Effectiveness of and implementation requirements for telehealth in palliative care patients with advanced cancer: A systematic review and meta-analysis

Abstract

Background:

Telehealth is being integrated with palliative care for patients with advanced cancer to improve access to specialized palliative care. However, its effectiveness and implementation requirements in palliative care remain unclear.

Aim:

This study evaluates the effectiveness of and implementation requirements for telehealth in palliative care patients with advanced cancer.

Design:

This was designed as a systematic review and meta-analysis with narrative synthesis (registered; CRD42024581786). The effects on patients’ quality of life, symptom burden, and depression were analyzed using a random-effects meta-analysis of randomized controlled trials. A narrative synthesis was conducted for all included studies.

Data sources:

MEDLINE, Embase, and Cochrane Library databases were searched in September 2025. Eligible studies comprised controlled trials, observational studies, and qualitative studies involving adults with advanced cancer who received telehealth in palliative care.

Results:

Of the 4232 records screened, 42 met the inclusion criteria, and six were eligible for meta-analysis. Telehealth interventions primarily involved videoconferencing, telephone, or text-based communication. Telehealth in palliative care demonstrated significant improvement in quality of life (standardized mean difference: 0.81; 95% CI: 0.09-1.53) and reduction in symptom burden (standardized mean difference: −1.44; 95% CI: −2.24 to −0.65) but had no significant effects on depression. Implementation requirements included trained multiprofessional teams, accessible digital infrastructure, sustainable reimbursement mechanisms, and standardized outcome measurements.

Conclusions:

Telehealth in palliative care may help improve quality of life and alleviate symptom burden among patients with advanced cancer. Future research should identify optimal delivery models and examine equity-related barriers to support wider implementation and policy development.

Keywords

palliative care telemedicine neoplasms delivery of health care

What is already known about the topic?

Telehealth is increasingly integrated into palliative care for patients with advanced cancer to reduce geographical barriers and enhance access to specialized palliative care services.

Although telehealth was widely adopted during the COVID-19 pandemic, evidence on its clinical effectiveness in palliative care and implementation requirements remains limited.

What this paper adds?

This meta-analysis found that the use of telehealth in palliative care significantly improves quality of life and reduces symptom burden among patients with advanced cancer but has no significant effect on depression.

This review identified key requirements for implementation, including trained multiprofessional teams, accessible digital infrastructure, sustainable reimbursement mechanisms, and standardized outcome measurements.

Implications for practice

To ensure equitable access to palliative care, the implementation of telehealth in palliative care must be expanded to underserved populations, including rural and socioeconomically disadvantaged groups.

It is essential to establish guidelines that incorporate the identified requirements to support the effective integration of telehealth into routine palliative care.

Introduction

Individuals with advanced cancer often experience complex symptoms, functional decline, and increasing dependence on caregivers. Although hospital visits are often necessary for medical assessment and treatment, they can be physically, psychosocially, and spiritually burdensome.¹ Geographical distance, in particular, often limits timely access to specialized palliative care services.² In the wake of the COVID-19 pandemic, telehealth rapidly expanded as a practical approach to overcoming these barriers³ and improving both access to and experiences of specialized palliative care services for individuals with advanced cancer.

Previous studies have reported numerous benefits of the use of telehealth in the palliative care of patients with advanced cancer. For example, Greer et al.⁴ found that patients receiving early palliative care through video visits report a quality of life comparable to those receiving in-person care. Other studies have shown that receiving care at home, in a private and familiar environment, helps patients feel more emotionally supported and secure.⁵ Additionally, telehealth interventions such as remote symptom monitoring and regular vital sign checks can lead to the early detection of clinical deterioration, promote patient engagement, and facilitate timely palliative care interventions.⁶ For family caregivers, telehealth can ease travel demands and reduce physical caregiving burdens.^7,8 Additionally, regular virtual contact with the care team can help caregivers feel more supported and informed, ultimately reducing their stress.⁹ For healthcare providers, telehealth in palliative care can improve time and resource efficiency by reducing the time spent in home visits and enabling more flexible scheduling.¹⁰ Moreover, some studies have reported that early integration of telehealth into palliative care may contribute to cost savings at the health system level.¹¹ Overall, telehealth has the potential to complement or, in some contexts, be an alternative to traditional face-to-face palliative care.

Despite growing evidence supporting the feasibility of telehealth, its effectiveness in palliative care remains unclear. Previous systematic or scoping reviews have largely examined how telehealth has been implemented and used in specific contexts. These include advanced cancer, chronic heart failure, family caregivers, pediatric populations, home-based care, nursing homes, and rural or underserved settings.^12–18 The reviews have primarily discussed its benefits and challenges, such as barriers and facilitators to adoption and ethical considerations.^19,20 However, randomized controlled trials have produced mixed results regarding the impact of telehealth on quality of life, symptom burden, and depression. Furthermore, key requirements—including human resources, technological infrastructure, and financial frameworks—for using telehealth in palliative care, along with outcome measures for evaluating telehealth in palliative care are yet to be clearly defined.

A comprehensive synthesis is essential to clarify the effectiveness of and implementation requirements for telehealth in palliative care patients with advanced cancer.²¹ Therefore, this study conducted a systematic review and meta-analysis to evaluate the effectiveness of telehealth on patients’ quality of life, symptom burden, and depression, and to synthesize implementation requirements related to human resources, technological infrastructure, and financial frameworks in the palliative care of patients with advanced cancer. With this objective, the study aimed to support clinical practice, guideline development, and policymaking concerning the palliative care of patients with advanced cancer.

Methods

Design

We conducted a systematic review and meta-analysis to assess the effectiveness of and implementation requirements for telehealth in the palliative care of patients with advanced cancer. The protocol was registered in PROSPERO in 2024 (CRD42024581786, https://www.crd.york.ac.uk/PROSPERO/view/CRD42024581786). Additionally, the review was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions, and its reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines.^22,23 This study did not require ethical approval because we used only publicly available data.

Data source and search strategy

We searched MEDLINE, Embase, and Cochrane Library including the Cochrane Central Register of Controlled Trials for relevant articles published in English from the date of inception to September 5, 2025. A concept-based search strategy was collaboratively developed by the research team, informed by previous systematic reviews^5,8,24–26 and focused on two core concepts: (1) population—patients with advanced cancer and (2) intervention—telehealth. Palliative care was not used as a separate search concept because of heterogeneous terminology (e.g. symptom management, comfort care). Instead, eligibility regarding the definition of palliative care was determined during screening. Moreover, we supplemented the electronic database searches by conducting additional manual searches. Supplemental Table 1 presents the full search strategy. All retrieved records were managed using Rayyan and EndNote software. Rayyan was used for title and abstract screening, while EndNote was used for full-text and reference management.

Eligibility criteria

We included randomized trials and observational (including descriptive) and qualitative studies involving adults (individuals aged 18 or older) with advanced cancer who received telehealth in palliative care. Telehealth was defined as the use of telecommunications technology to enable real-time, bidirectional communication between healthcare providers and patients or family caregivers, aligning with the WHO definitions of telemedicine and eHealth.²⁵ Palliative care was defined based on the framework used by Kavalieratos et al.²⁶ We included interventions that addressed at least two of the eight domains of palliative care outlined by the National Consensus Project for Quality Palliative Care.²⁷ In accordance with the American Cancer Society²⁸ and the Cochrane review,²⁹ advanced cancer was defined as cancer that “cannot be cured,” including cases of metastatic or unresectable disease. We excluded studies that (1) addressed only a single symptom or domain (e.g. opioids for dyspnea or advance care planning), to focus on interventions delivering holistic or multidimensional palliative care,³⁰ (2) targeted only caregivers or other non-patient populations, as our review focused on telehealth interventions delivered to patients to evaluate direct effects on patient outcomes, or (3) were not original research articles, reviews, editorials, commentaries, conference abstracts, or publications written in English (Supplemental Table 2).

