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

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Abstract

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.

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Notes

  1. The Duval and Tweedie’s trim and fill statistic showed that six studies were missing from the published literature that could establish symmetry on the funnel plot, which even if considered not favoring SPC, the standardized mean effect would remain significant and would still not traverse the zero axis, with d = 0.117 (95% CI – 0.012, 0.245).

References

  1. Stewart BWKP, & Wild CP (2014) World cancer report 2014. 2014. Lyon CEDEX, France

  2. Peppercorn JM, Smith TJ, Helft PR et al (2011) American society of clinical oncology statement: toward individualized care for patients with advanced cancer. J Clin Oncol 29:755–760. https://doi.org/10.1200/JCO.2010.33.1744

    Article  PubMed  Google Scholar 

  3. Care P (1999) Discussing palliative care with patients. Ann Intern Med 130:744–749

    Article  Google Scholar 

  4. Saito AM, Landrum MB, Neville BA et al (2011) The effect on survival of continuing chemotherapy to near death. BMC Palliat Care 10:14

    Article  Google Scholar 

  5. Von Gruenigen V, Daly B, Gibbons H et al (2008) Indicators of survival duration in ovarian cancer and implications for aggressiveness of care. Cancer 112:2221–2227

    Article  Google Scholar 

  6. Kao S, Shafiq J, Vardy J, Adams D (2009) Use of chemotherapy at end of life in oncology patients. Ann Oncol 20:1555–1559

    Article  CAS  Google Scholar 

  7. Rose JH, O’Toole EE, Dawson NV et al (2004) Perspectives, preferences, care practices, and outcomes among older and middle-aged patients with late-stage cancer. J Clin Oncol 22:4907–4917

    Article  Google Scholar 

  8. Charalambous H, Silbermann M (2012) Clinically based palliative care training is needed urgently for all oncologists. J Clin Oncol 30:4042–4043

    Article  Google Scholar 

  9. Wright AA, Zhang B, Ray A et al (2008) Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 300:1665–1673

    Article  CAS  Google Scholar 

  10. World Health Organisation (2003) Palliative care: what is it http://www.who.int/cancer/palliative/definition/en/. Accessed 01 June 2016

  11. Echteld MA, van Zuylen L, Bannink M et al (2007) Changes in and correlates of individual quality of life in advanced cancer patients admitted to an academic unit for palliative care. Palliat Med 21:199–205

    Article  Google Scholar 

  12. Higginson IJ, Finlay IG, Goodwin DM et al (2003) Is there evidence that palliative care teams alter end-of-life experiences of patients and their caregivers? J Pain Symptom Manag 25:150–168

    Article  Google Scholar 

  13. Levy MH, Back A, Benedetti C et al (2009) Palliative Care. J Natl Compr Cancer Netw 7:436–473

    Article  Google Scholar 

  14. Ferris FD, Bruera E, Cherny N et al (2009) Palliative cancer care a decade later: accomplishments, the need, next steps—from the American Society of Clinical Oncology. J Clin Oncol 27:3052–3058

    Article  Google Scholar 

  15. Quill TE, Abernethy AP (2013) Generalist plus specialist palliative care—creating a more sustainable model. N Engl J Med 368:1173–1175

    Article  CAS  Google Scholar 

  16. Strand JJ, Mansel JK, Swetz KM, others (2014) The growth of palliative care. Minn Med 97:39–43

  17. Kavalieratos D, Corbelli J, Zhang D et al (2016) Association between palliative care and patient and caregiver outcomes: a systematic review and meta-analysis. JAMA 316:2104–2114

    Article  Google Scholar 

  18. Zimmermann C, Riechelmann R, Krzyzanowska M et al (2008) Effectiveness of specialized palliative care: a systematic review. JAMA 299:1698–1709

    Article  CAS  Google Scholar 

  19. Davis MP, Temel JS, Balboni T, Glare P (2015) A review of the trials which examine early integration of outpatient and home palliative care for patients with serious illnesses. Ann Palliat Med 4:99–121

