Integration of early palliative care in cancer treatment: a meta-analysis of 39 randomized controlled trials on clinical outcomes and management optimization.

OBJECTIVE

To compare the effects of early palliative care (EPC) and standard cancer care in terms of QoL, survival, depression, and symptom burden in patients with cancer. Early palliative care refers to palliative care starting ≤ 12 weeks since diagnosis or the beginning of first-line treatment, alongside the usual cancer care.

METHODS

Randomized controlled trials (RCTs) conducted until March 2026 and comparing EPC and standard care among adult patients with cancer were found using the search engines PubMed, Web of Science, Cochrane Library, CNKI, and Wanfang. The primary outcomes included QoL and OS; the secondary outcomes included depression and symptom burden. Meta-analysis was carried out using random-effect models to calculate SMDs and HRs. Potential biases were assessed with Cochrane RoB 2 and Egger's test.

RESULTS

We included 39 RCTs (8399 patients, 2002-2024). EPC improved QoL significantly (SMD = 0.30, 95% CI 0.25-0.35, p < 0.001; I2 = 15.4%). An exploratory OS benefit was seen (HR = 0.84, 95% CI 0.78-0.90, p < 0.001; I2 = 25.4%). Results were consistent across cancer types and regions, and most trials were of low risk of bias and from North America/Europe.

CONCLUSION

EPC enhances QoL and may extend the survival of cancer patients. These findings support early integration of palliative care, but findings for OS and generalizability to low- and middle-income countries (LMICs) should be interpreted with caution.