TYPE Review

PUBLISHED 26 August 2024

DOI 10.3389/fonc.2024.1432805

Bibliometric analysis of global

OPEN ACCESS research in palliative care for
EDITED BY
Peter Kokol,
University of Maribor, Slovenia
cervical cancer
REVIEWED BY
Abdelbaset Mohamed Elasbali,
Fhaied Almobarak *
Jouf University, Saudi Arabia
Fundamentals of Nursing Department, College of Nursing, Imam Abdulrahman Bin Faisal University,
Shuluan Li,
Dammam, Saudi Arabia
Chinese Academy of Medical Sciences and
Peking Union Medical College, China

*CORRESPONDENCE
Fhaied Almobarak Objective: The present study aims to conduct a comprehensive bibliometric
fkmobarak@iau.edu.sa analysis of global research in palliative care for cervical cancer, providing insights
RECEIVED 14 May 2024 into publication trends, authorship patterns, influential journals, and
ACCEPTED 06 August 2024 thematic concentrations.
PUBLISHED 26 August 2024

CITATION Methods: A bibliometric analysis approach was employed using metadata

Almobarak F (2024) Bibliometric
extracted from Scopus spanning 2000-2023. The search utilized main terms
analysis of global research in
palliative care for cervical cancer. related to cervical cancer and palliative care. Data analysis and visualization were
Front. Oncol. 14:1432805. performed using the Bibliometrix R Package’s web app Biblioshiny and
doi: 10.3389/fonc.2024.1432805
VOSviewer software.
COPYRIGHT
© 2024 Almobarak. This is an open-access
article distributed under the terms of the
Results: The study identified 2,492 publications on palliative care for cervical
Creative Commons Attribution License (CC BY). cancer, with a notable peak in 2021. The analysis revealed a diverse publication
The use, distribution or reproduction in other landscape, encompassing primarily articles. Citation analysis showed a
forums is permitted, provided the original
author(s) and the copyright owner(s) are staggering 63,994 citations. The most relevant journals were The Lancet
credited and that the original publication in Oncology, Gynecologic Oncology, and International Journal of Gynecological
this journal is cited, in accordance with
accepted academic practice. No use,
Cancer. The study also highlighted influential authors, institutions, and countries,
distribution or reproduction is permitted with Harvard University, the University of Toronto, and the University of Texas MD
which does not comply with these terms. Anderson Cancer Center leading in publications.

Discussion: The findings reflected a growing interest in palliative care for cervical
cancer, marked by increasing publications over the years. However, the analysis
indicated limited international collaborations, with research efforts concentrated
in high-income countries. Thematic areas include surgery, palliative care,
chemotherapy, radiotherapy, and quality of life. Thus, further collaborations
and research in developing countries are needed.

Conclusion: This bibliometric analysis showcased a comprehensive overview of

the global research landscape on palliative care for cervical cancer. The study
identified trends, key contributors, and thematic concentrations, offering
valuable insights for future research directions and enhancing palliative care
services. Addressing the identified gaps, fostering international collaborations,
and directing research efforts toward developing countries can contribute to the
advancement of palliative care for cervical cancer globally.

KEYWORDS

cervical cancer, palliative care, Scopus, bibliometric analysis, Bibliometrix R Package’s

