Integration of early specialist palliative care in cancer care and patient related outcomes: A critical review of evidence

Abstract

Introduction:World Health Organization and American Society of Clinical Oncology recommend early integration of specialist palliative care in patients with cancer. This paper focuses on critical review of evidence on integration of early specialist palliative care in cancer care and patient-related outcomes.Methods:The question for the literature search was – Does integration of early specialist palliative care in cancer care influences patient-related outcomes? 31 articles related to literature search review question were included in this paper.Results:Ten patient-related outcomes of early specialist palliative care in adult cancer care was studied. Studies by Temel et al. (2012), Bakitas et al. (2009), Zimmermann et al. (2014), Rugno et al. (2014), Lowery et al. (2013) and Walker et al. (2014) showed early specialist palliative care improves health-related quality of life (HRQOL). Studies by Pirl et al. (2012), Lowery et al. (2013), and Walker et al. (2014) showed early specialist palliative care improved mood depression and anxiety. Studies by Zimmermann et al. and Rugno et al. (2014) showed symptom control benefit of early specialist palliative care. Studies by Temel (2010), Bakitas (2015) and Rugno et al. (2014) showed survival improvement with early specialist palliative care. All these studies were carried in ambulatory palliative care setting. No survival benefit of palliative care intervention was seen in inpatient palliative care setting. The studies by Geer et al. (2012), Rugno et al. (2014), and Lowery et al. (2013) showed that early palliative care intervention positively influences treatment decision making. All the studies showed that palliative care intervention group received less intravenous chemotherapy in last few weeks of life. Studies by Yoong et al. and Temel et al. (2011) shows early specialist palliative care improves advanced care planning. Studies by Temel et al. (2010), Greer et al. (2012), McNamara et al. (2013), Hui et al. (2014), and Kwon et al.(2013) showed that early specialist palliative care improves health care utilization, planned discharge, less emergency room visits, and better hospice utilization. Studies by Wiese et al. (2013), Hui et al. (2014) and Temel et al. (2010) showed that early specialist palliative care improves end-of-life care outcomes. Study by Rugno et al. (2014) showed that early specialist palliative care improves health-related communication. Studies by Wallen et al. (2012) and Zimmermann et al. (2014) shows early specialist palliative care improves patient and family satisfaction. There is a lack of robust evidence at present to support role of early specialist palliative care interventions in pediatric and geriatric oncology. Qualitative studies have demonstrated few negative outcomes of early specialist palliative care intervention.Conclusions:In adult oncology, there is evidence to suggest early specialist palliative care improves HRQOL, mood, treatment decision-making, health care utilization, advanced care planning, patient satisfaction, and end-of-l...

Integration of oncology and palliative care: a Lancet Oncology Commission

“…[162][163][164][165][166][167][168][169][170][171][172] Oncologists' end of life care attitudes can influence their timely palliative care referral and end of life cancer treatment decisions. There is evidence that oncologists often refer patients late in the course of illness, 166,167,[173][174][175][176] despite believing, as found in recent surveys, that integration of early specialist palliative care in cancer improves symptom control, end-of-life care, health-related communication, and continuity of care. 173,176 A survey of 182 oncologists in the USA from a major cancer centre, found that comfort with the concepts of end of life care was associated with higher rates of specialist palliative care referral and self-reported primary palliative care delivery.…”

“…There is evidence that oncologists often refer patients late in the course of illness, 166,167,[173][174][175][176] despite believing, as found in recent surveys, that integration of early specialist palliative care in cancer improves symptom control, end-of-life care, health-related communication, and continuity of care. 173,176 A survey of 182 oncologists in the USA from a major cancer centre, found that comfort with the concepts of end of life care was associated with higher rates of specialist palliative care referral and self-reported primary palliative care delivery. 177 A recent systematic review found that the concepts of integration were varyingly defined.…”

Integrating Palliative Care Services in Ambulatory Oncology: An Application of the Edmonton Symptom Assessment System

“…[1][2][3][4][5] Thus, the American Society of Clinical Oncology has recommended that "combined standard oncology care and palliative care should be considered early in the course of illness for any patient with metastatic cancer and/or high symptom burden." 1(p880) In addition, to improve the overall management of distress in patients with cancer, the National Comprehensive Cancer Network has recommended that all patients be screened throughout the trajectory of their disease course.…”

What is the value of palliative care provision in low-resource settings?

“…Yet this model fails in low-resource settings where the alternative is no care. The potential benefit palliative care can offer patients, their children, grandchildren and local economy lies in mitigation of the costs of illness and suffering, rather than avoidance of costs of expensive treatment 25. On a societal level, palliative care can serve as a health system expander in offering patients with incurable disease the possibility of care within their homes, thereby reserving hospital-based care, with its limited resource of nurses, doctors and supplies for patients with potentially reversible illness.…”