Study selection and data extraction

Figure 1 illustrates the study selection process. Ten reviewers independently screened titles and abstracts. AK, ST, and AU independently reviewed the full texts of potentially eligible studies, and discrepancies were resolved either by consensus or adjudication by KS. Data extraction was conducted by AK and TN; they collected the following information from each study: author, year, country, study design, sample size, participant characteristics, telehealth modality, palliative care domains addressed, comparator (if any), outcomes, and details of the implementation requirements. The inter-rater reliability of full-text screening between AK, ST, and AU was assessed using the percentage of agreement.

Figure 1.

PRISMA flow diagram.

Quality appraisal of the included studies

To assess the risk of bias, we used the Risk of Bias 2 tool for randomized controlled trials and the Risk Of Bias In Non-randomized Studies - of Exposures tool for non-randomized studies.^31,32 AK and ST independently evaluated each study. AK was contacted to provide additional details required for making informed judgments.

Data analysis and synthesis

We performed descriptive analyses and narrative syntheses for all included studies to describe the implementation requirements for telehealth and other outcomes that could not be included in the meta-analysis because of heterogenous outcome measures. Specifically, we narratively synthesized information on implementation requirements, including human, technological, and financial factors, along with outcome measurements used to evaluate implementation effectiveness, as reported in each included study. These domains were identified based on commonly reported facilitators and barriers to telehealth in palliative care described in previous literature.

The meta-analysis involved the synthesis of outcomes related to patients’ quality of life, symptom burden, and depression. For our analysis, we treated depression separately from overall symptom burden because depression-specific measures are more sensitive to psychological changes, whereas symptom burden scales combine a range of physical and psychosocial symptoms into a summary score. Only studies with sufficient outcome data, either available in the published article or obtained through contact with the authors, were included in the meta-analysis. Given the diversity of measurement tools across the studies, effect sizes were expressed as standardized mean differences. To account for the anticipated heterogeneity among the included trials, random-effects models were employed using the R software (version 4.5.0). Statistical significance was determined using two-tailed tests, with a p-value less than 0.05 considered significant. Between-study heterogeneity was assessed using the I² statistic, with qualitative interpretation thresholds of low (25%–50%), moderate (50%–75%), and high (75%–100%), and further evaluated using τ² statistics.³³ To minimize variations in follow-up duration, only outcomes assessed between 1 and 3 months were included in the meta-analysis. When multiple outcomes were reported within the 1- to 3-month window, the latest time point within that range was used for the analysis. We could not conduct sensitivity analyses based on risk of bias or the follow-up window because the number of included studies was limited.²³ Potential publication bias was examined by visual inspection of funnel plots.

Results

Selection of studies

The electronic database search identified 5333 records (4596 from databases and 737 from trial registers). After removing duplicates, 4232 records were screened according to the title and abstract. Of them, 202 were assessed for eligibility. Following full-text screening, 42 reports^3,4,34–73 met the inclusion criteria, among which six^{27,50,51,59,68,69} were eligible for meta-analysis (Figure 1). The most common reasons for exclusion were not targeting patients with advanced cancer and not being related to palliative care. The interrater agreement for full-text screening among the independent reviewers was 90% for abstract screening and 94% for the full-text review.

Characteristics of the included studies

The 42 included reports encompassed various study designs, such as randomized controlled trials (n = 13), prospective cohort studies (n = 10), retrospective studies (n = 7), pilot and feasibility studies (n = 7), and qualitative studies (n = 5; Table 1). Moreover, some studies employed multiple designs. The studies were conducted in several countries, with the United States being the most common setting (n = 17), followed by Canada (n = 6) and the United Kingdom (n = 5). Across the studies, the sample size ranged from 6 to 586 participants, with a combined total of 7627 participants. The participants’ mean or median ages ranged from 55 to 75 years. The proportion of female participants ranged from 34% to 85%. Furthermore, all studies targeted adult patients (patients aged 18 or older) with advanced cancer, including those with metastatic, incurable, or stage IV cancer.

Table 1.

Characteristics of the 42 included reports.

