Meta-analysisindependent cross-checkabstract checked I-CHM-128 standard review
Palliative care and survival: a meta-analysis
Impact of Interdisciplinary Outpatient Specialty Palliative Care on Survival and Quality of Life in Adults With Advanced Cancer: A Meta-Analysis of Randomized Controlled Trials.
Overview
Hoerger M et al.. Ann Behav Med 2019 · PMID 30265282 · DOI 10.1093/abm/kay077
In three good-quality trials, patients with palliative care alongside cancer treatment were more often alive after one year (56% vs 42%).
Does the study support the specific claim? Partly · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Measure palliative care effect on survival
- How was the study done?
Meta-analysis of RCTs
- How many people, animals or samples were studied?
646 patients for survival
- What was actually found?
Longer survival, better quality of life
- How large was the observed effect?
56% vs 42% alive at 1 year
- What do the results mean in everyday life?
Palliative care added to treatment may help people live longer and better
- What are the study's limitations?
Few trials; conflicts with Cochrane
- What does it say about Elawady's specific claim?
Partly supports the claim
- Do the results apply to Germany and Europe?
Moderate
- What can explicitly not be concluded from this study?
Does not mean stopping cancer treatment
Scientific in-depth review
1. Full reference
- Authors
- Hoerger M et al.
- Journal
- Ann Behav Med
- Year
- 2019
- Identifier
- PMID 30265282 DOI 10.1093/abm/kay077
- Verification
- verified – PubMed efetch 2026-10-26 (PublicationType and CommentsCorrections checked); Crossref 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
NIGMS (NIH) grant; COI not stated in abstract.
2. Research question
Does outpatient specialty palliative care improve survival and quality of life in advanced cancer?
3. Study design and population
- Study design
- Meta-analysis – Systematic review and meta-analysis of RCTs (PRISMA), stratified by study quality
- Population
Adults with advanced cancer
- Country
International
- Period
Not stated in abstract
- Sample size
9 studies (5 high quality); survival analysis n=646 (3 studies); QoL n=1398 (5 studies)
- Inclusion and exclusion criteria
RCTs of outpatient specialty palliative care vs usual care
4. Methods and endpoints
- Exposure / intervention
Outpatient interdisciplinary specialty palliative care
- Comparator
Usual care
- Endpoints
1-year survival; quality of life
- Statistical methods
Meta-analysis; Hedges g
5. Actual results
- Results
High-quality studies with long-term survival data (n=646): 1-year survival 56% vs 42% (p<.001); median survival 14.55 vs 9.99 months; QoL g=0.18 (p<.001).
- Absolute risks
1-year survival +14 percentage points (NNT about 7)
- Authors' conclusion
Patients randomised to outpatient specialty palliative care lived longer and had better quality of life.
6. Strengths
- Restricted to RCTs; quality stratification
7. Weaknesses
- Only 3 studies for survival
- Small pooled sample
- Likely overlap with Cochrane review trials
- No CI for survival difference in abstract
8. Risk of bias
- Orienting tool
- AMSTAR 2
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Abstract only; small number of trials.
9. Assessment of the statistical interpretation
NNT about 7 for 1-year survival (stats/C-CHM-07.py); conflicts with Cochrane HR 0.85 (0.56-1.28) because of different trial selection and outcome (fixed time point vs hazard).
10. Relevance to the specific claim
Supports the 'even survival' part of C-CHM-07 more strongly than the Cochrane review does; the survival effect remains uncertain because the two syntheses disagree and rest on few trials. Palliative care in these trials was given alongside oncology care.
11. Independent contrary findings
Haun 2017 Cochrane (I-CHM-104).
12. Transferability to Germany and Europe
Applicable.
13. Overall methodological judgement
Low-certainty support for a survival benefit.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | low |
| Directness | direct |
| Reproducibility | partly replicated |
| Consistency with the overall evidence | inconsistent |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Survival effect in larger trials.