More than 500,000 Americans, including 40,000 Veterans, are diagnosed with advanced cancer annually in the United States. Palliative care improves quality of life by managing patients’ physical symptoms and psychosocial and spiritual distress, often provided concurrently with oncology care. Palliative care occurs across a continuum, beginning at the time of diagnosis of a serious illness and continuing until end of life. Integration of palliative care services with oncology care is now considered standard of care for patients with advanced cancer.

Contents

• PREFACE
• STAKEHOLDER AND TECHNICAL EXPERT PANEL
• EXECUTIVE SUMMARY
  • INTRODUCTION
  • METHODS
  • RESULTS
  • DISCUSSION
• INTRODUCTION
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • CATEGORIZATION OF THE INTERVENTIONS
  • QUALITY ASSESSMENT
  • DATA SYNTHESIS
  • QUALITATIVE SYNTHESIS
  • RATING THE BODY OF EVIDENCE
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • KEY QUESTION 1. In patients with symptomatic or advanced cancer, what are the benefits and harms of integrated outpatient palliative and oncology care compared with usual oncology care?
  • KEY QUESTION 2. Which features of integrated palliative and oncology care are associated with greater benefit to patients with symptomatic or advanced cancer?
  • KEY QUESTION 3. What are the most common and important barriers to implementing integrated palliative and oncology care in Veterans Affairs settings?
• SUMMARY AND DISCUSSION
  • SUMMARY OF EVIDENCE BY KEY QUESTION
  • CLINICAL AND POLICY IMPLICATIONS
  • LIMITATIONS
  • RESEARCH GAPS/FUTURE RESEARCH
  • CONCLUSIONS
• REFERENCES
• APPENDIX A. SEARCH STRATEGIES
• APPENDIX B. STUDY ELIGIBILITY CRITERIA
• APPENDIX C. EXCLUDED STUDIES
• APPENDIX D. INTERVENTION ELEMENTS AND DEFINITIONS
• APPENDIX E. AUTHOR SURVEY OF INCLUDED PALLIATIVE CARE INTERVENTION ELEMENTS
• APPENDIX F. DEFINITIONS AND DATA USED FOR IMPACT RATING DETERMINATIONS
• APPENDIX G. PEER REVIEW COMMENTS
• APPENDIX H. STUDY CHARACTERISTICS FOR KEY QUESTIONS 1 AND 2

Research Associate: Avishek Nagi, MS, Medical Editor: Liz Wing, MA

Suggested citation:

Fulton J, LeBlanc T, Porter-Starr K, Kamal A, Ramos K, Cutson T, Freiermuth C, McDuffie J, Adam S, Kosinski A, von Isenburg M, Van Noord M, Williams JW Jr. Integrated Outpatient Palliative Care in Oncology. VA ESP Project #09-009; 2017.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Durham VA Medical Center, Durham, NC, funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.