This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Timing Matters: A Systematic Review of Early Versus Delayed Palliative Care in Advanced Cancer
by
, , , , and
Ioana Creangă-Murariu
1,2,3
,
Eliza-Maria Froicu
4,*,
Dragos Viorel Scripcariu
5,
Gema Bacaoanu
4,6,
Mihaela Poroch
7,
Mihaela Moscalu
7,
Claudia Cristina Tarniceriu
8,
Teodora Alexa-Stratulat
1,2 and
Vladimir Poroch
4,6 1
Advanced Research and Development Center for Experimental Medicine (CEMEX), 700454 Iasi, Romania
2
Medical Oncology-Radiotherapy Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
3
Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
4
2nd Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
5
Department of Surgery, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
6
Department of Palliative Care, Regional Institute of Oncology, 700483 Iasi, Romania
7
Department of Preventive Medicine and Interdisciplinarity, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
8
Department of Morpho-Functional Sciences “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
*
Author to whom correspondence should be addressed.
Cancers 2025, 17(15), 2598; https://doi.org/10.3390/cancers17152598 (registering DOI)
Submission received: 10 July 2025
/
Revised: 2 August 2025
/
Accepted: 4 August 2025
/
Published: 7 August 2025
(This article belongs to the Special Issue Integrating Palliative Care in Oncology)
Simple Summary
Many believe palliative care is only for end of life, but starting early can improve symptoms, quality of life, and even survival in advanced cancer. However, when and how to deliver it remain unclear. This review examines clinical trials to understand the true impact of early palliative care and what makes it most effective. The findings can guide better care, future research, and policies that support earlier integration into cancer treatment.
Abstract
(1) Background: Early palliative care (EPC) is increasingly recognized as a key component of comprehensive cancer management, with evidence supporting improvements in quality of life, symptom control, and clinical outcomes in advanced malignancies. (2) Methods: This systematic review followed PRISMA 2020 guidelines and was prospectively registered in PROSPERO (CRD42024623219). We searched PubMed, Embase, and the Cochrane CENTRAL Library for randomized controlled trials (RCTs) evaluating EPC in adults with advanced, incurable, or metastatic cancer. Eligible studies reported on at least one of the following: overall quality of life, symptom burden, or disease progression indicators. (3) Results: Forty-one RCTs met inclusion criteria. Despite heterogeneity in timing and structure, EPC consistently improved quality of life and reduced symptom burden in advanced cancer patients, with 32 trials demonstrating significant clinical benefit. Some studies also reported slowed disease progression. However, several RCTs showed no significant effects, highlighting variation in outcomes, possible subgroup effects, and challenges in implementation. Definitions and delivery of EPC varied widely, particularly in timing, frequency, and integration into oncology care. (4) Conclusions: These findings support the integration of EPC alongside disease-directed treatments, challenging the misconception that palliative care is only appropriate at the end of life and reinforcing its role early in the cancer care continuum.
Keywords:
early palliative care; cancer care; quality of life; symptom burden
