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Palliative versus hospice care in patients with cancer: a systematic review
  1. Matthieu Frasca1,2,
  2. Angeline Galvin2,
  3. Chantal Raherison3,
  4. Pierre Soubeyran4,5,
  5. Benoît Burucoa1,
  6. Carine Bellera2,4 and
  7. Simone Mathoulin-Pelissier2,5
  1. 1 Department of Palliative Medicine, CHU of Bordeaux, Bordeaux, Aquitaine, France
  2. 2 Epicene Team, Inserm UMR 1219, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, Aquitaine, France
  3. 3 Department of Pneumology, CHU of Bordeaux, Bordeaux, Aquitaine, France
  4. 4 CIC1401, Bergonie institute, Comprehensive Cancer Center, Bordeaux, Aquitaine, France
  5. 5 UMR 1218, ACTION, University of Bordeaux, Bordeaux, Aquitaine, France
  1. Correspondence to Dr Matthieu Frasca, Palliative Medicine department, CHU de Bordeaux, 33000 Bordeaux, Aquitaine, France; matthieu.frasca{at}


Background Guidelines recommend an early access to specialised palliative medicine services for patients with cancer, but studies have reported a continued underuse. Palliative care facilities deliver early care, alongside antineoplastic treatments, whereas hospice care structures intervene lately, when cancer-modifying treatments stop.

Aim This review identified factors associated with early and late interventions of specialised services, by considering the type of structures studied (palliative vs hospice care).

Design We performed a systematic review, prospectively registered on PROSPERO (ID: CRD42018110063).

Data sources We searched Medline and Scopus databases for population-based studies. Two independent reviewers extracted the data and assessed the study quality using Joanna Briggs Institute critical appraisal checklists.

Results The 51 included articles performed 67 analyses. Most were based on retrospective cohorts and US populations. The median quality scores were 19/22 for cohorts and 15/16 for cross-sectional studies. Most analyses focused on hospice care (n=37). Older patients, men, people with haematological cancer or treated in small centres had less specialised interventions. Palliative and hospice facilities addressed different populations. Older patients received less palliative care but more hospice care. Patients with high-stage tumours had more palliative care while women and patients with a low comorbidity burden received more hospice care.

Conclusion Main disparities concerned older patients, men and people with haematological cancer. We highlighted the challenges of early interventions for older patients and of late deliveries for men and highly comorbid patients. Additional data on non-American populations, outpatients and factors related to quality of life and socioeconomic status are needed.

  • hospice care
  • cancer
  • supportive care
  • terminal care

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  • Contributors MF and SM-P conceived the presented idea. They also planned and conducted the literature search and the data collection. MF, AG, CB and SM-P contributed to the design and the analytical methods. CR, PS and BB contributed to data interpretation. MF is responsible for the overall content of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.