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Specialized palliative care in advanced cancer: What is the efficacy? A systematic review

  • Kristina Holmenlund (a1), Per Sjøgren (a1) (a2) (a3) and Mie Nordly (a1) (a2) (a3)

Abstract

Objective:

Due to the multiple physical, psychological, existential, and social symptoms involved, patients with advanced cancer often have a reduced quality of life (QoL), which requires specialized palliative care (SPC) interventions. The primary objective of the present systematic review was to review the existing literature about SPC and its effect on QoL, on physical and psychological symptoms, and on survival in adult patients with advanced cancer.

Method:

We utilized a search strategy based on the PICO (problem/population, intervention, comparison, and outcome) framework and employed terminology related to cancer, QoL, symptoms, mood, and palliative care. The search was performed in Embase, PubMed, and the Cochrane Central Register of Controlled Trials. Selected studies were analyzed and categorized according to methods, results, quality of evidence, and strength of recommendation.

Results:

Six randomized controlled trials (RCTs) were selected for analysis (out of a total of 1,115 studies). Two other studies were found by hand search, one of which was only published in conference abstract form. The RCTs differed in terms of aims, interventions, control groups, and outcomes; however, the primary aim of all of them was to investigate the effect of SPC on patient QoL. Five studies found improved QoL in the intervention group. Physical symptom intensity decreased in two studies, and three studies found improved mood in the intervention group. However, physical and psychological symptoms were secondary outcomes in these studies. Survival was improved in two studies. All the studies offered generalizability, but the level of evidence validity varied among them.

Significance of results:

Due to several methodological limitations, the evidence offered in these studies ranged from low to high. The evidence in this field of study in general is still nascent, but there is growing support for the utilization of SPC to improve the quality of life of adult patients with advanced cancer. The evidence that SPC reduces physical and psychological symptoms is moderate, while the evidence that it prolongs survival is low.

Copyright

Corresponding author

Address correspondence and reprint requests to: Kristina Holmenlund, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen N, Denmark. E-Mail: kristina.rosengaard.holmenlund@regionh.dk.

