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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: kristina.rosengaard.holmenlund@regionh.dk.
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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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