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

Published online by Cambridge University Press:  13 June 2017

Kristina Holmenlund ,
Per Sjøgren  and
Mie Nordly
Kristina Holmenlund*
Affiliation:
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Per Sjøgren
Affiliation:
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Mie Nordly
Affiliation:
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
*
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: [email protected].
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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.

Keywords

Palliative careCancerQuality of lifeSymptomsMood
Type
Review Article
Information
Palliative & Supportive Care , Volume 15 , Issue 6 , December 2017 , pp. 724 - 740
Copyright
Copyright © Cambridge University Press 2017 

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References

REFERENCES

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/.Google ScholarPubMed
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), 741–749. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3657724/.Google Scholar
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), 1438–1445. Epub ahead of print Mar 23. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404422/.Google Scholar
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/.Google Scholar
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), 99–121. Available from http://apm.amegroups.com/article/view/6813/7819.Google ScholarPubMed
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), 403–412. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1894855/.Google Scholar
Felce, D. & Perry, J. (1995). Quality of life: Its definition and measurement. Research in Developmental Disabilities, 16(1), 51–74.Google Scholar
Gaertner, J., Lutz, S., Chow, E., et al. (2015). Integrating palliative care and oncology: Towards a common understanding. Annals of Palliative Medicine, 4(1), 3–4. Available from http://apm.amegroups.com/article/view/5639/6426.Google Scholar
Glare, P., Virik, K., Jones, M., et al. (2003). A systematic review of physicians' survival predictions in terminally ill cancer patients. BMJ, 327(7408), 195–198. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC166124/.Google Scholar
Gomes, B & Higginson, I.J. (2008). Where people die (1974–2030): Past trends, future projections and implications for care. Palliative Medicine, 22(1), 33–41.Google Scholar
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. 3–18. New York: Oxford University Press.Google Scholar
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.Google Scholar
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.Google Scholar
Hearn, J. & Higginson, I.J. (1998). Do specialist palliative care teams improve outcomes for cancer patients? A systematic literature review. Palliative Medicine, 12(5), 317–322.Google Scholar
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), 96–106.Google Scholar
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), 633–636. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2033650/.CrossRefGoogle ScholarPubMed
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), 893–903. Available from http://ascopubs.org/doi/10.1200/JCO.2000.18.4.893.Google Scholar
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), 77–89.Google Scholar
Hui, D., Kim, Y.J., Park, J.C., et al. (2015). Integration of oncology and palliative care: A systematic review. The Oncologist, 20(1), 77–83. Epub ahead of print Dec 5, 2014. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4294615/pdf/theoncologist_14312.pdf.Google Scholar
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), 491–501. Epub ahead of print May 14Google Scholar
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.Google Scholar
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), 3884–3894.Google Scholar
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), 2754–2760.Google Scholar
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), 2104–2114.Google Scholar
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. 355–370. Oxford: Blackwell Publishing.Google Scholar
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.), 395–412. Oxford: Blackwell Publishing.Google Scholar
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), 1057–1062. Epub ahead of print Oct 4, 2014.Google Scholar
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), 516–521. Epub ahead of print Sep 7.CrossRefGoogle ScholarPubMed
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), 375–383. Epub ahead of print May 9. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3657725/pdf/nihms-458601.pdf.CrossRefGoogle ScholarPubMed
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, 61–68. Epub ahead of print Jul 26.Google Scholar
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), 713–724. Epub ahead of print Jul 13.Google Scholar
Oxenham, D. & Cornbleet, M.A. (1998). Accuracy of prediction of survival by different professional groups in a hospice. Palliative Medicine, 12(2), 117–118.Google Scholar
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), 278–289. Available from http://www.eapcnet.eu/LinkClick.aspx?fileticket=f63pXXzVNEY%3d&tabid=735.Google Scholar
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), E1–E10.Google Scholar
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), 3–17.CrossRefGoogle ScholarPubMed
Seale, C. (2000). Changing patterns of death and dying. Social Science & Medicine, 51(6), 917–930.CrossRefGoogle ScholarPubMed
Simone, C.B. 2nd (2015). Early palliative care and integration of palliative care models in modern oncology practices. Annals of Palliative Medicine, 4(3), 84–86. Available from http://apm.amegroups.com/article/view/7004/7814.Google ScholarPubMed
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.Google Scholar
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, 1939–1944. Available from http://www.bmj.com/content/bmj/316/7149/1939.full.pdf.CrossRefGoogle ScholarPubMed
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), 880–887. Epub ahead of print Feb 6. Available from http://ascopubs.org/doi/pdf/10.1200/JCO.2011.38.5161.Google Scholar
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), 2784–2796. Available from http://ascopubs.org/doi/pdf/10.1200/JCO.2016.67.1412.Google Scholar
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), 3717–3721. Epub ahead of print Aug 7. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4239171/.Google Scholar
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), 733–742. Available from http://www.nejm.org/doi/pdf/10.1056/NEJMoa1000678.Google Scholar
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), 834–841. Epub ahead of print Dec 28.Google Scholar
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), 94–104. Epub ahead of print May 23.Google Scholar
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.Google Scholar
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), 1691–1703. Available from http://www.nejm.org/doi/full/10.1056/NEJMoa1304369#t=article.Google Scholar
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), 137–145. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3148693/.Google Scholar
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), 389–395.Google Scholar
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/.Google Scholar
World Health Organization (2016). WHO Definition of Palliative Care. Geneva: World Health Organization. Available from http://www.who.int/cancer/palliative/definition/en/.Google Scholar
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), 1698–1709.Google Scholar
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), 1721–1730.Google Scholar