RESUMO
BACKGROUND: Endometriosis is a chronic, inflammatory condition characterised by the presence of endometrial-like tissue outside the uterine cavity. Given the multi-system nature of the disease and the potential for significant negative impact on quality of life, there has been a long-standing recognition of the need for multidisciplinary care for people with endometriosis. However, there is paucity to the data supporting this approach, and much of the evidence is anecdotal. AIM: This systematic review aims to describe recent evidence-based models and patient-centred perspectives of multidisciplinary care for endometriosis, to improve understanding of the role of an integrated, multidisciplinary team in effectively addressing patients' care needs. MATERIALS AND METHODS: PubMed, Medline, Embase and Web of Science were searched for relevant articles published between 1 January 2010 to 7 July 2022. RESULTS: Nineteen studies met the inclusion and exclusion criteria and pinpointed a multidisciplinary team consisting of gynaecologists, pain specialists, nurses, physiotherapists, psychologists, sex therapists, nutritionists, complementary medicine practitioners, and social workers to be most commonly utilised in holistically managing people with pelvic pain and endometriosis. Furthermore, patient perspectives on care highlighted the need for reliable information, respect and validation of experiences or preferences, discussion of long-term treatment plans and social and emotional supports. CONCLUSION: The trend for multidisciplinary team care for people with endometriosis is growing. Further consumer-driven clinical studies and outcome evaluations need to be conducted to determine the effect of multidisciplinary care on improvements to quality of life for people living with endometriosis and or pelvic pain.
RESUMO
Stabilisation of disease (as well as objective response) is an important outcome in the treatment of cancer. To test the hypothesis that chemotherapy brings positive Quality of Life (QoL) benefits when disease stabilisation is achieved, a utility study involving 30 UK nurses experienced in oncology care has been carried out. Acting as proxies for cancer patients, the nurses were asked to assess the values of various health states associated with the treatment of metastatic colorectal cancer. The nurses rated the QoL benefits of stabilisation almost as highly as those of partial response (Utility score of 0.95 vs. 1). Side-effects associated with chemotherapy, however, mean that active management of toxicity is needed to preserve QoL benefits. More than 50% of metastatic colorectal cancer patients have a partial response or have their disease stabilised with the new topoisomerase I inhibitor (irinotecan, CAMPTO®). It is indicated for use when treatment with 5-fluorouracil (5-FU) has failed. Major side-effects are short-lived compared with treatment benefits, so it appears that, for patients who respond or who are stabilised, the QoL improvements will outweigh any short-term costs of toxicity.
