Palliative Care for Ovarian Cancer in Low- and Lower-Middle-Income Countries: A Scoping Review.

Abstract

Low- and lower-middle-income countries (LMICs) experience the highest mortality from gynecologic cancers globally. Previous literature has focused on the palliative management of cervical cancer and identified interventions that improve quality of life (QoL). There is limited research on the palliative management of ovarian cancer in LMICs, where high symptom burden and inconsistent access to health care present different challenges. This scoping review describes the state of the literature on palliative care for ovarian cancer in LMICs and highlights areas for future research. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses-ScR guidelines, we identified articles describing ovarian cancer burden and palliative symptom management in LMICs. Four databases (PubMed, Excerpta Medica database, Web of Science, Center for Agriculture and Biosciences International) were queried with terms developed by a health-sciences librarian. A total of 34 articles from nine LMICs were selected for full-text review. Three themes were identified in LMICs when compared with high-resource settings: (1) ovarian cancer frequently presents at advanced stages with poor disease-specific, functional, and social QoL; (2) access to comprehensive health systems and technology is limited, so cost-effective, home-based palliative care services provide an alternative in these settings; and (3) there are key differences in palliative treatment algorithms for advanced or recurrent ovarian cancer between LMICs and high-income countries. Ovarian cancer can be a significant burden to patients in LMICs. When available, palliative care has effectively improved QoL; however, there are key differences in symptom management when compared with high-resource settings. Future work in LMICs settings should target cost-effective, evidence-based, and standardized approaches to palliative care for patients with ovarian cancer.