Publication trends focused on palliative and end-of-life care for gynecologic malignancies

Objectives: Objective: To determine the frequency and contents of publications focused on palliative or end-of-life care for gynecologic malignancies across four major journals for the past 30 years. Methods: Methods: We conducted a bibliometric study in Web of Science of four major journals in our discipline: Gynecologic Oncology, AJOG, BJOG, and Obstetrics & Gynecology. We included original research, systematic reviews, and case series with at least 10 patients, published between January 1990 and December 2019. Publication title, abstract, year, and authors were extracted from Web of Science. After citation extraction, titles and abstracts were searched for keywords to identify articles addressing palliative care in gynecologic malignancies and then further classified into publication topics. Publications could contain more than one topic. Descriptive statistics were generated. Results: Results: Of the 35,370 articles available, 0.36% (n=127) were related to palliative care; of these, 94.5% (n=120) were published in Gynecologic Oncology. The frequency of publications increased over time (Figure 1A); 32% (n=41) appeared from 1990 to 2009 while 68% (n=86) appeared from 2010 to 2019. By disease site (Figure 1A), palliative care publications most commonly addressed ovarian cancers (n=44, 35%) or all gynecologic malignancies (n=43, 34%); cervical, uterine, and vulvar malignancies were less commonly discussed. The most frequent topics (Figure 1B) were the impact of gynecologic malignancies or their treatments on health-related quality-of-life (HRQOL; 53%, n=67). Symptom management following surgery, chemotherapy, or radiation was the focus of 32% (n=41) of publications. 31% (n=39) examined the role of psychologic factors (depression, anxiety, and/or coping skills) in the well-being of women with gynecologic malignancies. 19% (n=24) analyzed the impact of malignancy or its treatment on sexual function. 16% (n=20) of publications explored the process of decision-making, advanced care planning, and/or referral to palliative or supportive care services for women with gynecologic malignancies. 10% (n=13) of publications discussed the role of palliative radiation or surgery. Topics that were infrequently explored included exercise, nutrition, or body weight (6%, n=8), resource utilization or cost in end-of-life care (4%, n=5), the role of religion or spirituality (3%, n=4), disparities in palliative or end-of-life care (2%, n=2), education in palliative or end-of-life care for fellows or residents (2%, n=2), and the role of the caregiver (2%, n=2). Download : Download high-res image (175KB) Download : Download full-size image Conclusions: Conclusions: While the frequency is increasing over time, publications on palliative or end-of-life care rarely appear in journals commonly reviewed by those treating gynecologic cancers. Given that multiple randomized trials have demonstrated the importance of palliative care in oncology, this remains an unmet and critical need for the gynecologic cancer specialist and their patients.