Treatment and Palliative Care

Care for Women with Cervical Cancer

Many women, especially in low and low-middle income countries, are diagnosed with advanced stage cervical cancer, where the cancer has spread to other parts of the body.

Health facilities in low-and middle countries are currently faced with limited equipment and trained professionals to treat cervical cancer.

The provision of timely, accessible high-quality treatment gives women the best chance of cure or optimal management of their cancer.

Early and late stage disease treatment options may include surgery, radiotherapy and chemotherapy.

Timely treatment, pain management and palliative care are essential components to achieve elimination and important for dignity, comfort, and wellbeing of women living with cervical cancer.

Civil society groups, including cervical cancer patients and survivors play an important role in supporting patient navigation, identifying weaknesses in the health system, advocating for change, and providing information to the community.

Treatment Overview

Screening services aim to detect abnormal cells and treat (ablate) them, before they become cervical cancer. However, in some cases cervical cancer may be suspected upon screening, in which case, women should not be treated but instead should be promptly referred to a facility for diagnosis and treatment. No woman should be lost to the health system between screening and diagnosis and treatment. Effective patient-centered referral mechanisms that minimize inconvenience to patients must be established for suspicious cases to be further managed and tracked.

Early stage cervical cancer is highly treatable by surgery and/or radiotherapy that can result in long-term survival and/or cure. The five-year survival rate for early stage cancer is more than 80% in countries where timely diagnosis and high-quality treatment are available. Surgery and radiotherapy, with or without chemotherapy, are among the cost-effective interventions WHO recommends for early-stage cervical cancer. Even some locally advanced cervical cancers are curable with high-quality radiotherapy and chemotherapy.

Poor and inequitable access to standard treatment and palliative care are often due to weak infrastructure, lack of trained professionals, lack or unreliable availability of treatment and financial challenges that must be addressed. Additionally, women in low- and low-middle income countries and marginalized communities often face social and/or cultural barriers that can impact their ability to seek care early and complete treatment and follow-up care. Many of these women continue to present with invasive cancers, necessitating costlier treatment, often with poor outcomes.

Demonstrating good care and positive outcomes for women diagnosed with cervical cancer will address fear and stigma of this debilitating cancer and help shape the readiness of women to engage in prevention and early detection. Part of demonstrating good care for women with diagnosed cervical cancer involves addressing the great suffering that the disease can cause. Pain management and palliative care are essential components to achieve elimination and important for dignity, comfort, and wellbeing of women living with cervical cancer.

Palliative Care Overview

Palliative care must be integrated into treatment plans and provided throughout the course of the disease. In addition to managing pain and other distressing symptoms, palliative care needs to encompass psychosocial and spiritual care for women and their families. Where possible, home-based models of palliative care should be integrated into primary health care. Treatment plans should not only be about end-of-life care and pain relief for patients but also about support and services to improve the comfort and wellbeing of women from the outset of the disease.

Currently, very few LMICs have palliative programs. Countries are encouraged to expand the availability of palliative services, which could readily be extended to other forms of advanced cancers and chronic illnesses.  Provisions for palliative care need to be included in cancer planning and budgets.

Action for Elimination

In addition to preventing 70 million cases of cervical cancer by the end of the century, achieving the elimination goal will also avert 62 million deaths due to cervical cancer. On average the current mortality rate of cervical cancer is 3 times higher for low and medium HDI (human development index) countries as compared to high HDI countries.

But real progress is possible. Investments in strengthening health systems; strengthening pathology services, ensuring adequate staffing, education and training for staff and improving access to radiotherapy and chemotherapy will be critical.

Action for Elimination

Implementation plans must be addressed by governments through evidenced-based polices, and strategies costed through national budgets, as part of a national cancer control plan. This will provide high returns for cervical cancer outcomes, as well as building capacity to address other cancers.

Integration of treatment and palliative care services across cancer type will increase the capacity to provide community-near services. This will particularly improve comfort and wellbeing for women diagnosed in late stages who need support and palliative care at home. Timely treatment, pain management and palliative care are essential components for ending cervical cancer and for ensuring the dignity, comfort, and wellbeing of women living with cervical cancer.

The WHO cervical cancer elimination strategy target is 90% of women identified with cervical disease are treated by 2030:

  • 90% of women with pre-cancer treated.
  • 90% of women with invasive cancer managed.