Palliative care interventions for thoracic cancer: a systematic review and meta-analysis identifying the core elements.

Abstract

Introduction: Despite increasing trials examining palliative care for people with thoracic cancer, implementation remains limited. Understanding the core elements of palliative care interventions is critical to improving design, scalability, and accessibility globally. This review aimed to determine the core elements and efficacy of palliative care interventions in thoracic cancer.

Methods: Five medical databases were searched from January 1987 to January 2025. Randomised controlled trials (RCTs) and nonrandomised studies of palliative care interventions in thoracic cancer addressing at least two National Consensus Project domains were eligible. Meta-analyses of RCTs were performed using a random-effects model.

Results: 34 palliative care interventions (n=6490, mean±sd age 65±10 years, 41% women) were identified. Interventions were categorised as comprehensive palliative care interventions (n=18), nonpharmacological symptom interventions (n=12) and psychosocial-educational interventions (n=4). Comprehensive interventions were significantly longer (21.7 weeks) than nonpharmacological symptom (4.8 weeks) and psychosocial-educational interventions (8.7 weeks; p<0.01), addressed more components (mean components: 8, 3, 4, respectively; p<0.01), were often provided by specialist palliative care clinicians (83%, 16%, 0%; p<0.01), and included interprofessional teams (61%, 8%, 0%; p<0.01). Comprehensive palliative care interventions improved quality of life (standardised mean difference (SMD) 0.25, 95% CI 0.11-0.38), survival (hazard ratio 0.76, 95% CI 0.62-0.94), overall symptoms (SMD 0.20, 95% CI 0.02-0.38) and depression (SMD 0.28, 95% CI 0.07-0.5). Nonpharmacological symptom interventions improved breathlessness (SMD 0.29, 95% CI 0.15-0.43) and depression (SMD 0.17, 95% CI 0.02-0.31). Psychosocial-educational interventions did not affect quality of life or mood.

Conclusions: Comprehensive palliative care interventions improved quality of life, survival and symptoms among people with thoracic cancers. Nonpharmacological symptom interventions improved breathlessness and depression.