Kassianos Angelos P, Ioannou Myria, Koutsantoni Marianna, Charalambous Haris
Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
Department of Psychology, University of Cyprus, Nicosia, Cyprus.
Support Care Cancer. 2018 Jan;26(1):61-79. doi: 10.1007/s00520-017-3895-1. Epub 2017 Sep 20.
Specialized palliative care (SPC) is currently underutilized or provided late in cancer care. The aim of this systematic review and meta-analysis is to critically evaluate the impact of SPC on patients' health-related quality of life (HRQoL).
Five databases were searched through June 2016. Randomized controlled trials (RCTs) and prospective studies using a pre- and post- assessment of HRQoL were included. The PRISMA reporting statement was followed. Criteria from available checklists were used to evaluate the studies' quality. A meta-analysis followed using random-effect models separately for RCTs and non-RCTs.
Eleven studies including five RCTs and 2939 cancer patients published between 2001 and 2014 were identified. There was improved HRQoL in patients with cancer following SPC especially in symptoms like pain, nausea, and fatigue as well as improvement of physical and psychological functioning. Less or no improvements were observed in social and spiritual domains. In general, studies of inpatients showed a larger benefit from SPC than studies of outpatients whereas patients' age and treatment duration did not moderate the impact of SPC. Methodological shortcomings of included studies include high attrition rates, low precision, and power and poor reporting of control procedures.
The methodological problems and publication bias call for higher-quality studies to be designed, funded, and published. However, there is a clear message that SPC is multi-disciplinary and aims at palliation of symptoms and burden in line with current recommendations.
专科姑息治疗（SPC）目前在癌症治疗中未得到充分利用或提供得较晚。本系统评价和荟萃分析的目的是严格评估SPC对患者健康相关生活质量（HRQoL）的影响。
检索了五个数据库至2016年6月。纳入使用HRQoL前后评估的随机对照试验（RCT）和前瞻性研究。遵循PRISMA报告声明。使用现有清单中的标准评估研究质量。分别对RCT和非RCT使用随机效应模型进行荟萃分析。
确定了11项研究，包括2001年至2014年间发表的5项RCT和2939名癌症患者。接受SPC治疗的癌症患者的HRQoL有所改善，尤其是在疼痛、恶心和疲劳等症状方面，以及身体和心理功能的改善。在社会和精神领域观察到的改善较少或没有改善。总体而言，住院患者的研究显示SPC带来的益处比门诊患者的研究更大，而患者的年龄和治疗持续时间并未调节SPC的影响。纳入研究的方法学缺陷包括高损耗率、低精度和效能以及对照程序报告不佳。
方法学问题和发表偏倚要求设计、资助和发表更高质量的研究。然而，有一个明确的信息是，SPC是多学科的，旨在按照当前建议缓解症状和减轻负担。
