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

Hoerger, Michael; Wayser, Graceanne R.; Schwing, Gregory; Suzuki, Ayako; Perry, Laura M.

doi:10.1093/abm/kay077

Cited by 90 publications

(66 citation statements)

References 64 publications

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“…Integration of PC in LT patients seems to be considered essential by all parts [13, 15, 21, 22]. Transplant candidates not only benefit from being provided PC, since they suffer from a terminal condition with significant needs, but also require a complete and complex medical care even when their condition is very advanced [39]. Also, LT patients who are removed from the waiting list often experience withdrawal of specialty care, feelings of abandonment and likely imminent death [34], all of which must be addressed.…”

Section: Discussionmentioning

confidence: 99%

Palliative Care in End-Stage Liver Disease Patients Awaiting Liver Transplantation: Review

Silva

Freire

Miranda

2020

GE Port J Gastroenterol

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Introduction: End-stage liver disease (ESLD) is the advanced phase of most liver diseases. The cure is liver transplantation (LT), only available for a minority of patients. This review summarizes the evidence regarding palliative care (PC) in ESLD patients awaiting LT. Methods: Review of the literature available in Medline, Scopus and Web of Knowledge, with keywords ESLD and PC. Results: Fifteen of the 230 articles reviewed met the inclusion criteria. Ten main themes were addressed: symptom burden; perspectives of life-sustaining treatment and comfort for patients, families and health professionals; goals of care discussions; patient and family needs; quality of life; PC and survival; referral to PC, barriers and opportunities; integration of PC; outpatient care and cost-effectiveness analysis. The referral of patients to PC was only evaluated in a few studies, all of which reported low referral rates. Better knowledge of how PC professionals can support other professionals was considered important, and also better ways to integrate PC were considered essential. Conclusion: ESLD patients awaiting LT have a significant need for PC and, despite the insufficient response, were reported to benefit from this type of care. Future research is essential to determine the means to overcome barriers and better integrate PC for ESLD patients awaiting LT.

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Section: Discussionmentioning

confidence: 99%

Palliative Care in End-Stage Liver Disease Patients Awaiting Liver Transplantation: Review

Silva

Freire

Miranda

2020

GE Port J Gastroenterol

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“…However, a series of studies published starting in 2010 demonstrated that early palliative care improved survival by an average of 4.6 months in patients with advanced cancer 20‐22 . These and other studies showed that early palliative care also improved quality of life and reduced distress in both patients and caregivers 20,22‐24 . Findings were extended in a recent high‐visibility study demonstrating that clinic‐based symptom monitoring and management improved quality of life and extended survival by 5 months in patients with cancer who received chemotherapy, perhaps because they received chemotherapy for a longer time 25,26 .…”

Section: The Need For Pghd In Cancer Carementioning

confidence: 96%

“…As recently as 1999, PROs were framed in terms of understanding tradeoffs between quantity and quality of life 19 . However, a series of studies published starting in 2010 demonstrated that early palliative care improved survival by an average of 4.6 months in patients with advanced cancer 20‐22 . These and other studies showed that early palliative care also improved quality of life and reduced distress in both patients and caregivers 20,22‐24 .…”

Section: The Need For Pghd In Cancer Carementioning

confidence: 99%

Innovations in research and clinical care using patient‐generated health data

Jim

Hoogland

Brownstein

et al. 2020

CA A Cancer J Clinicians

113

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Patient-generated health data (PGHD), or health-related data gathered from patients to help address a health concern, are used increasingly in oncology to make regulatory decisions and evaluate quality of care. PGHD include self-reported health and treatment histories, patient-reported outcomes (PROs), and biometric sensor data. Advances in wireless technology, smartphones, and the Internet of Things have facilitated new ways to collect PGHD during clinic visits and in daily life. The goal of the current review was to provide an overview of the current clinical, regulatory, technological, and analytic landscape as it relates to PGHD in oncology research and care. The review begins with a rationale for PGHD as described by the US Food and Drug Administration, the Institute of Medicine, and other regulatory and scientific organizations. The evidence base for clinic-based and remote symptom monitoring using PGHD is described, with an emphasis on PROs. An overview is presented of current approaches to digital phenotyping or device-based, real-time assessment of biometric, behavioral, self-report, and performance data. Analytic opportunities regarding PGHD are envisioned in the context of big data and artificial intelligence in medicine. Finally, challenges and solutions for the integration of PGHD into clinical care are presented. The challenges include electronic medical record integration of PROs and biometric data, analysis of large and complex biometric data sets, and potential clinic workflow redesign. In addition, there is currently more limited evidence for the use of biometric data relative to PROs. Despite these challenges, the potential benefits of PGHD make them increasingly likely to be integrated into oncology research and clinical care.

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“…Presumably, during the early phases of follow-up, palliative care has not yet provided a substantial "dose" to affect survival odds, and beyond 18 months, most patients succumb to their illness regardless of the care received. In contrast to the 2 previous meta-analyses, Hoerger et al 6 also conducted sensitivity analyses using Guyot et al's 11 method to develop composite Kaplan-Meier curves to assess survival differences across all the RCTs considered. From this statistical method, it was found that the median survival advantage of outpatient palliative oncology care was 4.56 months.…”

Section: Impact Of Palliative Oncology Care On Survivalmentioning

confidence: 99%

“…After considering the 4 meta-analyses on palliative oncology care, [4][5][6][7] the benefits for patient quality of life and survival are clear. Moving forward, disseminating these research findings will be critical to improve the lives of cancer patients and, more generally, public health.…”

Section: Disseminating Critical Findings Expanding Palliative Care Pmentioning

confidence: 99%

Summarizing the Evidence Base for Palliative Oncology Care: A Critical Evaluation of the Meta-analyses

Rogers

Perry

Hoerger

2020

Clin Med Insights Oncol

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Background: Palliative care is a specialized approach to symptom management that focuses on supporting patients’ physical and psychological quality of life throughout the disease course. In oncology, palliative care has been increasing in utilization. The evidence base for such care is also growing through the use of randomized controlled trials (RCTs). In this review, we aim to integrate the findings from 4 meta-analyses of palliative oncology care RCTs to examine the impact of palliative care on physical and psychological quality of life and survival. Method: We considered 4 meta-analyses of palliative oncology care RCTs, which each used slightly different methodologies and analyses. Two of the meta-analyses included both outpatient and inpatient populations, whereas the remaining meta-analyses focused specifically on outpatient palliative oncology care. Results: All 4 meta-analyses reported a robust quality of life advantage for patients randomized to receive palliative care. Two meta-analyses identified a survival advantage, whereas the other 2 detected no survival differences. In 1 meta-analysis that examined high-quality RCTs of outpatient palliative oncology care, it was found that an increased survival probability for palliative care, compared with standard of care, was confined to 6- to 18-month follow-up. Conclusions: There is a growing evidence base for palliative oncology care, as highlighted by the 4 meta-analyses considered. Such care successfully improves both physical and psychological quality of life for patients with serious illnesses, especially cancer. Clinicians should educate patients and their caregivers about the findings of these meta-analyses. Finally, governmental policies should focus on increasing palliative care access.

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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

Cited by 90 publications

References 64 publications

Palliative Care in End-Stage Liver Disease Patients Awaiting Liver Transplantation: Review

Palliative Care in End-Stage Liver Disease Patients Awaiting Liver Transplantation: Review

Innovations in research and clinical care using patient‐generated health data

Summarizing the Evidence Base for Palliative Oncology Care: A Critical Evaluation of the Meta-analyses

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