web app Biblioshiny, VOSviewer

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1 Introduction articles, and data sets, along with their associated metadata like
abstracts, keywords, and citations), identifying patterns, trends, and
Cervical cancer remains a significant global health concern, impacts within specific fields (16). It involves data collection,
ranking as the fourth most prevalent cancer among women cleaning, and subjecting data to various bibliometric methods to
worldwide. In 2022 alone, there were approximately 660,000 new generate meaningful information. This analysis technique is
cases and 350,000 deaths attributed to cervical cancer, and 94% of increasingly popular for examining and assessing enormous
these deaths occurred in low and middle-income Human amounts of scientific data to rectify flawed content or ethical
Development Index (HDI) countries (1). Despite initiatives such concerns (17), structure and centralize literature efficiently, and
as the World Health Organization’s (WHO) strategy to eradicate provide researchers with trends and insights (18). Additionally,
cervical cancer through a triple-pillar approach: HPV vaccination, bibliometric analysis is crucial in understanding the relevant
screening, and treatment, the impact of this disease persists (2). domain’s developments, impacts, and future directions,
Innovative methods, such as single-dose vaccination, HPV DNA highlighting trends, citation networks, and subject clusters in the
tests, and same-day screen-and-treat procedures, are being explored research (19).
to improve prevention and treatment outcomes (3). It is anticipated Lately, bibliometric analysis has gained importance in medical
that the successful implementation of these strategies could research, offering insights into research trends, influential papers,
significantly reduce new cervical cancer cases and related deaths authors, and institutions (20). Bibliometric studies often employ
by 2050 (4). However, challenges remain in achieving the WHO’s specialized software like VOSviewer, Bibliometrix R Package’s web
cervical cancer elimination targets, predominantly in low and app Biblioshiny, CiteSpace, etc., for data visualization and mapping
middle-income countries where the majority of the total cervical (21, 22). In medical sciences, bibliometrics can inform funding
cancer cases and deaths occur (4). While preventive measures such decisions, academic promotions, and healthcare planning (23). The
as human papillomavirus (HPV) vaccination and cervical growing acceptance of bibliometric analyses in medical literature
screenings have shown progress in reducing incidence rates, reflects their value in identifying influential research and guiding
particularly in regions with high HIV prevalence, many women future investigations (20).
still confront challenges associated with advanced or metastatic At present, there is absence of research analyzing the status of
cervical cancer and its mortality rates (5, 6). palliative care for cervical cancer using the bibliometrics approach.
Palliative care is a specialized approach that provides holistic A bibliometric analysis of global research in palliative care for
support to patients facing life-limiting illnesses, focusing on pain cervical cancer is warranted for several reasons. First, such an
and symptom management, communication, quality of life, family analysis can provide a comprehensive overview of the scientific
support, and grief support (7, 8). While traditionally associated with outputs, identify influential journals, authors, and institutions, and
cancer care, the need for palliative care extends to all serious highlight the collaboration between countries. Additionally, it can
illnesses, emphasizing the importance of addressing suffering and reveal research trends, gaps, and the field’s evolution, which is
preserving the welfare of the patients (9, 10). Palliative care is crucial for guiding future research and policy-making. Interestingly,
essential in cervical cancer management due to the high prevalence despite the recognized global health burden of cancer in palliative
of late-stage diagnoses and significant symptom burden (11). care and the specific challenges associated with cervical cancer,
Palliative care is particularly vital given that advanced cervical there is evidence of underutilization of palliative care services (24),
cancer can lead to severe symptoms that significantly interfere suggesting a potential disconnect between research outputs and
with quality of life (12). It addresses physical, psychological, clinical practice, highlighting the need for bibliometric studies to
social, and spiritual issues throughout the disease trajectory, inform strategies for better integrating palliative care in
improving patient satisfaction, treatment compliance, and well- oncology (14).
being (11). Palliative care is needed to manage pain, bleeding, The lack of a comprehensive grasp of global research
fistulas, and other complications from treatments such as developments and trends in this field underscores the need to
radiation and chemotherapy, which can affect ovarian, urinary, bridge this gap. Pinpointing research deficiencies, identifying key
and bowel function (13). An essential package of palliative care for contributors, and fostering collaboration are essential to advance
cervical cancer (EPPCCC) is designed to be universally accessible, palliative care for patients coping with cervical cancer. The current
but some patients may require an augmented package to address study addresses the critical gap in knowledge by employing a
refractory suffering, including specialized pain management, bibliometric analysis to investigate scholarly output on palliative
surgical procedures, and psycho-oncologic therapies (14). In care for cervical cancer thoroughly. This analysis examines
short, the severity of physical, psychological, social, and spiritual publication trends, authorship patterns, influential journals,
suffering experienced by cervical cancer patients and their trending topics, and thematic concentrations within relevant
caregivers highlights the urgent need for global and regional articles to understand the current state of research, identify best
strategic planning to align health investments with the identified practices, and address the unique challenges of managing cervical
needs for palliative care services (12, 15). cancer symptoms. The insights gained from this study are poised to
Bibliometric analysis uses mathematical and statistical methods direct future research directions, help develop evidence-based
to quantitatively analyze scientific literature (such as books, journal guidelines, and inform healthcare providers and policymakers

