Epithelial ovarian cancer
Section 9: Specialist palliative care

Patients who develop ovarian cancer may need rehabilitative, functional, social and/or financial support services. These can be provided by agencies both within and outwith the health service, most of which are available in specialist palliative care settings. The evaluation of the effectiveness of specialist palliative care involves assessment of the different dimensions of care provided, such as pain and other symptom control, psychological care, care of the family and carers, rehabilitation and terminal care.

The General Medical Council has stated that every member of the medical profession requires generic palliative care skills. NHS Quality Improvement Scotland has set standards for the provision of both basic and specialist palliative care.157, 158 Specialist palliative care is an integral component of the care of patients with advanced malignancy, required at varying times during their illness.

A systematic review of the effectiveness of specialist palliative care teams identified 18 studies, including five RCTs.159 Involvement of specialist palliative care teams was associated with patients spending more time at home, greater satisfaction amongst patients and carers, better symptom control, a reduction in the number of inpatient hospital days, a reduction in overall cost and an increase in the number of patients dying where they wished.

Three RCTs were identified that included patients with a variety of cancers, which, in the context of palliative care, are reasonable to relate to patients with ovarian cancer.160, 161, 162 Two studies looked at the effect of coordinating services within the NHS, local authorities and the voluntary sector via nurse coordinators. A total of 203 cancer patients expected to live for less than one year were randomly assigned to either the intervention or the routine services group. Patients assigned to the intervention group spent fewer days in hospital, required fewer home visits and their family were less likely to feel angry about their relative’s death.160, 161 The third RCT used place of death as the outcome measure in a study of 434 patients with incurable malignant disease.162 The intervention group had inpatient and outpatient hospital services provided by the palliative medicine unit. This unit served as a link to community services, produced guidelines, maintained communication between different services and invited community staff to participate in an educational programme. In the intervention group, more patients died at home and spent less time in nursing homes in their last months of life.

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