Role of palliative care intervention in patients with vulvar cancer: a retrospective study.

OBJECTIVE: To describe the experience of a Mexican cancer centre in vulvar cancer and the opportunity to incorporate palliative care (PC) during treatment. PATIENTS AND METHODS: A retrospective study of clinical and sociodemographic characteristics of women with vulvar cancer referred to the PC service (PCS) between 2010 and 2021 is reported. Frequencies were estimated, as well as medians and IQRs, accordingly. Referral time and overall survival were estimated using the Kaplan-Meier method. RESULTS: 125 women with vulvar cancer were seen between 2010 and 2021, but only 42% were seen at PCS, mostly polysymptomatic, after several visits to the emergency room. 89% of the patients seen at PCS died at home. CONCLUSIONS: Vulvar cancer is a rare type of cancer, while squamous cell carcinoma is the most frequent type. At the time of referral, almost half of the patients had severe pain, bleeding, malodor, infection and urinary incontinence. Most of these patients lived in poverty, were poorly educated and had multiple surgeries. PC may play an important role in the care of patients with advanced vulvar cancer, relieving the physical and psychological symptoms, avoiding unnecessary hospitalisation and favouring death at home without pain and other symptoms.

Tercera Cumbre Nacional de Delegados y Vocales de la Asociación Mexicana para Estudio y Tratamiento del Dolor (AMETD) / Third National Summit of Delegates and Vocals of the Mexican Association for the Study and Treatment of Pain (AMETD)

Resumen: La Asociación Mexicana para el Estudio y Tratamiento del Dolor nació en la década de los ochenta. Desde su fundación ha intervenido activamente en la educación continua de la nación y ha colaborado en la elaboración de documentos gubernamentales sobre diversos tópicos. En esta ocasión, durante la tercera reunión de delegados y vocales, se ponen a consideración diversas recomendaciones generales en materia de educación y regulación de opioides.

Abstract: The Mexican Association for the Study and Treatment of Pain was born in the eighties. Since its foundation, it has actively participated in the continuing education of the Nation and has collaborated in the preparation of government documents on various subjects. On this occasion, during the third meeting of delegates and members, various general recommendations regarding education and regulation of opioids are put for consideration.

Snapshot of symptoms of advanced cervical cancer patients referred to the palliative care service in a cancer center in Mexico.

OBJECTIVE: To report the clinical and demographic characteristics of patients with advanced cervical cancer referred to the palliative care service (PC) at a major cancer center in Mexico. METHODS: This is a retrospective cohort study of patients with advanced cervical cancer referred to the PC of INCan, between January 2011 and December 2015. Demographic and clinical characteristics at the time of admission to the INCan, time to referral to PC, initial Edmonton Symptom Assessment System evaluation, and follow up were recorded. RESULTS: In all, 359 patients were included, median age 51 years, predominantly poor with low education. Most patients 322 (90%) received tumor-specific treatment; presence of nephrostomies and other tumor-related complication was frequent. Median time to referral was 335 days, more than 180 (50%) had five or more symptoms, pain and fatigue were the most prevalent. CONCLUSION: Women with advanced cervical cancer have a high burden of symptoms; PC is only considered at the end of life. Efforts for an early referral to PC should be made.

Ketamine as augmentation for the treatment of major depression and suicidal risk in advanced cancer: Case report.

OBJECTIVE: Major depressive disorder (MDD) is common in patients diagnosed with advanced cancer (AC), with a prevalence of 16.5%. It is associated with great disability and worsened quality of life, increased number and intensity of physical symptoms, and lower survival. It is the main factor for the presence of suicidal ideation. Antidepressants show modest efficacy, and response requires several weeks. Ketamine has demonstrated a fast and robust antidepressant effect in subanesthetic doses. This effect may prove useful in patients with AC, MDD, and suicidal risk. METHOD: We report a case of a patient with advanced cervical cancer who presented with uncontrollable pain, MDD, and a suicide attempt. RESULT: A 39-year-old woman diagnosed with cervical cancer stage IVB presented to the Emergency Department after a suicide attempt by hanging. Upon evaluation by the palliative care psychiatrist, she reported intense pain, unresponsive to analgesics, and had a history of persistent suicidal ideation. Antidepressant treatment was started (sertraline 50mg/d) after a single dose of ketamine hydrochloride IV (0.5 mg/kg) was administered. Treatment response was measured using the Brief Edinburgh Depression Scale before and after the intervention. The depressive symptoms decreased by 17% on day 1, 39% on day 3, and 72% on day 17. SIGNIFICANCE OF RESULTS: This case report shows ketamine's efficacy as an augmentation agent alongside conventional antidepressant treatment in patients with AC. Moreover, it shows rapid response in suicidal ideation that has not been achieved with treatment as usual. More clinical trials are needed to support the potential benefit and safety of ketamine in patients with AC, MDD, and persisting suicidal ideation.