    PubMed  Google Scholar 

  20. Jenicek M (1989) Meta-analysis in medicine where we are and where we want to go. J Clin Epidemiol 42:35–44

    Article  CAS  Google Scholar 

  21. Byock I, Twohig JS, Merriman M, Collins K (2006) Promoting excellence in end-of-life care: a report on innovative models of palliative care. J Palliat Med 9:137–151

    Article  Google Scholar 

  22. Morrison RS, Meier DE (2004) Palliative Care. N Engl J Med 350:2582–2590. https://doi.org/10.1056/NEJMcp035232

    Article  CAS  PubMed  Google Scholar 

  23. Field MJ, Cassel CK, others (1997) Approaching death: improving care at the end of life. National Academies Press, Washington DC

  24. Foley K, & Gelband H (2001) Improving Palliative Care for Cancer, National Cancer Policy Board, National Research Council. National Academy of Sciences, 10

  25. Smith TJ, Temin S, Alesi ER et al (2012) American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J Clin Oncol 30:880–887

    Article  Google Scholar 

  26. Ferrell BR, Temel JS, Temin S et al (2016) Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 35:96–112. https://doi.org/10.1200/JCO.2016.70.1474

    Article  PubMed  Google Scholar 

  27. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264–269

    Article  Google Scholar 

  28. World Health Organization (2017) WHO definition of palliative care http://www.who.int/cancer/palliative/definition/en/ Accessed 24 Jul 2017

  29. McGowan J, Sampson M, Lefebvre C (2010) An evidence based checklist for the Peer Review of Electronic Search Strategies (PRESS EBC). Evid Based Libr Inf Pract 5:149–154

    Article  Google Scholar 

  30. Slim K, Nini E, Forestier D et al (2003) Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg 73:712–716

    Article  Google Scholar 

  31. Chalmers TC, Smith H, Blackburn B et al (1981) A method for assessing the quality of a randomized control trial. Control Clin Trials 2:31–49

    Article  CAS  Google Scholar 

  32. Von Elm E, Altman DG, Egger M et al (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Prev Med 45:247–251

    Article  Google Scholar 

  33. Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17:1–12

    Article  CAS  Google Scholar 

  34. Mowatt G, Grimshaw JM, Davis DA, Mazmanian PE (2001) Getting evidence into practice: the work of the cochrane Effective Practice and Organization of Care Group (EPOC). J Contin Educ Heal Prof 21:55–60. https://doi.org/10.1002/chp.1340210109

    Article  CAS  Google Scholar 

  35. Des Jarlais DC, Lyles C, Crepaz N (2004) Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Am J Public Health 94:361–366

    Article  Google Scholar 

  36. Shea BJ, Grimshaw JM, Wells GA et al (2007) Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 7:1

    Article  Google Scholar 

  37. Campbell MK, Piaggio G, Elbourne DR, & Altman DG (2012) Consort 2010 statement: extension to cluster randomised trials. BMJ 345:e5661

  38. Ozcelik H, Fadiloglu C, Karabulut B, Uyar M (2014) Examining the effect of the case management model on patient results in the palliative care of patients with cancer. Am J Hosp Palliat Med 31:655–664

    Article  Google Scholar 

  39. Bischoff K, Weinberg V, Rabow MW (2013) Palliative and oncologic co-management: symptom management for outpatients with cancer. Support Care Cancer 21:3031–3037

    Article  Google Scholar 

  40. Strömgren AS, Sjogren P, Goldschmidt D et al (2005) A longitudinal study of palliative care. Cancer 103:1747–1755

    Article  Google Scholar 

  41. Temel JS, Greer JA, Muzikansky A et al (2010) Early palliative care for patients with metastatic non–small-cell lung cancer. N Engl J Med 363:733–742

