Medical Ethics
Copyright ©2014 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Obstet Gynecol. Feb 10, 2014; 3(1): 14-20
Published online Feb 10, 2014. doi: 10.5317/wjog.v3.i1.14
Peritoneal carcinomatosis from advanced ovarian cancer: To treat or not to treat ethical issues suggested by a case study
Mirco Nacoti, Elena Colombetti, Maria Simonetta Spada, Marco Ceresoli, Luca Ansaloni, Gianmariano Marchesi, Luca Lorini, Davide Corbella, Federico Coccolini
Mirco Nacoti, Gianmariano Marchesi, Luca Lorini, Davide Corbella, Anesthesia and Intensive Care Department, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
Elena Colombetti, Centre for Bioethics, Università Cattolica del Sacro Cuore di Milano, 20121 Milan, Italy
Maria Simonetta Spada, Clinical Psychology Unit, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
Marco Ceresoli, Luca Ansaloni, Federico Coccolini, General Surgery Departement, Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
Author contributions: Nacoti M was the promoter of the bioethical conference and wrote the preliminary version of this manuscript; Colombetti E was the bioethical philosopher who conducted the conference, gave advice upon the ethical issues raised by the case and revised the discussion; Spada MS performed the psychological evaluation and wrote all the part inherent the psychological profile; Ceresoli M, Ansaloni L and Coccolini F wrote the part of the manuscript inherent the surgical procedure and presented the update upon the indication of HIPEC in advanced ovarian cancer; Ceresoli M wrote the case presentation; Marchesi G and Lorini L were committed in organising the bioethical conference and took part in the revision of the discussion; Corbella D made the post-editing of the paper and revised the whole paper; all the authors red and approved the final manuscript.
Correspondence to: Mirco Nacoti, MD, Anesthesia and Intensive Care Department, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy. mnacoti@hpg23.it
Telephone: +39-035-2675110 Fax: +39-035-2674836
Received: July 16, 2013
Revised: October 20, 2013
Accepted: November 2, 2013
Published online: February 10, 2014
Abstract

This article provides a brief description of an epithelial ovarian cancer (EOC) case (stage IV) treated with the association of complete CytoReductive Surgery and hypertermic intraPEritoneal chemotherapy (HIPEC). The use of HIPEC in EOC makes theoretic sense in view of the high rates of recurrence following standard treatment, but there are no randomized clinical trial to date and HIPEC for these patients still represents a radical treatment where the choice of no treatment may be acceptable since definitive cure is unlikely. We reviewed the entire decision making process considering the risk/benefit of the procedure in term of mortality/morbidity, the quality of life and the psychological profile of the patient 1 year after surgery. The platform World Health Organization-International Classification of Functioning, Disability and Health that permits evaluation of the person in relation to the psycho-social context is presented. A person-centred approach and assessment of health-related quality-of-life and disability in EOC survivors are of central importance for decision making.

Keywords: Advanced epithelial ovarian cancer, Peritoneal carcinomatosis, Platform World Health Organization-International Classification of Functioning, Disability and health, Ethical issues, Hyperthemic intraperitoneal chemotherapy, Health related quality of life

Core tip: This paper addresses the topic of “treating the untreatable”. Advanced epithelial ovarian cancer with peritoneal carcinomatosis is not susceptible of definitive treatment. Anyway we can gain time. To achieve this goal the patient undergoes extensive treatment that has a significant burden of morbidity and mortality with decrease in quality of life in the postoperative period. This manuscript is the report of the bioethical conference held in our institution between the multidisciplinary team that take care of these complex patients and the bioethical philosopher and the clinical psychologist. Aim of the conference was to seek for bioethical counsel in this cohort of patients highlighting the relationship of medical counseling, terminal state, the patient’s individual preferences, psychological evaluation and health related quality of life. The case is evaluated by a patient-centered approach through the platform World Health Organization-International Classification of Functioning, Disability and Health that is presented into the article text.