Abstract :

Background and aim: Gynecological cancers, including ovarian, cervical, and uterine cancers, are among the most prevalent malignancies affecting women globally. Patients with these cancers frequently encounter substantial physical, psychological, and social challenges. This systematic review aims to evaluate the existing quantitative evidence on palliative care interventions that offer coping skills that facilitate the quality of life and psychological well-being of women with Gynecological Cancers.

Method: PubMed, Google Scholar, Clinical Key, and Cochrane Reviews databases were searched from 2000 to 2024. Articles in English with quantitative evidence were screened to determine whether the population included women with gynecological cancers, whether interventions were related to offering coping skills, whether control groups were available, and whether outcomes were related to psychological well-being and quality of life. Data were extracted to report on intervention models, outcome measures, and intervention outcomes. The risk of bias on randomization, allocation concealment, blinding, incomplete outcome data, selection of outcomes for reporting, and other biases was assessed by using the RoB 2, ROBINS I, and ROBINS E. Two independent reviewers were involved in all the above steps, with a third contributing to solving discrepancies. Meta-analysis was not done following heterogeneity assessments.

Results: Searches returned 297 unique articles, with twelve being for review. There were eight randomized controlled trials (RCT), two quasi-experimental trials, one cohort study, and one comparative study. The interventions or exposures included: group therapy based on coping strategies, supportive and coordinated care, communication therapies, mindfulness sessions, educational sessions, psychological counseling, and use of engagement in active coping and seeking social support. Seven studies measured psychological outcomes, six using multidimensional instruments. Five studies measured quality of life, and three used multidimensional instruments. Across the evaluated outcomes, the results consistently and significantly indicated benefits linked to providing coping skills. The majority of RCTs show significant (<0.05) improvement in quality of life with the coping skills from the baseline to the endpoint as interval measures and Growth curve analyses based on the intent-to-treat approach showed that participants in both the coping and communication-enhancing intervention (CCI) and supportive counseling (SC) groups reported lower levels of depressive symptoms compared to those receiving usual care In the Quasi-experimental trials survival expectancy by group interaction (β = 5.102, P = 0.044) was significant as well the patients who survived throughout the study, changes in FACT-G score were greater over time for patients with high survival expectancy in the treatment group compared to with all other patients.

Conclusion: Palliative care interventions offering coping skills are effective in supporting women with gynecological cancers. These interventions significantly contribute to enhancing their mental and emotional well-being and overall quality of life.

---

Keywords :

coping skills, Gynecological Cancers, Palliative care, systematic review.

---

References :

1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–249.
2. Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, Bray F. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. Lancet Glob Health. 2020;8(2):e191–203.
3. Denny L, Anorlu R. Cervical cancer in Africa. Cancer Epidemiol Biomarkers Prev. 2012;21(9):1434–1438.
4. Sekse RJT, Hufthammer KO, Vika ME, Ellertsen B, Råheim M. Fatigue and quality of life in women treated for various types of gynecological cancers: A cross-sectional study. J Obstet Gynaecol. 2014;34(5):476–80.
5. Bodurka-Bevers D, Basen-Engquist K, Carmack CL, Fitzgerald MA, Wolf JK, de Moor C, Gershenson DM. Depression, anxiety, and quality of life in patients with epithelial ovarian cancer. Gynecol Oncol. 2000;78(3 Pt 1):302–308.
6. Ozga M, Lobczowska K, Grodzki T, Rzechonek A, Dziedzic R. Body image in patients undergoing surgery for gynecological malignancies. Psychooncology. 2021;30(1):104–110.
7. Hersch J, Juraskova I, Price MA, Mullan B, Butow P. Psychological distress in women with gynecologic cancer: A systematic review of longitudinal studies. Gynecol Oncol. 2009;114(3):598–604.
8. Cormie P, Galvão DA, Newton RU, Hayes SC. Exercise therapy in cancer: why it is needed, how it works, and what it can achieve. Nat Rev Clin Oncol. 2018;15(12):731–745.
9. Faller H, Schuler M, Richard M, Heckl U, Weis J, Küffner R. Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: systematic review and meta-analysis. J Clin Oncol. 2013;31(6):782–793.
10. Kissane DW, Patel SG, Baser RE, Bell R, Farberov M, Ostroff JS, et al. Prevalence of depression and anxiety in patients with cancer undergoing radiotherapy: a longitudinal study. J Clin Oncol. 2008;26(35):6069–6075.
11. World Health Organization. Palliative care. https://www.who.int/news-room/fact-sheets/detail/palliative-care. Accessed June 2024.
12. Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology Clinical Practice Guideline update. J Clin Oncol. 2017;35(1):96–112.
13. Kaasa S, Loge JH, Aapro M, Albreht T, Anderson R, Bruera E, et al. Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol. 2018;19(11):e588–653.
14. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, et al. Early palliative care for patients with metastatic non–small-cell lung cancer. N Engl J Med. 2010;363(8):733–742.
15. Haun MW, Estel S, Rücker G, Friederich HC, Villalobos M, Thomas M, Hartmann M. Early palliative care for adults with advanced cancer. Cochrane Database Syst Rev. 2017;(6):CD011129.
16. Applebaum AJ, Breitbart W. Palliative care in psycho-oncology. Cancer J. 2013;19(5):394–401.
17. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Palliative Care. Version 2.2023.
18. Folkman S, Moskowitz JT. Positive affect and the other side of coping. Am Psychol. 2000;55(6):647–654.
19. Stanton AL, Rowland JH, Ganz PA. Life after diagnosis and treatment of cancer in adulthood: contributions from psychosocial oncology research. Am Psychol. 2015;70(2):159–174.
20. Garland SN, Tamagawa R, Todd SC, Speca M, Carlson LE. Increased mindfulness is related to improved stress and mood following participation in a mindfulness-based stress reduction program in individuals with cancer. Integr Cancer Ther. 2013;12(1):31–40.
21. Breitbart W, Poppito S, Rosenfeld B, Vickers AJ, Li Y, Abbey J, et al. Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer. J Clin Oncol. 2012;30(12):1304–1309.
22. Pennebaker JW. Writing about emotional experiences as a therapeutic process. Psychol Sci. 1997;8(3):162–166.
23. Walczak A, Butow PN, Bu S, Clayton JM. A systematic review of evidence for end-of-life communication interventions: who do they target, how are they structured, and do they work? Patient Educ Couns. 2016;99(1):3–16.
24. Epstein RM, Street RL Jr. The values and value of patient-centered care. Ann Fam Med. 2011;9(2):100–103.