Author, year, country	Study design	Cancer types	Care provider site	Inclusion criteria	Domains addressed	Intervention (telehealth)	Control	Outcome	Mean age ± SD, female %
Alcalde Castro, 2023, Canada	Qualitative study using grounded theory	Advanced cancer including genitourinary, gastrointestinal, gynecological, breast, and lung cancers	Outpatient palliative care oncology clinic	English-speaking, ⩾ 18 years old, at least one visit to the outpatient palliative care clinic	Structure, physical, psychological, social, EoL	Telehealth outpatient palliative care visits during the COVID-19 pandemic	In-person visit	Patient perspectives on the appropriateness of in-person versus telehealth visits in outpatient palliative care	Control: 64 y ± 12; Intervention: 56 y ± 12, Control: 53%; Intervention: 77.7%
Bakitas, 2015, US	Multisite RCT	Advanced cancer with various solid tumors	National cancer center, a Veterans affairs medical center, and community outreach clinics	Patients aged ⩾18 with advanced-stage solid tumor or hematologic malignancy, prognosis of 6–24 months as determined by the oncologist, and able to complete baseline questionnaires	Structure, physical, psychological, EoL	Early initiation of palliative care with in-person consultations and structured telehealth nurse coaching sessions	Delayed group, receiving palliative care 3 months after enrollment	Patient-reported QOL, symptom impact, mood, 1-year survival, and resource use	Early group: 64.0 y ± 10.28; Delayed group: 64.6 y ± 9.59, Early: 46.15%; Delayed: 48.54%
Bergerot, 2025, Brazil	RCT	Various metastatic cancer (solid cancers)	An integrated private cancer care network located across multiple Brazilian states	Adults aged over 65 years, diagnosed with metastatic solid cancers and undergoing any cancer treatment, regardless of their ECOG performance status	Structure, physical, psychological, cultural, EoL	A multidisciplinary team developed a tailored intervention plan based on geriatric assessment impairments. Telehealth services included nutritional support, psychiatric care, personalized fitness training, and psychosocial assistance.	Usual care	Physical function (Instrumental Activities of Daily Living), mood, quality of life, and symptom burden.	74.5 y ± 6.1, 55.8%
Bernhardt, 2024, Germany	Noninferiority RCT	Advanced cancer including metastasized and non-metastasized cancer	Specialized outpatient palliative care services in an urban setting	Indication for specialized palliative care due to advanced malignant or nonmalignant disease, with minimum age of 18 years received Inpatient care with planned discharge to home: residing within the local palliative care service area, ownership of a device with video call capability and internet access, willingness to use telemedicine	Structure, physical, psychological, EoL	Telemedicine plus standard specialized outpatient palliative care	Standard specialized outpatient palliative care only	Change in symptom severity	Telemedicine group: 62.0 y ± 13.9; Control group: 62.8 y ± 13.8, Telemedicine group: 44%; Control group: 50%
Bhargava, 2021, Canada	Pilot feasibility study	Various types (metastatic lung, breast, pancreatic, ovarian, rectal cancers; multiple myeloma; metastatic cholangiocarcinoma)	Supportive palliative care clinic at Brampton civic hospital	Patients aged 18 years or older, alert and oriented, have access to a desktop/laptop/ smartphone/tablet with internet	Structure, physical, psychological, EoL	A remote symptom self-reporting app for daily assessment of symptoms using validated clinical tools	Single-arm	Feasibility and usability of a system, reduction in emergency department visits and hospital admissions, and healthcare cost	63 y ± 9, 46%
Cascella, 2023, Italy	Retrospective Cohort Study	Various types (bladder, breast, gastrointestinal, and other cancers)	Outpatient in a national institute	Adult cancer patients suffering from pain	Structure, physical, psychological	First in-person visit followed by remote consultations, with possible in-person assessments as needed	NA	Assessment of the efficacy of a telehealth-based model for cancer pain management, including patient demographics, clinical and process variables, and analysis of telehealth visit distribution and frequency	63.4 y ± 12.4, 51.8%
Castillo Padros, 2023, Spain	Mixed methods study	Advanced pathologies including cancer	Palliative care units in two hospitals	Patients with advanced illnesses who were either already in follow-up or included at the beginning of their follow-up	Structure, physical, psychological, EoL	Use of the app (a platform and smart remote monitoring system) designed for patients in palliative care	NA	Feasibility, usability, and acceptance of the app, functional status, medication adherence, and patient satisfaction	Median: 72 y, 60%
Chávarri-Guerra, 2021, Mexico	Observational retrospective study	Advanced cancer (gastrointestinal cancers, breast cancer, etc.)	Outpatient in a hospital	Patients with a recent diagnosis of advanced cancer	Structure, physical, psychological, EoL, ethical	Palliative care via video conferencing, or phone calls	NA	Feasibility of telemedicine in providing supportive care, types of interventions provided, communication methods used, barriers to telemedicine implementation	Median: 68 y (range 33–90), 57.7%
Cherny, 2022, Israel	Feasibility study	Various types including metastatic cancer	Community oncology practice	Adult cancer patients starting parenteral therapy at participating sites	Structure, physical, psychological	Use of a digital symptom monitoring platform for reporting PROs during treatment	NA	Feasibility of patient enrollment, engagement, retention, the generation of symptom alerts, and the handling of alerts by clinical staff	The majority (31.3%) of patients: 60–69 y, 61%
Chow, 2001, Canada	Prospective observational study	Various cancers, primarily lung, breast, and prostate	Regional cancer center	Patients referred for palliative radiotherapy, able to speak English, provide verbal consent, and complete symptom assessments.	Structure, physical, EoL	Palliative radiotherapy with symptom palliation	NA	Feasibility of telephone follow-up for assessing symptom palliation	Median: 68 y (range 39–89), 49%
Chumbler, 2007, US	Feasibility study	Lung, head and neck, colorectal, and others	Veterans affairs medical center	Veterans with a new cancer diagnosis undergoing chemotherapy, life expectancy > 6 months, no severe sensory impairments, psychosis, dementia, or traumatic brain injury, non-institutionalized, and touch-tone landline telephone service	Structure, physical, psychological	Cancer care dialogs model with daily telehealth interactions and home messaging device	No control	Health-related quality of life, and cooperation rate with home messaging device	64 y ± 10, 6%
Cleeland, 2011, US	RCT	Lung cancer and lung metastases	University of Texas MD Anderson Cancer Center	Patients scheduled for thoracic surgery for primary lung cancer or lung metastases, at least 18 years old, able to understand English and the study requirements, willing and able to use an IVR-administered symptom rating scale. The surgical clinician had to agree to receive and respond to symptom alerts	Structure, physical	Automated IVR system with email alerts sent to clinicians when patients in the intervention group reported moderate to severe symptoms.	Automated monitoring without email alerts sent to clinicians.	Reduction in postoperative symptom severity and symptom interference	Intervention: 59.2 y ± 13.6; Control: 60.9 y ± 11.8, Intervention: 44.7%; Control: 48.8%
Cornetta, 2023, US	Feasibility study	Various types such as cervical cancer, squamous cell carcinoma, adenocarcinoma, etc	A tertiary care hospital	Adult patients with suspected or biopsy-confirmed advanced/metastatic cancer, PPS of 30-60, on opioid therapy, able to communicate symptoms, not eligible for further chemotherapy or radiation, and having at least one caregiver and access to a phone	Structure, physical, social, EoL	Weekly telephone monitoring of symptoms and provision of a “comfort kit” with essential medications for symptom management.	NA	Participation in weekly calls, medication use from the comfort kit, and symptom assessments	Range: 20–93 y, 73.3%
Formica, 2009, Italy	Pilot study	Various solid tumors, including breast and colorectal cancer	Outpatient	Cancer outpatients receiving chemotherapy who could consent to participate	Structure, physical, psychological	Video-assisted home care using the Medical Care Continuity system to monitor chemotherapy side effects	Single-arm	Reduction in unnecessary hospital admissions, patient and caregiver satisfaction with video-assisted home care	Median: 69 y (range:44–76), 60%
Fuchsia Howard, 2021, Canada	Qualitative study using interpretive description	Patients with bone metastasis, brain metastasis, and receiving palliative RT to the chest	Six Cancer centers	Cancer patients older than 19 years English-speaking Diagnosed with incurable bone metastasis or brain metastasis, or received palliative RT to the chest	Structure, physical, psychological, social, EoL	Telephone follow-up with PROs collected by nurses to guide nursing care and symptom management	NA	Improved symptom management, better patient access to healthcare services, enhanced transition to home care, and addressing complex health challenges	70.5 y (range 56–93 years), 50%
Chua, 2022, US	Early analysis of Greer 2024	Advanced NSCLC	20 academic cancer centers	Same as Greer 2024.	Same as Greer 2024	Same as Greer 2024	Same as Greer 2024	Visit adherence, modality (telehealth vs in-person), and the frequency of cancelled or rescheduled visits, and other outcomes were same as Greer 2024	Median: 67 y (IQR 59.8–74.2), 40.9%
Greer, 2024, US	Multisite RCT	Advanced NSCLC	22 outpatient cancer centers	Patients diagnosed with advanced NSCLC within the past 12 weeks, not treated with curative intent, ECOG PS score of 0–3	Structure, physical, psychological, social	Early palliative care delivered either via secure video visits every 4 weeks throughout the disease course.	In-person palliative care	Primary: QoL at 24 weeks. Secondary: Caregiver participation, satisfaction with care, patient coping, mood symptoms, and perceptions of prognosis.	65.5 y ± 10.8, 54.0%
Hennemann-Krause, 2015, Brazil	Qualitative, case series study	Advanced cancer (lung, head and neck, cancer with undetermined primary site, and bile duct cancer)	Outpatient palliative care at a hospital	Patients at least 18 years old, diagnosed with advanced cancer, with no chance of cure, and access to computing resources	Structure, physical, psychological, social, EoL	Telemedicine support through monthly in-person consultations, weekly web conferences, and other forms of remote communication such as emails and telephone calls	NA	Improvement in access to healthcare, reduced emergency service use, enhanced symptom assessment and control, increased confidence in care provided by family members, and improved overall palliative care quality	68 y ± 9.43, 41.7%
Hoek, 2017, The Netherlands	RCT	Advanced cancer	Outpatient palliative clinics of a tertiary university hospital and regional home care organizations	Aged 18 or older Dutch speaking and able to give informed consent Diagnosed with a progressive oncological condition Residing at home Having a general practitioner who agrees to participate Karnofsky Performance Status of 60 or below	Structure, physical, EoL	Weekly teleconsultations from a hospital-based specialist palliative care consultation team for 12 weeks	Usual palliative care without teleconsultations	Patient-experienced symptom burden, unmet palliative care needs, continuity of care, hospital admissions, satisfaction with teleconsultations, and burden on informal caregivers	Intervention: 62.3 y ± 9.0; Control: 61.9 y ± 10.6, Intervention: 29%; Control: 39%
Jang, 2024, Taiwan	Retrospective cohort employing 1:1 matching based on propensity scores	Various types of terminal cancer	A regional hospital	Patients who passed away during 2012–2020, had a primary medical diagnosis of cancer at the time of death or cancer listed as one of the five diagnoses during their last hospitalization before death.	Structure, physical, cultural, EoL	Tele-assisted home-based palliative care	No tele-assisted home-based palliative care	Health care costs before death (eg. ED admission, hospitalization, ICU admission), place of death	Intervention: <65 y 25.9%, 65–79 y 34.8%, 80 y- 39.2%, Control: <65 y 32.4%, 65–79 y 36.9%, 80 y- 30.7%, 45.4%
Johnsen, 2020, Denmark	Multicenter, parallel-group RCT	Various types metastatic cancer	Six Danish specialized palliative care outpatient centers	Patients with stage IV cancer or central nervous system cancer (grade 3 or 4). Age ⩾ 18 years. Resided in the area of the participating palliative care teams. No contact with specialized palliative care teams in the previous year. Met thresholds for symptoms and problems based on EORTC QLQ-C30.	Structure, physical, psychological, social, EoL	Referral to a specialized multidisciplinary palliative care team in addition to standard care.	Standard care alone	Change in symptom burden, anxiety, depression, health-related quality of life, and satisfaction with care.	Age: NA (⩾ 18 y), Intervention: 57%; control: 59%