References

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Atkins, D., Best, D., Briss, P.A., et al. (2004). Grading quality of evidence and strength of recommendations. BMJ, 328(7454), 1490. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC428525/.
Bakitas, M., Lyons, K.D., Hegel, M.T., et al. (2009). Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: The project ENABLE II randomized controlled trial. The Journal of the American Medical Association, 302(7), 741749. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3657724/.
Bakitas, M.A., Tosteson, T.D., Li, Z., et al. (2015). Early versus delayed initiation of concurrent palliative oncology care: Patient outcomes in the ENABLE III randomized controlled trial. Journal of Clinical Oncology, 33(13), 14381445. Epub ahead of print Mar 23. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404422/.
Bee, P.E., Bower, P., Lovell, K., et al. (2008). Psychotherapy mediated by remote communication technologies: A meta-analytic review. BMC Psychiatry, 8(1), 60. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2496903/.
Davis, M.P., Temel, J.S., Balboni, T., et al. (2015). A review of the trials which examine early integration of outpatient and home palliative care for patients with serious illnesses. Annals of Palliative Medicine, 4(3), 99121. Available from http://apm.amegroups.com/article/view/6813/7819.
Doorenbos, A.Z., Given, C.W., Given, B., et al. (2006). Symptom experience in the last year of life among individuals with cancer. Journal of Pain and Symptom Management, 32(5), 403412. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1894855/.
Felce, D. & Perry, J. (1995). Quality of life: Its definition and measurement. Research in Developmental Disabilities, 16(1), 5174.
Gaertner, J., Lutz, S., Chow, E., et al. (2015). Integrating palliative care and oncology: Towards a common understanding. Annals of Palliative Medicine, 4(1), 34. Available from http://apm.amegroups.com/article/view/5639/6426.
Glare, P., Virik, K., Jones, M., et al. (2003). A systematic review of physicians' survival predictions in terminally ill cancer patients. BMJ, 327(7408), 195198. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC166124/.
Gomes, B & Higginson, I.J. (2008). Where people die (1974–2030): Past trends, future projections and implications for care. Palliative Medicine, 22(1), 3341.
Gomes, B., Cohen, J., Deliens, L., et al. (2011). International trends in circumstances of death and dying among older people. In Living with Ageing and Dying: Palliative and End of Life Care for Older People. Gott, M. & Ingleton, C. (eds.), pp. 318. New York: Oxford University Press.
Gomes, B., Calanzani, N., Curiale, V., et al. (2013). Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. The Cochrane Database of Systematic Reviews, 6, CD007760. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4473359/pdf/CD007760-0001.pdf.
Grønvold, M., Petersen, M.A., Damkier, A., et al. (2015). The Danish Palliative Care Trial (DanPaCT), a randomised trial of early palliative care in cancer: Results of the primary analysis. Paper presented at the 14th Congress of The European Association for Palliative Care, 8–10 May, Copenhagen, Denmark. Available from http://www.eapc-2015.org/abstract_book.html.
Hearn, J. & Higginson, I.J. (1998). Do specialist palliative care teams improve outcomes for cancer patients? A systematic literature review. Palliative Medicine, 12(5), 317322.
Higginson, I.J., Finlay, I., Goodwin, D.M., et al. (2002). Do hospital-based palliative teams improve care for patients or families at the end of life? Journal of Pain and Symptom Management, 23(2), 96106.
Hopwood, P. & Stephens, R.J. (1995). Symptoms at presentation for treatment in patients with lung cancer: Implications for the evaluation of palliative treatment. The Medical Research Council (MRC) Lung Cancer Working Party. British Journal of Cancer, 71(3), 633636. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2033650/.
Hopwood, P. & Stephens, R.J. (2000). Depression in patients with lung cancer: Prevalence and risk factors derived from quality-of-life data. Journal of Clinical Oncology, 18(4), 893903. Available from http://ascopubs.org/doi/10.1200/JCO.2000.18.4.893.
Hui, D., Nooruddin, Z., Didwaniya, N., et al. (2014). Concepts and definitions for “actively dying,” “end of life,” “terminally ill,” “terminal care,” and “transition of care”: A systematic review. Journal of Pain and Symptom Management, 47(1), 7789.
Hui, D., Kim, Y.J., Park, J.C., et al. (2015). Integration of oncology and palliative care: A systematic review. The Oncologist, 20(1), 7783. Epub ahead of print Dec 5, 2014. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4294615/pdf/theoncologist_14312.pdf.
Johnsen, A.T., Petersen, M.A., Pedersen, L., et al. (2009). Symptoms and problems in a nationally representative sample of advanced cancer patients. Palliative Medicine, 23(6), 491501. Epub ahead of print May 14
Johnsen, A.T., Damkier, A., Vejlgaard, T.B., et al. (2013). A randomised, multicentre clinical trial of specialised palliative care plus standard treatment versus standard treatment alone for cancer patients with palliative care needs: The Danish Palliative Care Trial (DanPaCT) protocol. BMC Palliative Care, 12(1), 37. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874751/pdf/1472-684X-12-37.pdf.
Jordhøy, M.S., Fayers, P., Loge, J.H., et al. (2001). Quality of life in palliative cancer care: Results from a cluster randomized trial. Journal of Clinical Oncology, 19(18), 38843894.
Karvonen-Gutierrez, C.A., Ronis, D.L., Fowler, K.E., et al. (2008). Quality of life scores predict survival among patients with head and neck cancer. Journal of Clinical Oncology, 26(16), 27542760.
Kavalieratos, D., Corbelli, J., Zhang, D., et al. (2016). Association between palliative care and patient and caregiver outcomes: A systematic review and meta-analysis. The Journal of the American Medical Association, 316(20), 21042114.
Kirkwood, B.R. & Sterne, J.A.C. (2009 a). Analysis of clustered data. In Essential Medical Statistics, 2nd ed. Goodgame, F. et al. (eds.), pp. 355370. Oxford: Blackwell Publishing.
Kirkwood, B.R. & Sterne, J.A.C. (2009 b). Linking analysis to study design: Summary of methods. In Essential Medical Statistics, 2nd ed. Goodgame, F. (eds.), 395412. Oxford: Blackwell Publishing.
