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What Is the Appropriate Approach to Treating Women With Incurable Cervical Cancer?

Lois Ramondetta

Women should not die of cervical cancer...but they do. Most cases of cervical cancer are preventable and, if caught early, highly curable. Despite this, cervical cancer is the second most common cause of cancer death in women worldwide. Unfortunately, cure is less likely when the disease is diagnosed at an advanced stage. Treatment of locally advanced disease often has serious lifelong side effects, including cystitis, proctitis, intestinal strictures, fistulas, vaginal agglutination/sexual dysfunction, and chronic pain. Unresectable recurrent disease may be associated with all these symptoms, in addition to disturbing malodorous discharge and bleeding and a life expectancy of less than 6 to 10 months. Supportive/palliative care interventions are needed at diagnosis and recurrence. Honest, conflict-free conversations about potential for response and expectations are needed for women with recurrent disease to help preserve and improve quality of life and avoid treatments that offer no benefit. Aims of trial design should include not only molecular targeting but also supportive care objectives, such as reducing pain, anxiety, depression, cachexia, and fatigue. A β-adrenergic blockade could potentially be part of these intervention trials. This article addresses the following questions and issues: whether therapeutic treatment of incurable cervical cancer is ever appropriate, the common symptoms of recurrent cervical cancer, the quantifying benefits of treatment, decision aids in treatment planning, doctor-patient candor, and integrating psychosocial factors into treatment.