Limited knowledge and access to palliative care among women with cervical cancer: an opportunity for integrating oncology and palliative care in Zimbabwe

O Tapera,A M Nyakabau

doi:10.1186/s12904-020-0523-5

Abstract

BackgroundCervical cancer is mostly diagnosed at advanced stages among the majority of women in low-income settings, with palliative care being the only feasible form of care. This study was aimed at investigating palliative care knowledge and access among women with cervical cancer in Harare, Zimbabwe.MethodsSequential mixed methods design was used, consisting of two surveys and a qualitative inquiry. A census of 134 women diagnosed with cervical cancer who visited two cancer treating health facilities and one palliative care provider in Harare between January and April, 2018 were enrolled in the study. Seventy-eight health workers were also enrolled in a census in the respective facilities for a survey. Validated structured questionnaires in electronic format were used for both surveys. Descriptive statistics were generated from the surveys after conducting univariate analysis using STATA. Qualitative study used interview/discussion guides for data collection. Thematic analysis was conducted for qualitative data.ResultsMean ages of patients and health workers in the surveys were 52 years (SD = 12) and 37 years (SD = 10,respectively. Thirty-two percent of women with cervical cancer reported knowledge of where to seek palliative care. Sixty-eight percent of women with cervical cancer had received treatment, yet only 13% reported receiving palliative care. Few women with cervical cancer associated treatment with pain (13%) and side effects (32%). More women associated cervical cancer with bad smells (81%) and death (84%). Only one of the health workers reported referring patients for palliative care. Seventy-six percent of health workers reported that the majority of patients with cervical cancer sourced their own analgesics from private pharmacies. Qualitative findings revealed a limited or lack of cervical cancer knowledge among nurses especially in primary health care, the existence of stigma among women with cervical cancer and limited implementation of palliative policy.ConclusionsThis study revealed limited knowledge and access to palliative care in a low-income setting due to multi-faceted barriers. These challenges are not unique to the developing world and they present an opportunity for low-income countries to start considering and strategizing the integration of oncology and palliative care models in line with international recommendations.

Highlights

Cervical cancer is mostly diagnosed at advanced stages among the majority of women in low-income settings, with palliative care being the only feasible form of care
While the government and its partners have been scaling up screening for cervical cancer using visual inspection with acetic acid cervicography (VIAC) and treatment of cervical precancers with cryotherapy and loop electrosurgical excision procedure (LEEP) across the country, diagnosis and treatment of cervical cancer is only available in two tertiary health facilities
Target population The target population for the study consisted of women with cervical cancer, men, caregivers, health workers and stakeholders working in the cancer spaces in Zimbabwe

Summary

Introduction

Cervical cancer is mostly diagnosed at advanced stages among the majority of women in low-income settings, with palliative care being the only feasible form of care. In Zimbabwe, cervical cancer is a growing public health burden and at least 1308 new cases were reported in 2016 [2]. About 80% of the cervical cancer cases present late in low-income settings when not much can be done to treat the disease. The majority of cervical cancer cases in developing countries are treated with palliative care interventions as curative modalities will not be effective due to advanced disease [3, 4]. The majority of cervical cancer cases are still presented in late stages with palliative care as the only treatment modality [4]. Demand for palliative care services among women with cervical cancer is growing with increasing burden

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