The Role of Specialty Palliative Care in Elective Surgical Oncology: A Systematic Review

BackgroundUnlike advanced cancer populations, for whom early and routine specialty palliative care (PC) referral has demonstrated clear benefits for quality of life and symptom control, evidence supporting PC for patients undergoing curative-intent cancer surgery has been inconclusive.MethodA systematic review of the PubMed, Embase, Cochrane Library, and MEDLINE databases was performed to identify all studies evaluating the role of PC for patients undergoing curative-intent surgery for cancer.ResultsAmong the 12,886 publications initially retrieved, 14 met all inclusion criteria: two cross-sectional studies comprised of physician surveys, four cohort studies, five qualitative studies, one prospective trial, and two randomized controlled trials (RCTs). In non-randomized studies, PC was associated with increased advanced care planning and symptom control; however, both the PERIOP-PC and SCOPE RCTs found no significant improvement in quality of life with routine perioperative PC among patients undergoing major abdominal cancer surgery. Qualitative studies characterized patient experiences and physician perspectives of PC.ConclusionThis systematic review summarizes the existing literature on the role of PC in surgical oncology, highlighting the unique considerations and unmet needs of surgical patients that differ from those with advanced cancer. While the routine use of perioperative PC for patients undergoing cancer surgery is not supported, future research should focus on identifying high-risk patients who would most benefit from specialty PC and innovative methods of delivering supportive care in surgical oncology.