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about the need to enhance palliative care services for individuals Bibliometrix R Package’s web app Biblioshiny were used to
affected by cervical cancer. analyze the data. Lastly, visual representations such as charts,
graphs, three-field plots, etc. were created to aid interpretation
and the findings were reported concisely. The study flowchart is
2 Materials and methods presented in Figure 1. Ethics approval was not required for
this study.
2.1 Data collection

The Scopus database was selected as the data source for the 3 Results
current study. Searches were performed on the Scopus database,
one of the largest, most comprehensive, and multidisciplinary This study identified 2,492 publications about palliative care for
databases. Scopus includes a plethora of literature within the cervical cancer published in Scopus between 2000 and 2023,
biomedical and social sciences, encompassing the entire content including 79.9% articles and 20.1% reviews. This investigation
of Medline (25). To retrieve the available studies, the title, abstract, revealed that 12,804 authors contributed to producing 2,492
and keyword search function of Scopus was used with the key terms manuscripts published in 677 journals and citing 63,994 references.
including (“cervi* cancer” OR “cervical cancer” OR “cervical
Neoplasm” OR “cervical Tumor*” OR “cervical Malignant”) AND
(“palliative care nurse*” OR “palliative care” OR “hospice” OR 3.1 Trends in publications
“Palliative Treat*” OR “Palliative Therapy” OR “Palliative
Supportive Care”). Studies were included after applying the The study examined the yearly publication trends to comprehend
filtration by year (2000-2023), including literature from 01/01/ the evolution of related research. Annual publications during the
2023 till 31/12/2023 and language (English). The search was study period showed a clear upward trajectory (Figure 2). Notably,
conducted on 26th July 2024. the peak of publications was in 2021 (n=114). Since 2000, when 14
scientific articles were published, the number of publications has
steadily increased, although the output was relatively lower in 2023
after peaking in 2021.
2.2 Data analysis

After conducting a literature search to attain a comprehensive

data set of relevant publications, the next step was to clean and
preprocess the data to ensure the accuracy of the dataset and to
refine the raw data before analysis. Therefore, all the duplicates and
missing entries were removed, and author names, etc., were
corrected. Subsequently, the appropriate bibliometric analysis
techniques were identified. The two fundamental components of
a bibliometric analysis are performance analysis and science
mapping. When analyzing research performance, metrics like
total publications, author contributions, and citation-related
indicators are used to evaluate the influence of researchers,
institutions, and nations (26). The structure and dynamics of
scientific research can be mapped with science mapping as it
helps to gauge the relationships between research constituents.
Several techniques are used for science mapping, such as citation
and co-citation analysis, bibliographic coupling, co-word analysis,
co-authorship analysis, etc. (18, 26). In the current study,
performance analysis and science mapping were conducted by
employing bibliometric measures such as overall publication
trends, contributions of authors, journals, institutions, and
countries, productivity and impact analysis of authors and
sources/journals, keywords analysis, citation and co-citation
analysis, and examining collaboration networks. After selecting FIGURE 1
the bibliometric techniques and measures, the analysis was Study flow chart.
performed using suitable software tools. VOSviewer and

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FIGURE 2
Publications over the years (2000-2023).

3.2 Authors analysis perspective indicated that the top three authors were Bray F (H-
index=17), Sullivan R (H-index=15), and Grover S (H-index=13).
Examining the seminal work of impactful authors in a field Lotka’s law provided a glimpse of the productivity of the
provides a way to comprehend its classic theories. The H-index is a authors, revealing that the majority of authors (84.2%) published
novel measurement standard for evaluating scholarly achievement. only one paper, and only 9 (0.1%) authors produced 10
Figures 3 and 4 showcase the top 10 most relevant authors based on publications (Figure 5).
the number of publications and H-index.
A total of 12,804 authors contributed to the 2,492 publications,
yielding a co-authorship index of 6.68. There were 119 single- 3.3 Affiliations/Institutions analysis
authored documents. Figure 3 shows the top 10 most relevant
authors. Bray F, Grover S, and Wang Y were the most significant Research institutions play a crucial role in advancing research,
authors, with 22 papers each, followed by Sullivan R with 21 papers. and the course of top institutions frequently influences the
The H-index assists in measuring both the productivity and academic direction in the field. Published research on palliative
citation impact of the publications of authors and scholarly care for cervical cancer originated from a diverse range of 3,885
journals/sources. The author’s local impact from an H-index institutions/affiliations worldwide. Harvard University, the

FIGURE 3
The top 10 most relevant authors.

