Table 4. Early integration of palliative care; data from a Cochrane analysis (17)*1, a systematic review and meta-analysis (18), and a recent study involving more than 20 000 patients (19)*1.
| Source | Outcome parameters | Number of study participants (RCTs) | Diagnoses | Results [95-%-KI] |
| (17) | health-related quality of life | 1028 (7 RCTs) | cancer | significant improvement with early integration of palliative care:standardized mean difference (SMD) 0.27; 95% confidence interval [0.15; 0.38] (weak effect, low evidence level) |
| (17) | depressiveness | 762 (5 RCTs) | cancer | no significant improvement with early integration of palliative careSMD –0.11; [−0.26; 0.03] (trend toward improvement with early integration of palliative care, very low evidence level) |
| (17) | symptom burden | 1054 (7 RCTs) | cancer | significant improvement with early integration of palliative careSMD –0.23; [− 0.35; − 0.10] (weak effect, low evidence level) |
| (17) | survival | 800 (4 RCTs) | cancer | no significant improvement with early integration of palliative careSMD 0.85; [0.56; 1.28] (no trend toward improvement with early integration of palliative care, low evidence level) |
| (18) | health-related quality of life | 2355 (15 RCTs) | cancer, heart failure, other diagnoses | significant improvement with early integration of palliative careSMD 0.46; [0.08; 0.83] (weak effect, low evidence level) |
| (18) | symptom burden | 1342 (10 RCTs) | cancer, heart failure, multiple sclerosis, other diagnoses | significant improvement with early integration of palliative careSMD −0.66; [−1.25; −0.07] (weak effect, low evidence level) |
| (18) | survival | 2184 (7 RCTs) | cancer, heart failure, other diagnoses | no significant improvement with early integration of palliative careSMD 0.90; [0.69; 1.17] (no trend for or against early integration, low evidence level) |
| (18) | utilization of health-care resources | 4794 (24 RCTs) | various diagnoses | 11 studies report lower resource utilization with early integration of palliative care |
| (19) | survival | 23,154 | lung cancer | 0–30 days after diagnosis: adjusted hazard ratio (aHR) 2.13; [1.97; 2.30] (increased risk of dying in the early integration group)*2 31–365 days after diagnosis: aHR 0.47; [0.45; 0.49] (significant survival advantage in the early integration group) 365 days after diagnosis aHR 1.00; [0.94; 1.07] (no difference between groups) significant overall survival advantage with early integration of palliative care for patients with advanced lung cancer |
aHR, adjusted hazard ratio; RCT, randomized and controlled trial; SMD, standardized mean difference
*1 the studies evaluated in publications (17) and (19) overlapped in part
*2 The authors interpret these data to mean that the very early integration of palliative care tended to occur in very ill patients with the aim of easing the dying process rather than prolonging life.