Ambulatory palliative care and cancer symptom control: a systematic review and meta-analysis.

IF 1.8 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

BMJ Supportive & Palliative Care Pub Date : 2025-06-27 DOI:10.1136/spcare-2024-005152

Rajvi Shah, Rachel Everitt, Dana Hince, David Kissane, Natasha Michael

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引用次数: 0

Abstract

Background: Ambulatory palliative care clinics are associated with improved outcomes in cancer patients, including short-term quality of life. However, their impact on individual patient-reported symptoms is not well understood.

Aim: We evaluated the impact of ambulatory palliative care on individual symptoms in adult cancer patients.

Design: Following a standard protocol (PROSPERO: CRD42022321909), investigators independently identified randomised and non-randomised intervention studies that assessed patient-reported symptom scores using validated symptom assessment scales longitudinally. Data were synthesised using random-effects meta-analyses.

Data sources: Database of PubMed, CINAHL, EMBASE, PsycINFO and Cochrane Central was searched from inception to September 2023 for eligible studies.

Results: 20 studies encompassing 4 prospective cohort studies, 1 randomised control trial and 15 retrospective studies were included. Most studies focused on cohorts with advanced cancers of mixed primary tumour type, were colocated within or linked to a tertiary cancer centre and assessed symptoms using the Edmonton Symptom Assessment Scale (ESAS). The meta-analyses confirmed evidence for improvement in pain (standardised mean difference (SMD) 0.31, 95% CI 0.18 to 0.44), anxiety (SMD 0.31, 95% CI 0.12 to 0.49), fatigue (SMD 0.31, 95% CI 0.10 to 0.51), insomnia (SMD 0.29, 95% CI 0.15 to 0.42), depression (SMD 0.25, 95% CI 0.09 to 0.40), drowsiness (SMD 0.23, 95% CI 0.11 to 0.34), well-being (SMD 0.28, 95% CI 0.12 to 0.45) and overall symptom burden (SMD 0.29, 95% CI 0.22 to 0.36). There was no evidence for improvement in nausea (SMD 0.19, 95% CI -0.02 to 0.40), dyspnoea (SMD 0.16, 95% CI 0.02 to 0.29) and appetite scores (SMD 0.14, 95% CI -0.00 to 0.29).

Conclusions: Ambulatory palliative care had positive effects on multiple common symptoms. The strength of this evidence however is low, largely due to the considerable heterogeneity among included studies. Further research could determine thresholds on symptom assessment scales to guide urgency of referral, timing of follow-up and optimal multidisciplinary staff involvement.

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门诊姑息治疗和癌症症状控制：系统回顾和荟萃分析。

背景：门诊姑息治疗可改善癌症患者的预后，包括短期生活质量。然而，它们对个别患者报告的症状的影响尚不清楚。目的：我们评估门诊姑息治疗对成年癌症患者个体症状的影响。设计：遵循标准方案（PROSPERO: CRD42022321909），研究者独立确定随机和非随机干预研究，使用经验证的症状评估量表纵向评估患者报告的症状评分。数据采用随机效应荟萃分析进行综合。数据来源：检索PubMed， CINAHL， EMBASE， PsycINFO和Cochrane Central数据库，从成立到2023年9月，检索符合条件的研究。结果：共纳入20项研究，包括4项前瞻性队列研究、1项随机对照试验和15项回顾性研究。大多数研究集中在混合原发肿瘤类型的晚期癌症患者队列中，这些患者位于三级癌症中心内或与三级癌症中心相关，并使用埃德蒙顿症状评估量表（ESAS）评估症状。meta分析证实了疼痛（标准化平均差值（SMD） 0.31, 95% CI 0.18至0.44）、焦虑（SMD 0.31, 95% CI 0.12至0.49）、疲劳（SMD 0.31, 95% CI 0.10至0.51）、失眠（SMD 0.29, 95% CI 0.15至0.42）、抑郁（SMD 0.25, 95% CI 0.09至0.40）、嗜睡（SMD 0.23, 95% CI 0.11至0.34）、幸福感（SMD 0.28, 95% CI 0.12至0.45）和整体症状负担（SMD 0.29, 95% CI 0.22至0.36）的改善证据。没有证据表明恶心（SMD 0.19, 95% CI -0.02至0.40）、呼吸困难（SMD 0.16, 95% CI 0.02至0.29）和食欲评分（SMD 0.14, 95% CI -0.00至0.29）有改善。结论：门诊姑息治疗对多种常见症状有积极作用。然而，这一证据的强度很低，主要是由于纳入的研究之间存在相当大的异质性。进一步的研究可以确定症状评估量表的阈值，以指导转诊的紧迫性、随访时间和最佳的多学科工作人员参与。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMJ Supportive & Palliative Care Medicine-Medicine (miscellaneous)

CiteScore

4.60

自引率

7.40%

发文量

170

期刊介绍： Published quarterly in print and continuously online, BMJ Supportive & Palliative Care aims to connect many disciplines and specialties throughout the world by providing high quality, clinically relevant research, reviews, comment, information and news of international importance. We hold an inclusive view of supportive and palliative care research and we are able to call on expertise to critique the whole range of methodologies within the subject, including those working in transitional research, clinical trials, epidemiology, behavioural sciences, ethics and health service research. Articles with relevance to clinical practice and clinical service development will be considered for publication. In an international context, many different categories of clinician and healthcare workers do clinical work associated with palliative medicine, specialist or generalist palliative care, supportive care, psychosocial-oncology and end of life care. We wish to engage many specialties, not only those traditionally associated with supportive and palliative care. We hope to extend the readership to doctors, nurses, other healthcare workers and researchers in medical and surgical specialties, including but not limited to cardiology, gastroenterology, geriatrics, neurology, oncology, paediatrics, primary care, psychiatry, psychology, renal medicine, respiratory medicine.