Kim, 2025, US	Retrospective study involving chart review	Various advanced cancer (86%)	A supportive care center at cancer center	At least 18 years old, had a supportive care center visit (in-person or telemedicine)	Structure, physical, psychological	Telemedicine palliative care visits (preference for video appointments was collected)	In-person palliative care visits	Patient preferences for in-person versus telemedicine palliative care visits, perceived difficulty coming in-person	59 y ±13.3, 54%
Lefresne, 2017, Canada	Prospective study	Incurable lung cancer (primarily NSCLC and small cell lung cancer)	Vancouver rapid access clinic	Patients with newly diagnosed incurable lung cancer referred to the clinic	Structure, physical, EoL, Ethical	Multidisciplinary care at the clinic, including palliative radiotherapy and holistic supportive care services	Single-arm	Patient-reported symptoms, overall health improvement, and palliation of respiratory symptoms and bone pain	Median: 71 y (range 45–99), 46%
Mir, 2022, France	RCT phase3	Metastatic cancer in general	Comprehensive cancer center	Patients with advanced or metastatic cancer, aged 18 or older, performance status ⩽2, life expectancy of at least 6 months, must have access to a phone and the internet.	Structure, physical	Nurse navigator-led follow-up with digital remote monitoring using a mobile app and web portal, in addition to usual care	Usual care with symptom monitoring at the discretion of the treating oncologist	Relative dose intensity, grade ⩾3 toxicities, patient experience, hospitalization rates and duration, treatment response, survival, and QoL	Median: 62 y (range, 20–92 y), 59%
Mkanta, 2007, US	Prospective pilot study	Various types (lung, head and neck, and colorectal cancer)	Department of Veterans affairs medical center	Noninstitutionalized Veterans, newly diagnosed with cancer, planning to undergo chemotherapy, life expectancy > 6 months. No severe sensory impairment, psychosis, dementia, or traumatic brain injury, and access to touch-tone landline telephone service	Structure, physical, psychological	Cancer Care Dialogues Model involving daily telehealth interactions with a care coordinator	Single-arm	HRQoL measured by the FACT-G scale.	63.7 y±10.3, 6%
Nemecek, 2019, Austria	Controlled feasibility study	Advanced cancer: NSCLC, melanoma, and pancreatic cancer	A medical university	Patients aged 18–75 with advanced cancer, ECOG performance status 0 or 1, and patients with ECOG 2 without cognitive impairment.	Structure, psychological, social	Telemedically augmented palliative care, including an iPad with video call capability and data tracking for symptoms and vital signs.	Standard palliative care	QoL improvements, decrease in frequency and duration of hospital admissions	Control: 49.9 y; Intervention: 47 y (patients and their caregivers), 43%
Neo, 2024, Singapore	Pragmatic prospective study	Advanced solid tumors in the gastrointestinal, respiratory, genitourinary, or head and neck regions	A national cancer center	Adults aged 18 or older diagnosed with advanced solid tumors with oncologist-estimated prognosis of 2 years or less	Structure, physical, psychological, EoL	Nurse-led symptom monitoring and virtual telehealth program. (An initial consult with a specialist palliative care physician and nurse via tele-videoconference)	Single-arm	IPOS scores over time and changes in healthcare utilization	63.4 y ± 11.3, 34.3%
Oelschlagel, 2023, Norway	Qualitative, longitudinal, exploratory study	Various types (pulmonary, ventricular, myelomatosis, cholangiocarcinoma, colon, ovarian, cervical, and gallbladder cancers)	Community care services	Patients aged 18 or older, living at home, diagnosed with cancer in the palliative phase	Structure, physical, EoL	Remote home care app to support palliative care needs with devices for monitoring physiological parameters and symptom reporting via a tablet	Single-arm	Explores patients’ ability to manage their illness at home, self-governance of daily life, interpersonal needs, and the challenges and benefits of the remote home care system	66 y (range: 30–94), 45%
Pimentel, 2015, US	Retrospective cohort study	Various types (gastrointestinal, thoracic, breast, head and neck, gynecologic, and others)	The university of Texas MD Anderson cancer center, including both inpatient and outpatient palliative care settings	Advanced cancer patients referred to palliative care at the center who were given access to the supportive care center telephone triaging program	Structure, physical, psychological, EoL	Nurse-led telephone triage service for palliative care needs	Single-arm	Frequency and type of the program utilization, associated symptom changes, and nursing interventions	Median: 59 y (IQR: 51–68), 55%
Pozzar, 2022, US	Prepilot study of Pozzar 2024	Gynecologic cancer-associated peritoneal carcinomatosis	A hospital	Adults hospitalized for gynecologic cancer-associated peritoneal carcinomatosis; able to identify a caregiver	Structure, physical, psychological, social, EoL	Nurse-led care management program	Single-arm	Feasibility, acceptability, HRQoL, and symptom management	Prepilot I: Patients: 64 y ± 7.31; Prepilot II: Patients: 58 y ± 14.03, 92%
Pozzar, 2024, US	Pilot RCT	Advanced gynecologic and gastrointestinal cancers with peritoneal carcinomatosis	A hospital	Patients with a new complex care need, recently hospitalized, and accompanied by a family caregiver	Structure, physical, psychological, social, EoL, ethical	Nurse-led care management program, consisting of six weekly sessions	Enhanced discharge planning, which included a single visit and standard discharge materials	Feasibility, acceptability, HRQoL, self-efficacy, and ACP	Control: 61.9 y ± 7.5; Intervention: 60.1 y ± 10.2, 84.2%
Wall, 2024, US	Secondary analysis of Pozzar 2024	Same as Pozzar 2024	A hospital	Same as Pozzar 2024	Same as Pozzar 2024	Same as Pozzar 2024	Same as Pozzar 2024	Decision-making experiences of patients and caregivers regarding palliative procedures	58 y ± 10.6, 95.7%
Reinke, 2022, US	Multisite RCT	Lung cancer	Veterans affairs medical centers	Patients diagnosed with lung cancer within 8 weeks or recurrence within 5 years, aged over 40, English literacy, and telephone access	Structure, physical, EoL	Nurse-led, telephone-based primary palliative care intervention delivered by trained registered nurses	Usual oncologic care	QOL, and satisfaction with care	70 y, Control: 1.3%; Intervention: 2.7%
Rosa, 2025, US	Prospective study	Various advanced solid tumor malignancies.	A cancer center	⩾21 years old diagnosed with a solid tumor malignancy receiving inpatient care, and planned for discharge home on best supportive care with no further available cancer-directed treatment, and had declined hospice	Structure, physical, psychological, social, EoL	Post-Acute Transition to Home With Supportive Care. An NP-led telehealth palliative care intervention that provided symptom management support including medication education and prescribing.	Single-arm	Cumulative incidence of hospital readmission following discharge, hospice transition/referral, hospice enrollment and disposition	Median: 67 y (range: 28–88 y) 53%
Shepherd, 2006, Australia	Non-randomized pilot study	Various types (specific types not detailed)	Hospital	Adult cancer patients (⩾ 18 years) with psychological distress identified via the Distress Thermometer (score ⩾7) or clinical identification by treating professionals	Structure, psychological,	Brief CBT delivered via videoconferencing. Individual sessions (1–6 sessions) with techniques like problem-solving, activity scheduling, and controlled breathing.	Single-arm	Reduction in anxiety and depression levels, Improvement in quality of life	53 y ± 10.53 (range: 28–70 y), 64%
Shih, 2024, US	Cross-sectional survey	Various types (breast, gastrointestinal, genitourinary, gynecological, head & neck, hematologic, and respiratory cancers)	Outpatient palliative care clinic at the cancer center	Patients with a diagnosis of advanced cancer (locally advanced, recurrent, or metastatic disease), and with at least two consecutive follow-up virtual-video visits	Structure, physical, social	Telehealth virtual-video visits for palliative care during and after the COVID-19 pandemic	Single-arm	Preference for video versus in-person visits, analyzed based on factors such as convenience, cost, wait time, and COVID-19 safety concerns	55.7 y ± 12.4, 73.5%
Steel, 2016, US	RCT	Hepatocellular carcinoma, cholangiocarcinoma, gallbladder carcinoma, neuroendocrine carcinoma, pancreatic carcinoma, and other cancers with liver metastases	Oncology outpatient clinics and hospital settings	Biopsy and/or radiograph-proven diagnosis of cancer; age ⩾ 21 years	Structure, physical, psychological, social, EoL	A web-based stepped collaborative care intervention, including a psychoeducational website, face-to-face care coordinator visits, and telephone follow-ups every 2 weeks	Enhanced usual care (standard medical care plus referrals for patients with elevated symptoms)	Reductions in depression, pain, and fatigue; improvements in quality of life; and changes in biomarkers	61 y ± 11, 27%
Steel, 2024, US	Phase3 RCT	Any cancer type	Oncology outpatient clinics associated with a cancer center	Patients aged ⩾21 years Biopsy-proven or radiograph-proven diagnosis of cancer Clinical levels of depression, pain, or fatigue Family caregivers aged ⩾ 21 years providing care for a participating patient	Structure, physical, psychological, social	Integrated screening and novel stepped collaborative care intervention with weekly CBT sessions via telemedicine, with potential pharmacotherapy adjustments based on clinical recommendations or patient preferences.	Standard of care involves symptom screening and referral to a healthcare provider for treatment.	Health-related QoL, depressive symptoms, pain, fatigue, serum cytokine levels, caregiver stress, cardiometabolic abnormalities, and healthcare utilization	Intervention: 65.9 y ± 11.37; Control: 65.5 y ± 11.49, Intervention: 58%; Control: 55%
Valenti 2023, Italy	Retrospective study	Advanced cancer including thoracic and gastrointestinal cancers	Outpatient clinic, palliative care unit, community, and cancer ward	NA *80.8% were from patients followed at the outpatient clinic	Structure, physical, EoL	Nurse-led telephone follow-up for patients in early palliative care	Single-arm	Effectiveness of nurse-led telephone follow-up in managing patient care and symptom control, avoiding hospital visits, and improving continuity of care	Median: 55–74, 39.0%
van Gurp, 2015, Netherlands	Qualitative study	Various types (sarcoma, gastrointestinal, brain, urogenital, head and neck, etc)	Outpatient, home-based palliative care	Advanced-stage cancer patients with an estimated life expectancy of ⩽3 months, poor functional status (Karnofsky score ⩽60), home-based with primary care physician supervision, supported by an informal caregiver, aged over 18, and Dutch-speaking. Two non-oncological patients with end-stage COPD were also included	Structure, psychological, social, EoL	Weekly teleconsultations between patients, family caregivers, primary care physicians, and hospital-based palliative care specialists.	NA	Transcendence of institutional walls, transparency of technology, and technologized, intimate relationships between patients and specialists, fostering trust and empathy in patient care	61 y (range 24–85), 44%
Viitala, 2021, Finland	Qualitative study	Incurable cancer including breast cancer, gastrointestinal cancer, and lymphoma	Oncology outpatient clinic of one university hospital	Diagnosed with incurable cancer, 18+ years of age receiving disease-controlling chemotherapy or palliative care, be able to give informed consent and participate in the interview, over six months’ experience using the mobile application for symptom tracking	Structure, physical, psychological	Use of a mobile application for reporting symptoms and side effects of chemotherapy, as part of supportive care for incurable cancer patients.	NA	Improved coping with incurable cancer, enhanced sense of security, involvement in care, freedom, and better communication with healthcare professionals, perceived disease-centredness	Median 54 y (range 31–74), 75%
Yount, 2014, US	RCT	Advanced lung cancer	Multisite, including academic medical centers and a public hospital	Diagnosed with advanced (Stages III or IV) non-small cell lung cancer or small cell lung cancer, receiving active treatment with traditional chemotherapy or oral therapy	Structure, physical	Weekly symptom monitoring using interactive voice response technology, with an automated reporting system for clinically significant symptoms that generated alerts for healthcare providers to initiate follow-up care.	Symptom monitoring alone without reporting to the clinical team	Primary outcome: Symptom burden Secondary outcomes: Health-related QoL, treatment satisfaction, perceived barriers to symptom management, self-efficacy, and medical utilization	60.6 y ±10.2, 50.6%

