Indian J Palliat Care Home 

Year : 2005  |  Volume : 11  |  Issue : 2  |  Page : 62--63

Doubly disadvantaged - dying of cervical cancer

Reena George 
 Christian Medical College,Vellore, India

Correspondence Address:
Reena George
Christian Medical College,Vellore

How to cite this article:
George R. Doubly disadvantaged - dying of cervical cancer.Indian J Palliat Care 2005;11:62-63

How to cite this URL:
George R. Doubly disadvantaged - dying of cervical cancer. Indian J Palliat Care [serial online] 2005 [cited 2021 May 10 ];11:62-63
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Full Text

71, 000 women are estimated to die of cervical cancer each year in India.[1],[2] The majority of these are very preventable and very painful deaths. These women die because they have not had access to effective screening methods that have reduced mortality in many parts of the world.[3] And as they die, they are even less likely to receive effective palliative care than other patients in India.This is not just because they are poor women, living in rural areas far away from our palliative care clinics, not just because the quality of death of such a person is unimportant in our scheme of things, but also because there is very little information on the palliative care needs of this voiceless group.

We are making a small attempt to bridge this gap- through this special issue on Ca cervix, and through the online edition of the Indian Journal of Palliative Care.[4] The website provides free full text articles of the current and recent issues of the journal; as well as links to guidelines, addresses, and educational resources in palliative care. We hope that these would be useful to palliative care workers in the resource poor world who do not have easy access textbooks and journals.

In this issue of the journal, the articles by Palat et al and Das et al discuss pain in cervical cancer. Lumbosacral plexopathy, renal impairment and rectal obstruction present challenging pain management problems.[5],[6] The paper by Lee and colleagues reviews the oncologic management of relapsed cervical cancer, highlighting the clinical situations where patients should be referred for potentially curative therapy; as well as the burden/ benefit balance of the various palliative interventions available on the market.[7] Nursing research has improved the care of patients with fungating wounds and lymphoedema but financial and educational constraints have prevented these benefits from trickling down into the developing world. Ananthi and Casilda et al share low cost adaptations of palliative nursing methods for wound care and lymphoedema.[8],[9]

For all this to reach the patient, palliative care coverage needs to improve. Jan Sterjnsward, former chief WHO cancer division, draws attention to the community based palliative care initiative in Northern Kerala- organized, funded and run by community volunteers; as a model that has much to teach the world.[10],[11]

Another intervention using trained lay volunteers has evaluated different methods of screening for cervical cancer.[12] trained women to collect cytology specimens and peform visual inspection screening for cervical cancer in Mumbai. In addition health care workers were trained in cytology, cryotherapy and loop electrosurgical excision procedure (LEEP).[1],[2],[13] The results of this study suggest that despite a slightly lower specificity, visual inspection techniques with acetic acid and Lugol's iodine may be promising screening techniques in resource poor settings where good quality cytology and HPV testing are not possible. Visual inspection tests have the additional advantage that further diagnostic investigations and treatment can be undertaken at the same setting as results are immediately available. This work was funded by the The Bill and Melinda Gates Foundation through the Alliance for Cervical Cancer Prevention (ACCP) set up to prevent cervical cancer in developing countries.[14] With appropriate funding and training, the community model for palliative care can justifiably be extended to cervical cancer screening.

A different sort of networking is also needed between palliative care associations in resource poor countries. We need culturally sensitive research into psychosocial and physical concerns. We have to use the limited evidence we have, to develop cost effective guidelines for troublesome symptoms- fistulae, bleeding, vaginal discharge and lymphoedema. These can then be audited and reviewed.

Palliative care in cervical cancer is but one example of a problem that should be the focus of research in the resource poor world, precisely because it is no longer a significant need in countries where research is better funded and supported. We also need to recognize, prioritize and explore many other issues which concern our patients, but remain unaddressed within the blind spot of academic medicine.


1Sankaranarayanan R, Nene BM, Dinshaw K, Rajkumar R, Shastri S, Wesley R, et al. Early detection of cervical cancer with visual inspection methods: a summary of completed and on-going studies in India. Salud Publica de Mexico 2003;45:S274-82.
2Sankaranarayanan R, Wesley R. A practical manual on visual screening for cervical neoplasia. Lyon: IARC Press; 2003a (IARC Technical Publication No. 41).
3IARC Working Group on Cervical Cancer Screening. Summary chapter. In: Hakama M, Miller AB, Day NE, editors. Screening for cancer of the uterine cervix. Lyon: IARCPress; 1986. p. 133-42 (IARC Scientific Publications No. 76).
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5Palat G, Rajagopal MR, Biji MS. Assessment and management of pain in cancer cervix. Indian J Palliat Care 2005;11.
6Das S, Jenifer J, George R. Cancer and treatment related pains in patients with cervical carcinoma. Indian J Palliat Care 2005;11.
7Lee Hsueh Ni, Patel F, Chakraborty S, Sharma S. The oncologic management of carcinoma cervix after primary treatment failure. Indian J Palliat Care 2005;11.
8Ananthi G. Nursing measures for lymphoedema in gynaecologic cancers. Indian J Palliat Care 2005;11.
9Casilda S, Krishnaswammy. Wound care in resource poor settings. Indian J Palliat Care 2005;11.
10Stjernsward J. Community participation in palliative care. Indian J Palliat Care 2005;11.
11Paleri A, Numpeli M. The evolution of palliative care programmes in North Kerala reference. Indian J Palliat Care 2005;11;15-8.
12Shastri S, Dinshaw K, Amin G, Goswami S, Patil S, Chinoy R, et al. Concurrent evaluation of visual, cytological and HPV testing as screening methods for the early detection of cervical neoplasia in Mumbai, India. Bull World Health Organ vol. 83 no. 3 Genebra Mar. 2005.
13Sellors J, Sankaranarayanan R. Colposcopy and treatment of cervical intraepithelial neoplasia: A beginners' manual. Lyon: IARC Press; 2003.
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