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FIGURE 4
List of top 10 most influential authors by H-index.

FIGURE 5
Analysis of author productivity by Lotka’s Law.

University of Toronto, and the University of Texas MD Anderson Science, Supportive Care in Cancer, PLOS One, JCO Global
Cancer Center were the top three relevant affiliations, with 73, 71, Oncology, Asian Pacific Journal of Cancer Prevention, BMC
and 57 publications, respectively (Figure 6). Palliative Care, Journal of Palliative Medicine, Frontiers in
Oncology, and a few other journals (Figure 9).

3.4 Sources/Journals analysis

3.5 Countries analysis
The identified papers originated from 677 sources, with
Gynecologic Oncology being the most relevant source with 87 Publications from 2000 to 2023 were examined in this study to
publications, trailed by the International Journal of Gynecological determine which countries have contributed the most to this field of
Cancer with 72 publications (Figure 7). study. The distribution of country-wise scientific production
Based on the H-index standard, the top three influential showed the USA having the most studies (827 publications),
sources/journals in the field of palliative care for cervical cancer making up 33.19% of all the documents. UK (257 publications),
were The Lancet Oncology, Gynecologic Oncology, and India (185 publications), and Canada (176 publications) were the
International Journal of Gynecological Cancer (Figure 8). subsequent three highest contributors. As shown in Figure 10, the
According to Bradford’s law, the core sources of central countries refer to the locations of the corresponding authors. The
importance in the domain of palliative care for cervical cancer depth of the blue color is related to their scientific production: the
were as follows: Gynecologic Oncology, International Journal of higher the production, the bluer the color. The USA has the darkest
Gynecological Cancer, The Lancet Oncology, Ecancer Medical color, indicating the highest scientific production levels.

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FIGURE 6
Top 10 most relevant institutions.

FIGURE 7
Top 10 most relevant sources.

3.6 Citations and co-citations analysis structure of the cited references in the palliative care for the
cervical cancer field. The analysis obtained a set of 78 references
Citation analysis was conducted to shed light on the relative used for co-citation analysis of cited references by applying the
importance or impact of publications and countries within the threshold 20 times, which indicates that a cited reference should
cervical cancer palliative care field using the bibliometric data from have a minimum of 20 citations. The result showed that the 78
2000 and 2023. Co-citation analysis, in particular, groups papers reference sets are divided into four clusters; each color represents a
frequently cited together, allowing researchers to visualize the cluster. Bray F (2018), Sung H (2021), Temel JS (2010), and Ferlay J
cognitive structure of a field. Arbyn M, 2019, The Lancet Global (2014) held the most co-citation collaboration/relationship
Health (Total Citations= 2,492), Cohen Pa, 2019, The Lancet (total networks (Figure 13).
Citations=1,631), Ward E, 2004, CA A Cancer Journal for
Clinicians (Total Citations=1,489) were the top three most cited
publications globally (Figure 11). 3.7 Keywords analysis
The analysis of the most cited countries revealed some
interesting findings. Belgium leads the pack with 2,573 citations, Keywords are crucial indicators of the central themes of a
followed by the USA with only 190 citations and France with 140 publication, and keyword analysis helps reveal the main focus
citations (Figure 12). areas, patterns of trends, and thematic paths within a field. An
The study carried out a co-citation analysis of the cited author’s keyword analysis is presented in Figure 14. It was revealed
references to gain a clear and profound understanding of the that the prevalent author keywords linked to cervical cancer

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FIGURE 8
Top 10 influential journals by H-index.