Note. ACP: advance care planning; CBT: cognitive-behavioral therapy; CNS: clinical nurse specialist; Cont: control group; ECOG: Eastern Cooperative Oncology Group; EORTC QLQ-C30: European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30; EoL: end-of-life; FACT-G: Functional Assessment of Cancer Therapy-General; HRQoL: health-related quality of life; Int: intervention group; IQR: interquartile range; IVR: interactive voice response; NA: not applicable; NSCLC: non-small cell lung cancer; PC: palliative care; PRO: patient-reported outcome; PPS: Palliative Performance Scale; PS: performance status; QoL: quality of life; RCT: randomized controlled trial; RT: radiation therapy; SCCTP: Supportive Care Center Telephone Triaging Program; y: years.

Regarding settings, the patients resided at home and received palliative care delivered by outpatient clinics, cancer centers, or community-based services. The studies involved diverse models of palliative care, such as specialized palliative care led by multiprofessional specialist teams and general palliative care provided by non-specialists in palliative care. Telehealth services were delivered via videoconferencing, telephone calls, and messaging through mobile applications, with some studies also incorporating remote symptom monitoring (Table 2). Furthermore, the most frequently addressed palliative care domains were physical care, psychological care, and end-of-life care. Palliative care was categorized into domains according to its stated components (e.g. physical symptom management as “physical care,” mental health support as “psychological care,” and comprehensive support for patients’ needs in the final days of life as “end-of-life care”). These domains often overlap, but we categorized them for analytical purposes while recognizing that palliative care is fundamentally a philosophy of holistic care.

