Timely palliative care is a systematic process to identify patients with high supportive care needs and to refer these individuals to specialist palliative care in a timely manner based on standardized referral criteria.
1. Introduction
Patients with cancer encounter significant supportive care needs throughout the disease trajectory, starting from the time of diagnosis [
1]. These supportive care needs fluctuate with time and may include physical, psychological, social, spiritual, informational and financial concerns, often overlapping with each other, compromising patients’ quality of life. The demand for supportive care services increases with an aging patient population who often have multiple comorbid diagnoses. Moreover, there is a heightened need for supportive care in the era of novel cancer therapeutics, as patients are living longer while experiencing more chronic symptoms and adverse effects [
2,
3].
Over the past few decades, multiple supportive care programs have evolved to address these growing patient care needs [
1]. In particular, there has been substantial development in specialist palliative care teams that provide interdisciplinary, holistic care for patients with cancer and their families [
4,
5,
6]. Multiple randomized controlled trials have found that compared to primary palliative care provided by oncologists, early referral to specialist palliative care can improve patients’ quality of life, symptom control, mood, illness understanding, end-of-life care and survival [
7,
8,
9,
10,
11,
12,
13]. Meta-analyses over the past 5 years have consistently reported the benefits associated with specialist palliative care [
14,
15,
16,
17,
18] (
Table 1). To date, the evidence on primary palliative care remains limited [
19,
20,
21]. Thus, the focus of this article is on delivery of timely specialist palliative care.
Table 1. Meta-analyses on the outcomes of specialist palliative care for patients with cancer.
|
Setting |
No. of Studies |
No. of Patients |
Quality of Life SMD (95% CI) |
Symptoms SMD (95% CI) |
Mood SMD (95% CI) |
Survival HR (95% CI) |
Kavalieratos et al. 2016 [16] |
IP/OP |
11 |
1670 |
0.12 (−0.2, 0.27) |
−0.14 (−0.39, 0.10) |
|
0.82 (0.60, 1.13) |
Gartner et al. 2017 [14] |
IP/OP |
5 |
828 |
0.20 (0.01, 0.38) |
−0.21 (−1.35, 0.94) |
|
|
|
OP (early only) |
2 |
388 |
0.33 (0.05, 0.61) |
|
|
|
Haun et al. 2017 [15] |
OP |
7 |
1614 |
0.27 (0.15, 0.38) |
−0.23 (−0.35, −0.10) |
−0.11 (−0.26, 0.03) |
0.85 (0.56, 1.28) |
Heorger et al. 2019 [17] |
OP |
8 |
2092 |
0.18 (0.09, 0.28) |
|
|
1y: 14.1% (6.5%, 21.7%) |
Fulton et al. 2019 [18] |
OP |
10 |
2385 |
0.24 (0.13, 0.35) |
−0.17 (−0.45, 0.11) |
−0.09 (−0.32, 0.13) |
0.84 (0.61, 1.18) |
This entry is adapted from the peer-reviewed paper 10.3390/cancers14041047