Specialist palliative care services linked with small positive effect on quality of life

The effect of palliative care on quality of life appeared to be more pronounced for patients with cancer and for those who received palliative care early, according to the review and meta-analysis.

Specialist palliative care may have a small but favorable effect on patients' quality of life, with the most pronounced effects among those with cancer who receive such care early, according to a recent systematic review and meta-analysis.

Researchers assessed 12 studies conducted in hospitals, including 10 randomized controlled trials of 2,454 patients (72% with cancer), to determine the effect of providing specialist palliative care on patients' quality of life. Interventions varied across trials but included initiating specialist palliative care to all intervention-arm participants according to diagnosis and stage of disease, whereas control groups typically received standard care.

The primary outcome was quality of life, with Hedges' g (a measure of effect size) as standardized mean difference (SMD) and pooled SMDs re-expressed on the global health/quality of life scale of the European Organization for Research and Treatment of Cancer QLQ-C30 (0 to 100, with higher values indicating better quality of life; minimal clinically important difference, 8.1). Results were published online on July 4 by The BMJ.

Overall, researchers found a small, positive effect of specialist palliative care on quality of life in six trials of 1,218 participants (SMD, 0.16; 95% CI, 0.01 to 0.31; QLQ-C30, 4.1; 95% CI, 0.3 to 8.2). A sensitivity analysis of seven trials of 1,385 participants showed an SMD of 0.57 (95% CI, −0.02 to 1.15; QLQ-C30, 14.6; 95% CI, −0.5 to 29.4).

Patients with cancer in five trials (n=828) saw a slightly larger effect (SMD, 0.20; 95% CI, 0.01 to 0.38; QLQ-C30, 5.1; 95% CI, 0.3 to 9.7), especially those who received palliative care early (SMD, 0.33; 95% CI, 0.05 to 0.61; QLQ-C30, 8.5; 95% CI, 1.3 to 15.6; n=388, two trials). Early care was defined as Eastern Cooperative Oncology Group 0 to 2, Karnofsky index 50 to 100, six to 24 months estimated survival, or initiation of specialist palliative care within eight weeks of diagnosis of an advanced incurable illness.

The authors noted limitations of the review, such as how not all trials assessed quality of life and how risk of bias was high in most studies. They added that the true effects of specialized palliative care might have been underestimated due to various methodological issues.

“The effect on quality of life might be more pronounced for patients with cancer and for those who received specialised palliative care early. This effect was observed even though all trials also provided specialised palliative care to patients who did not have symptoms nor had any other needs for palliative care. … We hypothesise that specialised palliative care could be most effective if it is provided early and if it identifies patients with unmet needs through screening (“care as needed”),” they wrote.