Lee, Y.J., Yang, J.H., Lee, J.W., et al. (2015). Association between the duration of palliative care service and survival in terminal cancer patients. Supportive Care in Cancer, 23(4), 10571062. Epub ahead of print Oct 4, 2014.
Mainio, A., Tuunanen, S., Hakko, H., et al. (2006). Decreased quality of life and depression as predictors for shorter survival among patients with low-grade gliomas: A follow-up from 1990 to 2003. European Archives of Psychiatry and Clinical Neuroscience, 256(8), 516521. Epub ahead of print Sep 7.
Maloney, C., Lyons, K.D., Li, Z., et al. (2012). Patient perspectives on participation in the ENABLE II randomized controlled trial of a concurrent oncology palliative care intervention: Benefits and burdens. Palliative Medicine, 27(4), 375383. Epub ahead of print May 9. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3657725/pdf/nihms-458601.pdf.
Maltoni, M., Scarpi, E., Dall'Agata, M., et al. (2016). Systematic versus on-demand early palliative care: Results from a multicentre, randomised clinical trial. European Journal of Cancer, 65, 6168. Epub ahead of print Jul 26.
Nordly, M., Vadstrup, E.S., Sjøgren, P., et al. (2016). Home-based specialized palliative care in patients with advanced cancer: A systematic review. Palliative & Supportive Care, 14(6), 713724. Epub ahead of print Jul 13.
Oxenham, D. & Cornbleet, M.A. (1998). Accuracy of prediction of survival by different professional groups in a hospice. Palliative Medicine, 12(2), 117118.
Radbruch, L. & Payne, S. (2009). EAPC update: White paper on standards and norms for hospice and palliative care in Europe, part 1. European Journal of Palliative Care, 16(6), 278289. Available from http://www.eapcnet.eu/LinkClick.aspx?fileticket=f63pXXzVNEY%3d&tabid=735.
Saevarsdottir, T., Fridriksdottir, N. & Gunnarsdottir, S. (2010). Quality of life and symptoms of anxiety and depression of patients receiving cancer chemotherapy: Longitudinal study. Cancer Nursing, 33(1), E1E10.
Salisbury, C., Bosanquet, N., Wilkinson, E.K., et al. (1999). The impact of different models of specialist palliative care on patients' quality of life: A systematic literature review. Palliative Medicine, 13(1), 317.
Seale, C. (2000). Changing patterns of death and dying. Social Science & Medicine, 51(6), 917930.
Simone, C.B. 2nd (2015). Early palliative care and integration of palliative care models in modern oncology practices. Annals of Palliative Medicine, 4(3), 8486. Available from http://apm.amegroups.com/article/view/7004/7814.
Slattery, M.L., Herrick, J.S., Mullany, L.E., et al. (2015). Improved survival among colon cancer patients with increased differentially expressed pathways. BMC Medicine, 13(1), 75.
Smeenk, F.W.J.M., van Haastregt, J.C.M., de Witte, L.P., et al. (1998). Effectiveness of home care programmes for patients with incurable cancer on their quality of life and time spent in hospital: Systematic review. BMJ, 316, 19391944. Available from http://www.bmj.com/content/bmj/316/7149/1939.full.pdf.
Smith, T.J., Temin, S., Alesi, E.R., et al. (2012). American Society of Clinical Oncology provisional clinical opinion: The integration of palliative care into standard oncology care. Journal of Clinical Oncology, 30(8), 880887. Epub ahead of print Feb 6. Available from http://ascopubs.org/doi/pdf/10.1200/JCO.2011.38.5161.
Sohal, D.P.S., Mangu, P.B., Khorana, A.A., et al. (2016). Metastatic pancreatic cancer: American Society of Clinical Oncology clinical practice guideline. Journal of Clinical Oncology, 34(23), 27842796. Available from http://ascopubs.org/doi/pdf/10.1200/JCO.2016.67.1412.
Steel, J.L., Geller, D.A., Robinson, T.L., et al. (2014). Health-related quality of life as a prognostic factor in patients with advanced cancer. Cancer, 120(23), 37173721. Epub ahead of print Aug 7. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4239171/.
Temel, J.S., Greer, J.A., Muzikansky, A., et al. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. The New England Journal of Medicine, 363(8), 733742. Available from http://www.nejm.org/doi/pdf/10.1056/NEJMoa1000678.
Temel, J.S., Greer, J.A., El-Jawahri, A., et al. (2016). Effects of early integrated palliative care in patients with lung and GI cancer: A randomized clinical trial. Journal of Clinical Oncology, 35(8), 834841. Epub ahead of print Dec 28.
Teunissen, S.C.C.M., Wesker, W., Kruitwagen, C., et al. (2007). Symptom prevalence in patients with incurable cancer: A systematic review. Journal of Pain and Symptom Management, 34(1), 94104. Epub ahead of print May 23.
United Nations Department of Economic and Social Affairs (2015). World Population Ageing 2015. Geneva: United Nations Department of Economic and Social Affairs, Population Division. Available from http://www.un.org/en/development/desa/population/publications/ageing/WPA2015_Infochart.shtml.
von Hoff, D.D., Ervin, T., Arena, F.P., et al. (2013). Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. The New England Journal of Medicine, 369(18), 16911703. Available from http://www.nejm.org/doi/full/10.1056/NEJMoa1304369#t=article.
Wang, X.S., Shi, Q., Lu, C., et al. (2010). Prognostic value of symptom burden for overall survival in patients receiving chemotherapy for advanced non-small-cell lung cancer. Cancer, 116(1), 137145. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148693/.
Whynes, D.K., Frew, E.J., Manghan, C.M., et al. (2003). Colorectal cancer, screening and survival: The influence of socioeconomic deprivation. Public Health, 117(6), 389395.
World Health Organization (2007). Cancer Control: Palliative Care. WHO Guide for Effective Programmes. Geneva: World Health Organization. Available from http://www.who.int/cancer/publications/cancer_control_palliative/en/.
World Health Organization (2016). WHO Definition of Palliative Care. Geneva: World Health Organization. Available from http://www.who.int/cancer/palliative/definition/en/.
Zimmermann, C., Riechelmann, R., Krzyzanowska, M., et al. (2008). Effectiveness of specialized palliative care: A systematic review. The Journal of the American Medical Association, 299(14), 16981709.
Zimmermann, C., Swami, N., Krzyzanowska, M., et al. (2014). Early palliative care for patients with advanced cancer: A cluster-randomised controlled trial. Lancet, 383(9930), 17211730.

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