    Article  CAS  Google Scholar 

  42. Melin-Johansson C, Axelsson B, Gaston-Johansson F, Danielson E (2010) Significant improvement in quality of life of patients with incurable cancer after designation to a palliative homecare team. Eur J Cancer Care (Engl) 19:243–250

    Article  CAS  Google Scholar 

  43. Yamagishi A, Sato K, Miyashita M et al (2014) Changes in quality of care and quality of life of outpatients with advanced cancer after a regional palliative care intervention program. J Pain Symptom Manag 48:602–610

    Article  Google Scholar 

  44. Zimmermann C, Swami N, Krzyzanowska M et al (2014) Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet 383:1721–1730

    Article  Google Scholar 

  45. Jordhøy MS, Fayers P, Loge JH avard, et al (2001) Quality of life in palliative cancer care: results from a cluster randomized trial. J Clin Oncol 19:3884–3894

    Article  Google Scholar 

  46. Bakitas M, Lyons KD, Hegel MT et al (2009) Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the project ENABLE II randomized controlled trial. JAMA 302:741–749

    Article  CAS  Google Scholar 

  47. Aaronson NK, Ahmedzai S, Bergman B et al (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376

    Article  CAS  Google Scholar 

  48. Cella D, Nowinski CJ (2002) Measuring quality of life in chronic illness: the functional assessment of chronic illness therapy measurement system. Arch Phys Med Rehabil 83:S10–S17

    Article  Google Scholar 

  49. Webster K, Cella D, Yost K (2003) The Functional Assessment of Chronic Illness Therapy (FACIT) measurement system: properties, applications, and interpretation. Health Qual Life Outcomes 1:79

    Article  Google Scholar 

  50. Cella DF, Tulsky DS, Gray G et al (1993) The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol 11:570–579

    Article  CAS  Google Scholar 

  51. Lyons KD, Bakitas M, Hegel MT et al (2009) Reliability and validity of the Functional Assessment of Chronic Illness Therapy-Palliative Care (FACIT-Pal) scale. J Pain Symptom Manag 37:23–32. https://doi.org/10.1016/j.jpainsymman.2007.12.015

    Article  Google Scholar 

  52. Cella DF, Bonomi AE, Lloyd SR et al (1995) Reliability and validity of the Functional Assessment of Cancer Therapy—Lung (FACT-L) quality of life instrument. Lung Cancer 12:199–220. https://doi.org/10.1016/0169-5002(95)00450-F

    Article  CAS  PubMed  Google Scholar 

  53. Peterman AH, Fitchett G, Brady MJ et al (2002) Measuring spiritual well-being in people with cancer: the Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being Scale (FACIT-Sp). Ann Behav Med 24:49–58. https://doi.org/10.1207/S15324796ABM2401_06

    Article  PubMed  Google Scholar 

  54. Steinhauser KE, Clipp EC, Bosworth HB et al (2004) Measuring quality of life at the end of life: validation of the QUAL-E. Palliat Support Care 2:3–14. https://doi.org/10.1017/S1478951504040027

    Article  PubMed  Google Scholar 

  55. Cohen SR, Mount BM, Strobel MG, Bui F (1995) The McGill quality of life questionnaire: a measure of quality of life appropriate for people with advanced disease. A preliminary study of validity and acceptability. Palliat Med 9:207–219

    Article  CAS  Google Scholar 

  56. Browne JP, O’boyle CA, McGee HM et al (1997) Development of a direct weighting procedure for quality of life domains. Qual Life Res 6:301–309

    Article  CAS  Google Scholar 

  57. Bertil Axelsson P-OS (1999) Assessment of quality of life in palliative care: psychometric properties of a short questionnaire. Acta Oncol 38:229–237. https://doi.org/10.1080/028418699431663

    Article  Google Scholar 

  58. Cohen SR, Boston P, Mount BM, Porterfield P (2001) Changes in quality of life following admission to palliative care units. Palliat Med 15:363–371