Table 2.

Modality types of telehealth intervention.

Author, year	Video	Telephone	Text
Alcalde Castro, 2023	✓	✓
Bakitas, 2015		✓
Bergerot, 2025	✓		✓
Burnhardt 2024	✓
Bhargava, 2021		✓
Cascella, 2023	✓
Castillo Padros, 2023	✓		✓
Chávarri-Guerra, 2021	✓
Cherny, 2022		✓
Chow, 2010		✓
Chumbler, 2007		✓
Cleeland, 2011		✓
Cornetta, 2023		✓
Formica, 2009	✓
Fuchsia Howard, 2021		✓
Chua, 2022 and Greer, 2024	✓
Hennemann-Krause, 2015	✓	✓	✓
Hoek, 2017	✓
Jang, 2024		✓	✓
Johnsen, 2020		✓
Kim, 2025	✓
Lefresne, 2017		✓
Mir, 2022		✓	✓
Mkanta, 2007			✓
Nemecek, 2019	✓
Neo, 2024	✓	✓
Oelschlagel, 2023		✓	✓
Pimentel, 2015		✓
Pozzar, 2022, Pozzar, 2024, and Wall 2024	✓	✓
Reinke, 2022		✓
Rosa, 2025	✓	✓
Shepherd, 2006	✓
Shih, 2024	✓
Steel, 2016	✓	✓	✓
Steel, 2024	✓	✓
Valenti, 2023		✓	✓
van Gurp, 2015	✓
Viitala, 2021			✓
Yount, 2014		✓

Quality appraisal of the included studies

Supplemental Tables 4–8 summarize the methodological quality of the 42 reports included in this review. Summary of findings table was shown in Supplemental Table 9. Among the randomized controlled trials, two were judged to have some concerns, while others exhibited a high risk of bias due to issues such as lack of blinding of outcome assessor. Among the observational studies, most demonstrated a high risk of bias, mainly due to confounding and selection biases.

Eligibility criteria for participants across included studies

Three studies set an upper age limit of ⩽ 75 years. The most common types of cancer were lung cancer (n = 12), breast cancer (n = 9), and colorectal cancer (n = 7), although some studies included patients with multiple types of cancer. Eighteen studies included patients with a prognosis of 6–24 months. Regarding functional status, 16 studies included patients with poor performance, which was defined as a Karnofsky Performance Status of ⩽ 60 or an Eastern Cooperative Oncology Group Performance Status of ⩽ 3. Fourteen studies required participants to be alert to complete symptom assessments or surveys, whereas eight studies excluded participants with cognitive impairments. Access to technology, more specifically access to smartphones, tablets, or desktop computers with Internet connectivity, was a prerequisite in 21 studies. Finally, nine studies required patients to have at least one caregiver to assist with complex care needs or to facilitate telehealth participation.

Meta-analysis

Patients’ quality of life

Five randomized controlled trials involving a total of 655 patients assessed how the use of telehealth in palliative care impacted patients’ quality of life at 1.5- to 3-month follow-up. The quality of life was measured using the summary score on the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, the Functional Assessment of Cancer Therapy – General questionnaire, and the Functional Assessment of Chronic Illness Therapy – Palliative Care questionnaire. Across all questionnaires, higher scores indicated better quality of life. A random-effects meta-analysis demonstrated a statistically significant improvement in quality of life in the intervention group compared with the control group (standardized mean difference (SMD): 0.81; 95% CI: 0.09–1.53), although heterogeneity was high (I² = 93%, τ² = 0.62, p < 0.01; Figure 2, Supplemental Figure 1). Individual effect sizes ranged from a large, significant benefit (SMD of 1.73 in Bergerot et al.⁶⁹) to a small, non-significant effect (SMD of −0.10 in Bakitas et al.³⁵).

Figure 2.

Random-effects meta-analysis of randomized clinical trials on the association between using telehealth in palliative care and patients’ quality of life at 1.5- to 3-month follow-up.

Symptom burden

Four randomized controlled trials involving a total of 431 patients evaluated how the use of telehealth in palliative care affects symptom burden at 2- to 3-month follow up. The symptom burden was measured using the Symptom Distress Scale, the total distress score on the Edmonton Symptom Assessment System, and the symptom burden subscale of the Quality of Life at the End of Life scale. A random-effects meta-analysis demonstrated a statistically significant reduction in symptom burden in the intervention group compared with the control group (SMD: −1.44; 95% CI: −2.24 to −0.65), although heterogeneity was high (I² = 88%, τ² = 0.59, p < 0.01; Figure 3, Supplemental Figure 2). Individual effect sizes ranged from a large benefit (SMD of −2.14 in Bakitas et al.³⁵) to a small, non-significant effect (SMD of −0.23 in Hoek et al.⁵⁰).

Figure 3.

Random-effects meta-analysis of randomized clinical trials on the association between using telehealth in palliative care and symptom burden at 2- to 3-month follow-up.

Depression

Five randomized controlled trails encompassing a total of 528 patients evaluated how the use of telehealth in palliative care impacted depressive symptoms at 2- to 3-month follow-up. Three studies used the Hospital Anxiety and Depression Scale–Depression subscale, one used the Center for Epidemiologic Studies Depression Scale, and one used the Geriatric Depression Scale. Across all instruments, higher scores indicated more severe depressive symptoms. A random-effects meta-analysis found a non-significant effect in the intervention group compared with the control group (SMD: −0.43; 95% CI: −1.17 to 0.31), with substantial heterogeneity (I² = 91%, τ² = 0.65, p < 0.01; Figure 4, Supplemental Figure 3).

Figure 4.

Random-effects meta-analysis of randomized clinical trials on the association between using telehealth in palliative care and depression at 2- to 3-month follow-up.

Human resource-related requirements for using telehealth in palliative care

Most interventions were conducted by multiprofessional teams that included, at a minimum, palliative care physicians and nurses (n = 14). Some studies encompassed additional team members, such as pharmacist, psychologists, social workers, music therapists, physiotherapists, and chaplains.^49,51,69,72 Physicians played a central role, particularly in video consultations. Their specialties included palliative care, pain medicine, and oncology.^4,36,38 Nurses were particularly central to telephone- and text-based interventions. Their responsibilities included symptom assessment, patient education, medication management, care coordination, follow-up, and monitoring. Regarding the training of personnel, five studies reported that personnel received preparatory instruction. The training topics included telehealth communication skills, use of digital platforms and equipment, symptom triage and escalation protocols, principles of foundational palliative care, and multiprofessional collaboration protocols. Only seven studies explicitly reported that staff members had prior experience in oncology, palliative care, or psychosocial care (Supplemental Table 3). While psychosocial expertise may be expected in specialized palliative care teams, most studies did not document such experience.

Technological infrastructure-related requirements for using telehealth in palliative care

Most interventions involved video-based communication platforms, typically requiring patients to have access to Internet-connected devices—such as smartphones, tablets, laptops, and desktop computers—along with reliable broadband or wireless networks. In nine studies, the participants were required to own or have access to devices equipped with a camera and microphone (e.g. smartphones and tablets) and sufficient internet speed (e.g. ⩾ 256 kbps). In some studies, tablet computers or laptops were provided to patients who lacked the necessary equipment.^4,63 Some interventions employed HIPAA-compliant platforms (e.g. VSee and Zoom), whereas some platforms offered accessibility features tailored to older adults, such as text-to-voice functionality and adjustable font size.⁶³ One study employed WhatsApp for remote assessments because of its widespread accessibility, built-in encryption, and the use of disappearing messages after 24 h to enhance security.⁶⁹ Technical issues such as audio-visual distortion, unstable Internet connections, and equipment malfunction were reported in six studies, although most interruptions were described as minor.^40,61,65

In seven studies that encompassed telephone-based care, patients were required to have a mobile phone service, and one study excluded individuals with unstable telephone access.³⁵ Interventions involving text messaging or mobile applications required Internet access and mobile devices at home.^37,53,66 In some studies (n = 6), symptom monitoring platforms were accessible via web portals or smartphone applications.^{37,39,41,53,58,59} These platforms also included features such as automated alerts to notify healthcare providers of concerning symptoms.

