Background: Lung cancer is the most common cancer and leading cause of cancer mortality globally, associated with significant morbidity and symptom burden for patients and caregivers due to poorly managed symptoms. Earlier integration of palliative care within oncology may be associated with improved patient and caregiver outcomes, and has been supported by national guidelines and two Lancet commissions. The evidence for its effectiveness, however, has been mixed across the cancer spectrum.
Aim: To evaluate the current evidence for the effectiveness of early integrated palliative care in improving outcomes for people with lung cancer and their caregivers.
Methods: A systematic review, with narrative synthesis and meta-analysis (for studies using the same measures). MEDLINE and PubMed were searched (1 January 2010 - 31 July 2019) for phase II and III randomized controlled trials (RCTs) published in English, reporting on the effectiveness of palliative care interventions provided to adult patients (>18 years) with advanced (metastatic) small cell lung cancer or non-small cell lung cancer, for any outcome of interest.
Results: Thirteen papers were included reporting on 11 RCTs, evaluating the effectiveness of: delivering specialized palliative care alongside standard oncology care vs standard oncology care alone (n=6) and providing individual palliative care interventions simultaneously with oncology care (n=5). Narrative synthesis included all 11 RCTs; the heterogeneity of measures and their reporting limited the meta-analysis to two RCTs. There is mixed evidence for the effectiveness of early referral to palliative care and use of individual palliative interventions for people with lung cancer and their caregivers across various domains, including: survival, quality of life, treatment and healthcare utilization, depression, other symptoms (both physical and emotional), self-efficacy, and communication.
Discussion: Evidence suggests that on-demand palliative care is equally and/or more effective than palliative care that is routinely provided. This raises the question whether the initiation and provision of palliative care as part of multidisciplinary lung cancer care ought to be guided by an early referral or need-based referral.
Conclusions: Better understanding of what constitutes palliative care when delivered to people with lung cancer and their caregivers will help delineate the correlation with reported outcomes for these populations.