Hartiah Haroen, Sidik Maulana, Hasniatisari Harun, Ristina Mirwanti, Citra Windani Mambang Sari, Hesti Platini, Novita Intan Arovah, Padila Padila, Shakira Amirah, Jerico Franciscus Pardosi
Background: Patients with cancer and their caregivers experience significant psychological, physical, and emotional burdens throughout the disease trajectory which reduces their quality of life (QoL). Early palliative care (EPC) has been proposed as a strategy to alleviate physical, psychological and emotional burdens and improve health outcomes. While evidence generally supports the benefits of EPC, variations in reported outcomes highlight the need for a deeper understanding of its impact across different patient populations and healthcare settings. Objective: The primary aim of this study was to evaluate the pooled effects of EPC on psychological, functional status, and QoL outcomes in both cancer patients and their caregivers. The secondary aim was to evaluate the satisfaction of the patients and their family caregivers. Methods: A systematic review and meta-analysis were conducted following the preferred reporting item for systematic review and meta-analysis (PRISMA) guidelines. Four databases, PubMed, Scopus, EBSCOhost, and Cochrane, were searched up to January 2024. This study included randomized controlled trial (RCT) and pilot-RCT studies reporting psychological outcomes (anxiety, depression), functional status, QoL, and satisfaction in cancer patients and their caregivers. Subgroup analysis was performed to explore the short-term (< 24 weeks) versus long-term (≥ 24 weeks) effects of EPC. Mean differences (MD) and standard mean differences (SMD) were calculated using a fixed-effects model according to the Mantel–Haenszel model and a random-effects model according to the DerSimonian and Laird method. Results: A total of 24 studies met our inclusion criteria. For cancer patients, EPC significantly reduced anxiety (MD = -0.62, 95% CI: -1.02; -0.23, p = 0.002) and improved QoL (SMD 0.13, 95%CI: 0.06; 0.19, p = 0.0004). However, there was no significant reduction in depression (SMD -0.15, 95% CI: -0.36; 0.05, p = 0.14) and improvement in functional status (MD = 2.14, 95% CI: -0.78; 5.06, p = 0.15). Subgroup analysis revealed that long-term EPC significantly reduced anxiety and depression while improving QoL, but had no significant effects on functional status. For caregivers, EPC did not significantly impact either physical or mental QoL (Short form/SF-36 physical: MD = 0.81, 95% CI: -0.46; 2.09, p = 0.21; SF-36 Mental: MD = 0.53, 95% CI: -1.03; 2.08, p = 0.51). Moreover, satisfaction was more likely to be higher in patients and their caregivers who received EPC than in those who received usual care (MD 2.45, 95% CI: 0.90; 4.01, p = 0.002, MD 4.09, 95% CI: 0.60; 7.58, p = 0.02, respectively). Conclusion: EPC reduces long term psychological burden and improve QoL and care satisfaction experience among patients with cancer. Therefore, EPC should be more broadly introduced into cancer care earlier to address patient’s psychological burdens. © The Author(s) 2025.
Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Jl. Ir. Soekarno KM. 21, Jatinangor, West Java, Sumedang, 45363, Indonesia; Postgraduate Program of Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, 45363, Indonesia; Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, 45363, Indonesia; Department of Critical Care and Emergency Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, 45363, Indonesia; Department of Sports Science, Faculty of Medicine, Universitas Negeri Yogyakarta, Sleman, 55281, Indonesia; Nursing Study Program, Faculty of Health Science, Universitas Muhammadiyah Bengkulu, Bengkulu, 38119, Indonesia; Clinical Clerkship Program, Faculty of Medicine, Central of Jakarta, Universitas Indonesia; Dr, Cipto Manungunkusumo National General Hospital, Central Jakarta, 1043, Indonesia; School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, 4000, QLD, Australia