    Article  CAS  Google Scholar 

  59. Morita T, Miyashita M, Yamagishi A et al (2013) Effects of a programme of interventions on regional comprehensive palliative care for patients with cancer: a mixed-methods study. Lancet Oncol 14:638–646

    Article  Google Scholar 

  60. Gaertner J, Siemens W, Daveson BA et al (2016) Of apples and oranges: lessons learned from the preparation of research protocols for systematic reviews exploring the effectiveness of specialist palliative care. BMC Palliat Care 15:43. https://doi.org/10.1186/s12904-016-0110-y

    Article  PubMed  PubMed Central  Google Scholar 

  61. Song F, Hooper L, Loke Y (2013) Publication bias: what is it? How do we measure it? How do we avoid it? Open Access J Clin Trials 2013:71–81

    Article  Google Scholar 

  62. Nipp RD, Currow DC, Cherny NI et al (2015) Best supportive care in clinical trials: review of the inconsistency in control arm design. Br J Cancer 113:6–11

    Article  CAS  Google Scholar 

  63. Siouta N, Van Beek K, Van der Eerden ME et al (2016) Integrated palliative care in Europe: a qualitative systematic literature review of empirically-tested models in cancer and chronic disease. BMC Palliat Care 15:56

    Article  Google Scholar 

  64. American Board of Internal Medicine (2008) Hospice & Palliative Medicine Certification Policies http://www.abim.org/certification/policies/internal-medicine-subspecialty-policies/hospice-palliative-medicine.aspx. Accessed 1 Mar 2017

  65. Breuer B, Fleishman SB, Cruciani RA, Portenoy RK (2011) Medical oncologists’ attitudes and practice in cancer pain management: a national survey. J Clin Oncol 29:4769–4775

    Article  Google Scholar 

  66. Weinstein MC, Skinner JA (2010) Comparative effectiveness and health care spending—implications for reform. N Engl J Med 362:460–465

    Article  CAS  Google Scholar 

  67. Burke LA, Ryan AM (2014) The complex relationship between cost and quality in US health care. Virtual Mentor VM 16:124–130

    Article  Google Scholar 

  68. World Health Organization (2002) National cancer control programmes: policies and managerial guidelines. World Health Organization

  69. Hui D, Elsayem A, De La Cruz M et al (2010) Availability and integration of palliative care at US cancer centers. JAMA 303:1054–1061

    Article  CAS  Google Scholar 

  70. Wentlandt K, Krzyzanowska MK, Swami N et al (2012) Referral practices of oncologists to specialized palliative care. J Clin Oncol 30:4380–4386

    Article  Google Scholar 

  71. Lynch T, Connor S, Clark D (2013) Mapping levels of palliative care development: a global update. J Pain Symptom Manag 45:1094–1106

    Article  Google Scholar 

  72. Meier DE, Beresford L (2008) Outpatient clinics are a new frontier for palliative care. J Palliat Med 11:823–828

    Article  Google Scholar 

  73. Levit L, Balogh E, Nass S et al (2013) Delivering high-quality cancer care: charting a new course for a system in crisis. Inst. Med. Wash, DC

    Book  Google Scholar 

  74. Lamas D, Rosenbaum L (2012) Painful inequities—palliative care in developing countries. N Engl J Med 366:199–201. https://doi.org/10.1056/NEJMp1113622

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK

    Angelos P. Kassianos

  2. Department of Psychology, University of Cyprus, Nicosia, Cyprus

    Myria Ioannou & Marianna Koutsantoni

  3. Bank of Cyprus Oncology Centre, Nicosia, Cyprus

    Haris Charalambous

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  1. Angelos P. Kassianos
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  2. Myria Ioannou
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  4. Haris Charalambous
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Correspondence to Angelos P. Kassianos.

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Kassianos, A.P., Ioannou, M., Koutsantoni, M. et al. The impact of specialized palliative care on cancer patients’ health-related quality of life: a systematic review and meta-analysis. Support Care Cancer 26, 61–79 (2018). https://doi.org/10.1007/s00520-017-3895-1

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