FIGURE 9
Core sources by Bradford’s Law.

palliative care included “cervical cancer”, “palliative care”, The theme of the green cluster highlighted inoculation and early
“radiotherapy”, “chemotherapy”, “quality of life”, “ovarian detection of cervical cancer.
cancer”, “brachytherapy”, and “quality of life (pro)/palliative Figure 15 illustrates the changing trend of the most popular
care”, highlighting the research hotspots. The analysis identified 9 keywords related to palliative care for cervical cancer over time. The
clusters, and the most prominent 3 clusters are colored dark blue, trend of the occurrence of the most commonly used words for the
green, and yellow. Based on synthetic knowledge synthesis (SKS), a topic from 2000 to 2023 is shown in this figure. The size of the
triangulation of bibliometrics, bibliometric mapping, and content circles represents the words’ frequency of occurrence, and the
analysis, each cluster can be categorized into themes (27). The dark length of the lines indicates their duration. The most popular
blue colored cluster consisted of keywords “cervical cancer”, words, research hotspots, or trend topics observed from 2020
“uterine cervical neoplasms”, “chemotherapy”, “gemcitabine”, onwards were uterine cervical neoplasms/diagnosis/prevention &
“cisplatin”, and “carboplatin”. Hence, the identified theme of the control, qualitative research, etc.
dark blue cluster was cervical cancer and its treatments. The
keywords that formed the yellow cluster were: “palliative care”,
“depression”, “hospice”, “nephrostomy”, “neoplasms”, and 3.8 Collaboration networks analysis
“qualitative research”. The theme of the yellow cluster revolved
around palliative care and its measures. The green cluster Collaboration network analysis determines relationships
comprised keywords “screening”, “prevention”, “vaccination”, between bibliographic elements like authors and institutions,
“HPV”, “HIV”, “cancer”, “mortality”, and “developing countries”. manifesting scientific collaboration. It employs social network

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FIGURE 10
Distribution of publications from different countries/regions.

FIGURE 11
Top 10 most cited documents globally.

analysis techniques to examine cooperative behaviors between 4 Discussion

authors, institutions, journals, and countries. A three-field plot,
also known as a Sankey chart, is displayed in Figure 16 and The current study conducted a scientometric analysis of 2,492
illustrates the relationships between sources, affiliations, and documents on palliative care for cervical cancer published from
countries. The height of the rectangular nodes in the collaborative 2000 to 2023. Analysis unveiled that during this period, there was a
network is directly proportional to the frequency of the presence of steady increase in the overall quantity of scientific output. The
a nation, affiliation/institution, or source/journal. The number of production of articles grew at an average annual rate of 10.82% and
connections is directly proportional to the width of the lines peaked in 2021. Although 2021 is well noticed for the COVID-19
connecting the nodes. The results showed that the USA was the pandemic lockdown, studies have shown that the COVID-19
dominant country, comprising most of the top 10 institutions, pandemic has led to a significant increase in research publications
followed by Belgium. In the source/journal section on the right, in 2021 (28). The upward trend indicated that the relevant research
USA was the leading contributor to Gynecologic Oncology. field thrived from 2000 to 2023. Notably, the rise in the number of
Co-authorship among countries measures the cooperative publications on palliative care for cervical cancer can be attributed
associations based on the number of co-authored documents. to the increase in the incidence and mortality of cervical cancer, as
Figure 17 portrays the collaboration network of the most well as the progression in awareness about the effective role of
productive countries. It presented that the USA maintains close palliative care in symptom management. In the future, with the
relationships with other countries and has a vast collaborative bond introduction of additional guidelines and the maturation of
with numerous countries. palliative care models, one can expect a continued expansion of

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FIGURE 12
Top 10 most cited countries.

FIGURE 13
Network visualization map of co-citation of cited documents.

literature in this field. Moreover, the high average citations per in the citation count. The country-wise contribution to palliative
article implied that publishing research on palliative care for care for cervical cancer publications was dominated by high-income
cervical cancer in reputable journals poses no challenge. countries, indicating that publications on this subject are
12,804 prolific authors contributed towards the research area of predominantly centred in developed countries, highlighting a
interest. The authors’ analysis used the number and citations of significant imbalance in research infrastructure and funding,
publications to assess individual authors. Bray F emerged as the leaving lower-income regions behind in this crucial field.
most significant author regarding the total number of publications 3,885 institutions and 677 journals were identified as the
and H-index. He also secured the most co-citation collaborative providers of publications in palliative care for cervical cancer.
networks. The analysis of countries/regions discovered North Harvard University appeared as the most productive institution
America (USA and Canada), the UK, and India as the hubs for in the field, while the Gynecologic Oncology firmed its place as the
scientific production in this field. Notably, with 827 papers, the most relevant journal. However, the H-index metric ranked Lancet
United States distinguished itself as the top nation in scientific Oncology as the most influential journal. The collaboration network
output, but citation-wise, Belgium aced the contest with 2,573 analysis depicted that the most prominent cluster was comprised
citations. Based on the total number of publications, the US was primarily of USA-based institutions. Also, the USA contributed the
at the forefront of this field’s research, and surprisingly, Belgium led most to the most pertinent journal, Gynecologic Oncology. The co-

