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Palliative care
Research
Treatment targeted at underlying disease versus palliative care in terminally ill patients: a systematic review
  1. Tea Reljic1,
  2. Ambuj Kumar1,2,
  3. Farina A Klocksieben1,
  4. Benjamin Djulbegovic1,2,3
  1. 1Comparative Effectiveness Research, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
  2. 2Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
  3. 3Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA
  1. Correspondence to Dr Benjamin Djulbegovic; bdjulbeg{at}health.usf.edu

Abstract

Objective To assess the efficacy of active treatment targeted at underlying disease (TTD)/potentially curative treatments versus palliative care (PC) in improving overall survival (OS) in terminally ill patients.

Design We performed a systematic review and meta-analysis of randomised controlled trials (RCT). Methodological quality of included RCTs was assessed using the Cochrane risk of bias tool.

Data sources Medline and Cochrane databases were searched, with no language restriction, from inception to 19 October 2016.

Eligibility criteria for selecting studies Any RCT assessing the efficacy of any active TTD versus PC in adult patients with terminal illness with a prognosis of <6-month survival were eligible for inclusion.

Results Initial search identified 8252 citations of which 10 RCTs (15 comparisons, 1549 patients) met inclusion criteria. All RCTs included patients with cancer. OS was reported in 7 RCTs (8 comparisons, 1158 patients). The pooled results showed no statistically significant difference in OS between TTD and PC (HR (95% CI) 0.85 (0.71 to 1.02)). The heterogeneity between pooled studies was high (I2=62.1%). Overall rates of adverse events were higher in the TTD arm.

Conclusions Our systematic review of available RCTs in patients with terminal illness due to cancer shows that TTD compared with PC did not demonstrably impact OS and is associated with increased toxicity. The results provide assurance to physicians, patients and family that the patients' survival will not be compromised by referral to hospice with focus on PC.

  • End of life care
  • PALLIATIVE CARE
  • Terminal illness

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi-org.ezproxy.u-pec.fr/10.1136/bmjopen-2016-014661

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    Footnotes

    • Twitter Follow Ambuj Kumar @drambuj

    • Contributors TR, AK and BD contributed to the study concept and design. TR, AK and FAK performed the data abstraction, analysis and interpretation. TR and AK participated in the drafting of the manuscript. TR, AK, FAK and BD performed the critical revision of the manuscript for important intellectual content. TR performed the statistical analysis. BD obtained funding. “TR and FAK were responsible for procurement of full text of all articles for data abstraction, printing of data abstraction forms and entering of data for analysis.” AK and BD were involved in the study supervision. TR, AK, FAK and BD approved final version of the manuscript for submission.

    • Funding This work was supported by Department of Defense (grant number W81-XWH-09-2-0175) (PI: Djulbegovic).

    • Disclaimer The funding agency did not play a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The researchers worked independently of the funding agency for this systematic review.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.