2505 - There is a lack of clinical research for patients with cancer in palliative care

Background

Worldwide, according to WHO 2014, over 19 million patients are in need of palliative care, 34% of them will die of cancer. Palliative care research brings many challenges. This metaresearch study aims to evaluate how clinical research on palliative care is conducted within the setting of incurable cancer.

Methods

Clinicaltrials.gov was searched to identify all registered studies investigating palliative care in patients with advanced or metastatic cancer. The EORTC QLQ-C15-PAL questionnaire was used to define the domains of interest. We excluded studies investigating cancer-directed therapy, management of cancer treatment-related adverse events, and diagnostic tests. Publication status was crosschecked using PubMed.

Results

Of 3950 identified studies, 514 studies were included. The most frequent reason for exclusion was cancer-directed therapy (2491). In 2007-2012, 161 studies were registered vs 245 in 2013-2018. Included studies were interventional (84%, 430/514) or observational (16%, 84/514). Most studies were sponsored by academia (79%), and conducted in North America (57%) or Europe (25%). 67% of studies evaluated a heterogeneous population (any tumour type). 60% were monocentric studies. Interventional studies most frequently investigated systemic drugs (34%, 148/430), behavioural interventions (29%, 125/430), and procedures for pain (24%, 103/430). Pain, quality of life and physical function were the most studied palliative issues (188, 95, 52 studies respectively). Fewer studies investigated health care planning (45), emotional function (35), appetite (22), social function (22), fatigue (20), dyspnea (18), sleep disturbance (5), cognitive function (5), nausea (4), and constipation (3). The most applied primary outcome measures were efficacy/symptom control (61.5%, 316), quality of life (14.2%, 73) and feasibility (11.7%, 60). Only 16% of the closed studies had published results.

Conclusions

The studies investigating palliative care in patients with incurable tumours constitute a very small part of cancer clinical research. More than one third of studies examine pain, leaving other palliative issues less explored in clinical research. Furthermore, the results of these studies are under reported in the literature.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.