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FIGURE 14
Network visualization map based on author’s keywords.

authorship collaborative ventures based on country showed that the palliative care for cervical cancer included surgery and survival,
US authors actively collaborated with a vast network of authors cervical cancer, palliative care and hospice, palliative chemotherapy,
from other countries. Therefore, broadening collaborative networks radiotherapy, ovarian cancer, treatment and diagnosis, cancer pain,
to encompass additional geographic areas to support developing quality of life (pro)/palliative care, screening, and prevention. The
countries is advisable. areas were found to be consistent with the subject domain theme.
The authors’ keyword examination gave insight into the central The growing attention to palliative care in cervical cancer is
themes and trends in publications related to palliative care for promising yet underexplored. It is pertinent to explore the role of
cervical cancer, indicating an increased research emphasis on palliative care in managing physical, social, spiritual, and
vaccination and early diagnosis, cervical cancer treatment, and psychological distress among cervical cancer patients, highlighting
enhancement of cervical cancer care by integrating palliative care the need for dedicated research efforts to explore this
into standard clinical management. The thematic research areas in potential synergy.

FIGURE 15
Trend topics from 2000-2023.

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FIGURE 16
Three-field plot showing the network between institutions (left), countries (middle), and journals (right).

FIGURE 17
The collaboration network between countries.

5 Limitations approaches could reveal further nuances within the field. Therefore,
while this analysis offers valuable insights into the global landscape
The current research’s analysis was conducted on data retrieved of palliative care for cervical cancer research, future research can
from Scopus, which offers extensive coverage of peer-reviewed build upon it by addressing these limitations and expanding the
literature but may not contain all journal publications across all scope of inquiry to optimize palliative care strategies further and
disciplines. This decision was justified by software limitations and improve patient outcomes worldwide.
the inherent challenges associated with merging data from diverse
databases. Exclusion criteria further imposed a language restriction,
limiting the study to English-language publications, which 6 Conclusion
inevitably omitted some potentially relevant articles. Moreover, as
with any bibliometric analysis, the chosen keywords and search The present study employed a bibliometric approach to explore
string might have inadvertently excluded relevant studies. No the current research landscape and emerging trends in palliative
search strategy can capture all pertinent research, and alternative care for cervical cancer, focusing on publications indexed in Scopus

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between 2000 and 2023. Based on the findings, it was evident that Funding
there has been a steady increase in the number of publications on
this topic over the past two decades. However, the study unveils The author(s) declare that no financial support was received for
limited collaborative engagement among nations and intercountry the research, authorship, and/or publication of this article.
institutional networks, with research predominantly concentrated
in high-income economies. As such, there is a notable scarcity of
studies conducted in developing countries. Therefore, to facilitate Conflict of interest
the widespread adoption of palliative care services in cervical cancer
treatment worldwide, aggressive collaborative efforts are required. The author declares that the research was conducted in the
Such as enhancing global and local collaboration in research, absence of any commercial or financial relationships that could be
augmenting funding assistance, and conducting cutting-edge construed as a potential conflict of interest.
research that addresses the specific needs and demands of
different regions. By fostering cooperation and conducting
demand-driven research, advancements in the realm of palliative
care for cervical cancer can be achieved, ultimately improving the
Publisher’s note
quality of care for patients globally (29).
All claims expressed in this article are solely those of the authors
and do not necessarily represent those of their affiliated organizations,
Author contributions or those of the publisher, the editors and the reviewers. Any product
that may be evaluated in this article, or claim that may be made by its
FA: Writing – original draft. manufacturer, is not guaranteed or endorsed by the publisher.

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