart MW, Grippon S, Kirkpatrick P. Aflibercept. Nat Rev Drug Discov. 2012;11(4):269–70.

    Article  CAS  PubMed  Google Scholar 

  28. Stewart MW. Aflibercept (VEGF Trap-eye): the newest anti-VEGF drug. Br J Ophthalmol. 2012;96(9):1157–8.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Gaya A, Tse V. A preclinical and clinical review of aflibercept for the management of cancer. Cancer Treat Rev. 2012;38(5):484–93.

    Article  CAS  PubMed  Google Scholar 

  30. Teng LS, Jin KT, He KF, Zhang J, Wang HH, Cao J. Clinical applications of VEGF-trap (aflibercept) in cancer treatment. J Chin Med Assoc. 2010;73(9):449–56.

    Article  CAS  PubMed  Google Scholar 

  31. Colombo N, Mangili G, Mammoliti S, et al. A phase II study of aflibercept in patients with advanced epithelial ovarian cancer and symptomatic malignant ascites. Gynecol Oncol. 2012;125(1):42–7.

    Article  CAS  PubMed  Google Scholar 

  32. Gotlieb WH, Amant F, Advani S, et al. Intravenous aflibercept for treatment of recurrent symptomatic malignant ascites in patients with advanced ovarian cancer: a phase 2, randomised, double-blind, placebo-controlled study. Lancet Oncol. 2012;13(2):154–62.

    Article  CAS  PubMed  Google Scholar 

  33. Clemens KE, Quednau I, Klaschik E. Is there a higher risk of respiratory depression in opioid-naïve palliative care patients during symptomatic therapy of dyspnea with strong opioids? J Palliat Med. 2008;11(2):204–16.

    Article  PubMed  Google Scholar 

  34. Gomutbutra P, O'Riordan DL, Pantilat SZ. Management of moderate-to-severedyspnea in hospitalized patients receiving palliative care. J Pain Symptom Manage. 2013;45(5):885–91.

    Article  PubMed  Google Scholar 

  35. Davidson PM, Johnson MJ. Update on the role of palliative oxygen. Curr Opin Support Palliat Care. 2011;5(2):87–91.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Irvine Medical Center, University of California, 101 The City Drive, Bldg 26, ZC 4076H, Orange, CA, 92868, USA

    Solomon Liao M.D., F.A.A.H.P.M. & Jamie Capasso D.O.

  2. Department of Pharmacy Services, UC Irvine Health Department of Pharmacy Services, Irvine Medical Center, University of California, 101 The City Drive, Orange, CA, 92868, USA

    Rosene D. Pirrello Pharm.D.

  3. Providence Trinity Care Hospice, 5315 Torrance Blvd, Torrance, CA, 90503, USA

    Rebecca Liddicoat Yamarik M.D.

Authors
  1. Solomon Liao M.D., F.A.A.H.P.M.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rosene D. Pirrello Pharm.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rebecca Liddicoat Yamarik M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jamie Capasso D.O.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Solomon Liao M.D., F.A.A.H.P.M. .

Editor information

Editors and Affiliations

  1. Dept. of Obstetrics and Gynecology Building 56, Suite 260, University of Calfornia, Irvine Irvine Medical Center, Orange, California, USA

    Ramez N. Eskander

  2. Dept. of Obstetrics and Gynecology Building 56, Room 260, University of California, Irvine Irvine Medical Center, Orange, California, USA

    Robert E. Bristow

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer Science+Business Media New York

About this chapter

Cite this chapter

Liao, S., Pirrello, R.D., Yamarik, R.L., Capasso, J. (2015). Palliative Care. In: Eskander, R., Bristow, R. (eds) Gynecologic Oncology. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1976-5_9

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-1976-5_9

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-1975-8

  • Online ISBN: 978-1-4939-1976-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation