The effects of integrated palliative care on quality of life and psychological distress in patients with advanced cancer: a systematic review and meta-analysis

Abstract

Background: Integrated palliative care (IPC) is regarded as the standard therapy for advanced cancer. We conduct a comprehensive analysis to evaluate current evidence for the effectiveness of IPC on quality of life (QoL) and psychological distress among patients with advanced cancer. Differences in effectiveness are explored regarding various types of IPC and the follow-up time/period. Methods: A systematic literature search of PubMed, PsycINFO, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials was conducted. We identified 12 randomized controlled trials, which included 2,356 participants, that were pooled using a random-effects meta-analysis. Results: Our results suggested no significant difference between the three different models of IPC and conventional treatment on overall QoL (SMD =0.06, 95% CI: –0.06 to 0.17, P=0.318). However, there was a long-lasting favorable effect of IPC on overall QoL throughout the follow-up period of 12 to 18 weeks (SMD =0.13, 95% CI: 0.02 to 0.24, P=0.016). The inpatient consulting model was more effective than other models in reducing depression and anxiety symptoms (SMD =−0.42, 95% CI: −0.64 to −0.19, P<0.001; SMD =−0.31, 95% CI: −0.54 to −0.09, P=0.006). In the early period of approximately 2 weeks of follow-up, IPC was shown to be significantly more effective in reducing depression and anxiety symptoms (SMD =−0.30, 95% CI: −0.52 to −0.07, P=0.009; SMD =−0.45, 95% CI: −0.68 to −0.23, P<0.001). IPC was also effective in decreasing posttraumatic stress disorder (PTSD) symptoms (SMD =−0.46, 95% CI: −0.69 to −0.23, P<0.001). Conclusions: IPC can effectively improve QoL and alleviate early psychological distress in patients with advanced cancer. The inpatient consulting model of IPC was more effective than other models in reducing depression and anxiety symptoms.