Student Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
Background: Early palliative care entails supportive communication with patients about their prognosis, advance care planning, and symptom assessment, irrespective of the healthcare provider.
Objectives: To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the impact of early palliative care compared to usual care on anxiety, depression, quality of life, and pain in patients diagnosed with advanced cancer.
Methods: The current systematic review was reported according PRISMA guidelines. A search was conducted in PubMed, CINAHL, and EMBASE. Randomized controlled trials, including in-patients diagnosed with advanced cancer were included. The search was restricted to the English language. Other study designs and studies reporting either gender alone were excluded from the review. Two reviewers independently screened and extracted the data based on a pre-designed template-. The conflicts were solved based on consensus. The continuous data were reported as mean difference (MD) or Standardized Mean Difference (SMD) if the effect size was small by conventional criteria which combined the different scales measuring the outcome of interest across studies. Random effect (I2 < 50%) or fixed effect model (I2>50%) was considered based on the I2 value. The meta-analysis was carried out using Review manager 5.4.1.
Results: Of the 1794 articles, 16 RCTs met the inclusion criteria that included 1977 patients. The pooled data from seven studies with 885 participants showed significant improvement in the early palliative care group that assessed depression (SMD:-0.14 95% CI -0.28 to -0.01, p=0.03 I2=50%). Positive SMDs reflected more depressive symptoms while negative reflects fewer depressive symptoms. Compared with standard care alone, early palliative care significantly improved quality of life at a small effect size (SMD :0.21,95% CI 0.07 to 0.35, p=0.04 I2=74%). Positive SMDs reflect benefit (better quality of life); while, negative SMDs indicate harm (lower quality of life ).
Conclusions: Early palliative care showed a positive improvement in humanistic outcomes in patients diagnosed with advanced cancer. Future studies focusing on the real-life effectiveness of these interventions should be considered for better patient care and satisfaction.
