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Supportive Care in Cancer
Published in: Supportive Care in Cancer 1/2018

01-01-2018 | Review Article

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

Authors: Angelos P. Kassianos, Myria Ioannou, Marianna Koutsantoni, Haris Charalambous

Published in: Supportive Care in Cancer | Issue 1/2018

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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.
Appendix
Available only for authorised users
Footnotes
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).
 
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Metadata
Title
The impact of specialized palliative care on cancer patients’ health-related quality of life: a systematic review and meta-analysis
Authors
Angelos P. Kassianos
Myria Ioannou
Marianna Koutsantoni
Haris Charalambous
Publication date
01-01-2018
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 1/2018
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-017-3895-1

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