Home-Based Hospice Care in Recurrent FIGO Stage IIIC High-Grade Serous Ovarian Carcinoma: A Three-Year Case Report From Cytoreductive Surgery to End-of-Life Care in India

Abstract

Background: Stage IIIC high-grade serous ovarian carcinoma (HGSOC) is commonly diagnosed with extensive peritoneal dissemination and is characterized by a high risk of recurrence despite optimal cytoreductive surgery and platinum-based chemotherapy. In low- and middle-income countries (LMICs), limited access to hospice and specialist palliative care often results in burdensome, low-value interventions during the terminal phase of illness.

Case Presentation: A 44-year-old woman presented with progressive abdominal distension and pain and was diagnosed with FIGO Stage IIIC HGSOC based on contrast-enhanced computed tomography (CT), 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), and histopathological examination. She underwent optimal primary cytoreductive surgery followed by six cycles of carboplatin–paclitaxel chemotherapy and maintenance therapy, achieving a disease-free interval of approximately 12 months. Six months after completion of maintenance treatment, she developed recurrent peritoneal and omental disease. Despite multiple subsequent lines of systemic chemotherapy and a second palliative abdominal operation, the disease progressed to diffuse peritoneal carcinomatosis, malignant bowel obstruction, and severe cancer-associated cachexia. During the terminal stage, her functional status deteriorated to an Eastern Cooperative Oncology Group (ECOG) performance status of 4, with loss of both oral intake and reliable intravenous access, rendering further anticancer treatment clinically inappropriate. Following multidisciplinary discussions and shared decision-making with the patient’s family, goals of care were redirected from life-prolonging treatment to comfort-focused management. She was enrolled in a district home-based hospice program, where symptoms were effectively controlled using subcutaneous morphine, antiemetics, and anxiolytic medications. Consistent with evidence-based end-of-life care principles, artificial nutrition and hydration, feeding tubes, and tracheostomy were not initiated. The patient died peacefully at home, surrounded by her family, approximately three years after her initial diagnosis.

Conclusion: This case illustrates the clinical trajectory of advanced HGSOC with recurrent peritoneal carcinomatosis and highlights the value of early palliative care integration and timely hospice referral. Home-based hospice care enabled effective symptom control, avoided non-beneficial invasive interventions, and supported a dignified end-of-life experience within a resource-constrained healthcare setting.