Impact of Interdisciplinary Outpatient Specialty Palliative Care on Survival and Quality of Life in Adults With Advanced Cancer: A Meta-Analysis of Randomized Controlled Trials.
Adult
Aged
Aged, 80 and over
Ambulatory Care
/ statistics & numerical data
Female
Humans
Male
Middle Aged
Neoplasms
/ mortality
Outcome Assessment, Health Care
/ statistics & numerical data
Palliative Care
/ statistics & numerical data
Quality of Life
/ psychology
Randomized Controlled Trials as Topic
/ statistics & numerical data
Behavioral medicine
Meta-analysis
Mortality
Palliative care
Quality of life
Journal
Annals of behavioral medicine : a publication of the Society of Behavioral Medicine
ISSN: 1532-4796
Titre abrégé: Ann Behav Med
Pays: England
ID NLM: 8510246
Informations de publication
Date de publication:
04 06 2019
04 06 2019
Historique:
pubmed:
29
9
2018
medline:
10
7
2020
entrez:
29
9
2018
Statut:
ppublish
Résumé
In advanced cancer, patients want to know how their care options may affect survival and quality of life, but the impact of outpatient specialty palliative care on these outcomes in cancer is uncertain. To estimate the impact of outpatient specialty palliative care programs on survival and quality of life in adults with advanced cancer. Following PRISMA guidelines, we conducted a systematic review and meta-analysis of randomized controlled trials comparing outpatient specialty palliative care with usual care in adults with advanced cancer. Primary outcomes were 1 year survival and quality of life. Analyses were stratified to compare preliminary studies against higher-quality studies. Secondary outcomes were survival at other endpoints and physical and psychological quality-of-life measures. From 2,307 records, we identified nine studies for review, including five high-quality studies. In the three high-quality studies with long-term survival data (n = 646), patients randomized to outpatient specialty palliative care had a 14% absolute increase in 1 year survival relative to controls (56% vs. 42%, p < .001). The survival advantage was also observed at 6, 9, 15, and 18 months, and median survival was 4.56 months longer (14.55 vs. 9.99 months). In the five high-quality studies with quality-of-life data (n = 1,398), outpatient specialty palliative care improved quality-of-life relative to controls (g = .18, p < .001), including for physical and psychological measures. Patients with advanced cancer randomized to receive outpatient specialty palliative care lived longer and had better quality of life. Findings have implications for improving care in advanced cancer.
Sections du résumé
BACKGROUND
In advanced cancer, patients want to know how their care options may affect survival and quality of life, but the impact of outpatient specialty palliative care on these outcomes in cancer is uncertain.
PURPOSE
To estimate the impact of outpatient specialty palliative care programs on survival and quality of life in adults with advanced cancer.
METHODS
Following PRISMA guidelines, we conducted a systematic review and meta-analysis of randomized controlled trials comparing outpatient specialty palliative care with usual care in adults with advanced cancer. Primary outcomes were 1 year survival and quality of life. Analyses were stratified to compare preliminary studies against higher-quality studies. Secondary outcomes were survival at other endpoints and physical and psychological quality-of-life measures.
RESULTS
From 2,307 records, we identified nine studies for review, including five high-quality studies. In the three high-quality studies with long-term survival data (n = 646), patients randomized to outpatient specialty palliative care had a 14% absolute increase in 1 year survival relative to controls (56% vs. 42%, p < .001). The survival advantage was also observed at 6, 9, 15, and 18 months, and median survival was 4.56 months longer (14.55 vs. 9.99 months). In the five high-quality studies with quality-of-life data (n = 1,398), outpatient specialty palliative care improved quality-of-life relative to controls (g = .18, p < .001), including for physical and psychological measures.
CONCLUSIONS
Patients with advanced cancer randomized to receive outpatient specialty palliative care lived longer and had better quality of life. Findings have implications for improving care in advanced cancer.
Identifiants
pubmed: 30265282
pii: 5108509
doi: 10.1093/abm/kay077
pmc: PMC6546936
doi:
Types de publication
Journal Article
Meta-Analysis
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
674-685Subventions
Organisme : NIGMS NIH HHS
ID : U54 GM104940
Pays : United States
Informations de copyright
© Society of Behavioral Medicine 2018. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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