The impact of specialized palliative care on cancer patients’ health-related quality of life: a systematic review and meta-analysis

• Published in: Supportive care in cancer Vol. 26; no. 1; pp. 61 - 79
• Main Authors: Kassianos, Angelos P., Ioannou, Myria, Koutsantoni, Marianna, Charalambous, Haris
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2018; Springer; Springer Nature B.V
• Subjects: Aged; Cancer; Cancer patients; Care and treatment; Evidence-based medicine; Female; Health; Humans; Male; Medical research; Medicine; Medicine & Public Health; Meta-analysis; Middle Aged; Neoplasms - psychology; Neoplasms - therapy; Nursing; Nursing Research; Oncology; Pain Medicine; Palliative care; Palliative Care - methods; Patients; Prospective Studies; Quality of life; Quality of Life - psychology; Rehabilitation Medicine; Review Article; Systematic review; Palliative care; Specialized palliative care; Cancer; Quality of life; Meta-analysis
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-017-3895-1

Purpose Specialized palliative care (SPC) is currently underutilized or provided late in cancer care. The aim of this systematic review and meta-analysis is to critically evaluate the impact of SPC on patients’ health-related quality of life (HRQoL). Methods Five databases were searched through June 2016. Randomized controlled trials (RCTs) and prospective studies using a pre- and post- assessment of HRQoL were included. The PRISMA reporting statement was followed. Criteria from available checklists were used to evaluate the studies’ quality. A meta-analysis followed using random-effect models separately for RCTs and non-RCTs. Results Eleven studies including five RCTs and 2939 cancer patients published between 2001 and 2014 were identified. There was improved HRQoL in patients with cancer following SPC especially in symptoms like pain, nausea, and fatigue as well as improvement of physical and psychological functioning. Less or no improvements were observed in social and spiritual domains. In general, studies of inpatients showed a larger benefit from SPC than studies of outpatients whereas patients’ age and treatment duration did not moderate the impact of SPC. Methodological shortcomings of included studies include high attrition rates, low precision, and power and poor reporting of control procedures. Conclusions The methodological problems and publication bias call for higher-quality studies to be designed, funded, and published. However, there is a clear message that SPC is multi-disciplinary and aims at palliation of symptoms and burden in line with current recommendations.