Financial and reimbursement considerations for using telehealth in palliative care

Although detailed descriptions of reimbursement mechanisms were often lacking, several studies provided insights into program costs and cost-saving potential. Several studies suggested that telehealth may reduce costs by decreasing patient travel and acute-care utilization.^4,34,69,70 In a rural-focused intervention, the goal was to reduce indirect costs for patients such as transportation expenses.⁶¹ A cost analysis of a multicomponent telehealth intervention reported an average cost of about USD 1100 per patient and demonstrated substantial annual cost savings compared to standard care.⁶³ One study analyzed the cost impact of reduced emergency department visits and hospital admissions,³⁷ while another reported a cost reduction associated with shorter hospital stays.⁵³ Some studies have acknowledged the high costs of advanced technologies and emphasized limited scalability due to their lack of large-scale production and limited public accessibility.⁴⁷ One study noted that recent changes in French healthcare policy now allow reimbursement for remote-monitoring services and that this development can support long-term implementation.⁵³ Another study from Taiwan highlighted that bundled payments under the National Health Insurance system did not fully account for the provision of 24-h telehealth services, resulting in limited incentives for providers.⁷⁰

Outcome measures used to evaluate telehealth in palliative care

The outcome measures examined in the included studies were categorized into five key domains: (1) symptom management, (2) quality of life, (3) psychosocial and emotional well-being, (4) patient and caregiver experience, and (5) healthcare utilization. Across all studies, 23 evaluated symptom management, 17 assessed quality of life, 14 examined psychosocial aspects, 14 assessed patient or caregiver experience, and 16 analyzed healthcare utilization.

Symptom management and quality of life were most frequently measured using validated instruments such as the Integrated Palliative Care Outcome Scale, the Edmonton Symptom Assessment System, and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire. These outcomes were quantitatively synthesized in the meta-analyses. Beyond these, several studies also assessed psychosocial and emotional outcomes (e.g. mood, anxiety, depression, sense of safety, and self-efficacy), patient and caregiver experience (e.g. satisfaction, perceived usefulness, emotional distress, caregiver burden), and healthcare utilization (e.g. emergency visits, hospital admissions, and readmissions). Additionally, four studies evaluated survival outcomes (e.g. 1-year survival), and 18 studies assessed feasibility and usability, including patient engagement and treatment adherence.

Discussion

A significant improvement was observed in quality of life and symptom burden, whereas no statistically significant effect was found for depression. Furthermore, trained multiprofessional teams, accessible digital infrastructure, sustainable reimbursement mechanisms, and standardized outcome measurements were found to be the key requirements for implementing telehealth in the palliative care of patients with advanced cancer.

There was substantial heterogeneity among the palliative care delivery models. The lack of sensitivity analyses limited to low-risk studies highlights the need for cautious interpretation of pooled estimates. Nevertheless, in line with findings from previous meta-analyses of face-to-face palliative care,^26,29 our analysis demonstrated that telehealth interventions significantly improved quality of life in patients with advanced cancer. These results suggest that telehealth can be an effective modality for delivering palliative care, offering outcomes comparable to in-person care. Such findings support the integration of telehealth into routine palliative care, particularly when timely in-person access is limited.

The finding that telehealth in palliative care significantly reduced symptom burden at 2- to 3-month follow-up aligns with the results of previous meta-analyses of face-to-face palliative care,²⁶ which demonstrated improved symptom burden at both 1- to 3-month and 4- to 6-month follow-ups. Routine symptom surveillance via electronic patient-reported outcomes (ePRO) may support the effectiveness of telehealth in palliative care by reducing symptom burden.⁷⁴ When an ePRO score exceeds a pre-specified threshold, an automated alert is sent to the clinical team, prompting timely supportive interventions; this rapid feedback may help alleviate symptoms. In addition, encouraging patients to self-monitor their symptoms may enhance engagement and adherence to treatment, both of which could be associated with a reduction in symptom burden.⁷⁵ However, survey data indicate that patients experiencing dyspnea are significantly less willing to substitute video consultations for in-person encounters,³ demonstrating that different symptoms vary in their applicability for telehealth interventions.

The implementation of telehealth in palliative care requires careful coordination of both human and technological infrastructures. Although the review emphasizes the importance of multiprofessional teams (as in in-person care), delivering such care via telehealth may involve greater complexity.⁷⁶ However, previous studies have shown that multiprofessional care can be effectively delivered—even in remote settings—through user-centered design, clear multiprofessional guidelines, stable IT infrastructure, and appropriate telecommunication tools.^77,78 To support these efforts, it may be essential to develop an online telehealth education resource for palliative care providers.²⁵

Access to and usability of technology were also identified as key facilitators, as many studies recruited participants who already owned digital devices, which likely contributed to higher feasibility. Yet, palliative care populations often include older adults with serious illnesses and limited familiarity with technology.⁷⁹ To ensure inclusive access, systems should incorporate user-friendly interfaces designed for individuals with physical or cognitive impairments. There is also a need to consider data privacy and security concerns, particularly when enabling communication between institutions and home-based patients. Although international telemedicine guidelines exist,^25,80 guidelines tailored to the unique needs of palliative care populations remain limited. Given the high proportion of older adults with serious illnesses, palliative-care-specific telehealth guidelines that comprehensively address accessibility, usability, and data security are urgently required.

Future implications

In terms of future research, it is essential to identify which populations in palliative care, not only cancer patients, benefit most from telehealth. To satisfy the needs of diverse populations, studies should evaluate telehealth across different models such as specialist-led, outpatient, and community-based approaches.^81,82 Given the heterogeneity of existing trials, meta-analyses will provide clearer estimates of telehealth’s impact when based on high-quality studies with consistent comparators and designs.

For implementation, applying structured frameworks such as the Consolidated Framework for Implementation Research can help systematically evaluate how organizational, technological, and individual-level factors influence the adoption and sustainability of telehealth interventions.⁸³ Research should also broaden its scope to include rural and underserved populations and address cultural and linguistic diversity, as most of the existing evidence is based on racially homogeneous urban groups.^84,85 From a policy perspective, the sustainability and equity of telehealth in palliative care depend on reimbursement mechanisms and regulations that recognize remote care as an equivalent alternative to in-person services. Policy support for telehealth, strengthened during the pandemic but now being scaled back, remains essential for sustaining telehealth in palliative care.

Looking ahead, ongoing clinical trials in Europe are testing remote palliative care models in intensive care settings. These initiatives highlight the potential of telehealth not only to support patients but also to address the needs of families and to support non-specialist healthcare providers. This indicates that telehealth may also expand palliative care across specialties.⁸⁶

Limitations

The strengths of this review include the use of diverse study designs, a dual focus on effectiveness and implementation, and a restriction to patients with advanced cancer to ensure clinical homogeneity. This focus enhances the internal validity of our findings and allows for more precise estimation of intervention effects, consistent with current trends in implementation science.

However, this study had several limitations. First, the small number of trials eligible for meta-analysis limited the robustness of the pooled estimates. Second, many included studies had methodological limitations, particularly related to the risk of bias due to lack of blinding of subjective outcomes. While blinding is a key methodological safeguard, it is often infeasible in palliative care trials. Third, this review did not stratify the findings based on delivery modality (e.g. video- vs telephone-based telehealth), follow-up duration (e.g. 1- to 3-month window vs 6- to 12-month window), timing (e.g. early use vs delayed use), or the degree of risk of bias, all of which may have influenced the outcomes. Post hoc subgroup analyses were not possible because of the limited number of studies. Fourth, there was a conceptual overlap between symptom burden and depression because some composite symptom burden scales included items related to depression. We addressed this by treating depression as a distinct outcome to allow for a clearer interpretation of its psychological impact. Finally, although all interventions met the prespecified definition of palliative care, substantial heterogeneity was observed. While variations in the delivery model, team composition, intervention intensity, modality, and timing of the outcome assessment were plausible contributors, their influence could not be verified in this review. Future studies should perform meta-regression or subgroup analyses to clarify potential sources of heterogeneity.

Conclusions

Using telehealth in palliative care is a feasible approach for patients with advanced cancer and may help improve quality of life and alleviate the symptom burden. The key requirements for telehealth use include trained multiprofessional teams, accessible digital infrastructure, sustainable reimbursement mechanisms, and standardized outcome measurements. Future research should clarify optimal care delivery models and implementation strategies. It should also examine equity-related barriers to support wider implementation and policy development.

Supplemental Material

sj-docx-1-pmj-10.1177_02692163251403395 – Supplemental material for Effectiveness of and implementation requirements for telehealth in palliative care patients with advanced cancer: A systematic review and meta-analysis

Supplemental material, sj-docx-1-pmj-10.1177_02692163251403395 for Effectiveness of and implementation requirements for telehealth in palliative care patients with advanced cancer: A systematic review and meta-analysis by Arisa Kawashima, Taiji Noguchi, Taiki Furukawa, Akiko Unesoko, Shintaro Togashi and Kazuki Sato in Palliative Medicine

Footnotes

Acknowledgements

We extend our gratitude to Dr. Yuki Sugihara, Ms. Chihiro Yamashita, Ms. Mika Onodera, Ms. Rina Hasebe, Ms. Rin Matsushita, Ms. Sakiho Miyamoto, Ms. Reika Yamamoto, and Ms. Mizuki Furukawa, who conducted the abstract screening. This study was supported by the Industry-University Collaborative Project for Human Resource Development to Accelerate AI R&D in the Health and Medical Fields (MEXT). This work is partially supported by Nagoya University Research Fund.

ORCID iDs

Arisa Kawashima

Taiji Noguchi

Taiki Furukawa

Akiko Unesoko

Ethical considerations

This study did not require ethical approval because we used only publicly available data.

Author contributions

Arisa Kawashima: Study design, data collection, screening, and data analysis, writing—original draft, and writing—review and editing. Taiji Noguchi: Study design, data analysis, writing, review, and editing. Taiki Furukawa: Study design, writing, review, and editing. Akiko Unesoko: Study design, screening, and writing, review, and editing. Shintaro Togashi: Data collection, screening, data analysis, writing, review, and editing. Kazuki Sato: Study design, writing, review, and editing.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by AMED under Grant Number 24uk1024009h0001 and JSPS KAKENHI under Grant Number 25K20696.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data availability statement

Data supporting the findings of this study are available from the corresponding author upon request.

Supplemental material

Supplemental material for this article is available online.

References

Gupta

Johnson

Henderson

, et al. Patient, caregiver, and clinician perspectives on the time burdens of cancer care. JAMA Netw Open 2024; 7(11): e2447649.

Ray

Park

, et al. System-level factors associated with use of outpatient specialty palliative care among patients with advanced cancer. J Oncol Pract 2018; 15(1): e10–e19.

Shih

Arechiga

Chen

, et al. Telehealth preferences among patients with advanced cancer in the post COVID-19 vaccine era. J Pain Symptom Manag 2024; 67(6): 525–534.e1.

Greer

Temel

El-Jawahri

, et al. Telehealth vs in-person early palliative care for patients with advanced lung cancer: a multisite randomized clinical trial. JAMA 2024; 332: 1153–1164.

Steindal

Nes

AAG

Godskesen

, et al. Patients’ experiences of telehealth in palliative home care: scoping review. J Med Internet Res 2020; 22(5): e16218.

Basch

Deal

Kris

, et al. Symptom monitoring with patient-reported outcomes during routine cancer treatment: a randomized controlled trial. J Clin Oncol 2016; 34(6): 557–565.

Calton

Shibley

Cohen

, et al. Patient and caregiver experience with outpatient palliative care telemedicine visits. Palliat Med Rep 2020; 1(1): 339–346.

Yang

Jiang

, et al. Effects of telemedicine on informal caregivers of patients in palliative care: systematic review and meta-analysis. JMIR Mhealth Uhealth 2024; 12: e54244.

Middleton-Green

Gadoud

Norris

, et al. ‘A friend in the corner’: supporting people at home in the last year of life via telephone and video consultation-an evaluation. BMJ Support Palliat Care 2019; 9(4): e26.

10.

Lomenick

Kuhlman

Barnes

, et al. Economics of using telemedicine to supplement hospice care in rural areas. J Palliat Med 2021; 24(10): 1461–1466.

11.

Haydon

Snoswell

Thomas

, et al. Enhancing a community palliative care service with telehealth leads to efficiency gains and improves job satisfaction. J Telemed Telecare 2021; 27(10): 625–630.

12.

Mathews

Chow

Wennberg

, et al. Telehealth palliative care interventions for patients with advanced cancer: a scoping review. Support Care Cancer 2023; 31(8): 451.

13.

Sebastian

Shah

Arsene

Effectiveness of integrated palliative care telehealth intervention in patients with chronic heart failure: A systematic review and meta-analysis of randomized controlled trials. Curr Probl Cardiol 2024; 49(9): 102685.

14.

Zheng

Head

Schapmire

TJ.

A systematic review of telehealth in palliative care: caregiver outcomes. Telemed J E Health 2016; 22(4): 288–294.

15.

Bradford

Armfield

Young

, et al. The case for home based telehealth in pediatric palliative care: a systematic review. BMC Palliat Care 2013; 12: 4.

16.

Steindal

Nes

AAG

Godskesen

, et al. Advantages and challenges of using telehealth for home-based palliative care: systematic mixed studies review. J Med Internet Res 2023; 25: e43684.

17.

Groom

McCarthy

Stimpfel

, et al. Telemedicine and telehealth in nursing homes: an integrative review. J Am Med Dir Assoc 2021; 22(9): 1784–1801.e7.

18.

Ghazal

Singh Beniwal

Dhingra

Assessing telehealth in palliative care: a systematic review of the effectiveness and challenges in rural and underserved areas. Cureus 2024; 16(8): e68275.

19.

Kirby

Griffin

Heavin

, et al. Telehealth adoption in palliative care: a systematic review of patient barriers and facilitators. BMC Palliat Care 2025; 24(1): 52.

20.

Krieckemans

Cavolo

Casaer

, et al. Telehealth in palliative care settings: a systematic review of argument-based ethics literature. Palliat Med. Epub ahead of print 2025. DOI: 10.1177/02692163251360115

21.

Nwosu

AC.

Telehealth requires improved evidence to achieve its full potential in palliative care. Palliat Med 2023; 37(7): 896–897.

22.

Page

McKenzie

Bossuyt

, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; 372: n71.

23.

Higgins

JPT

Thomas

Chandler

, et al. (eds). Cochrane Handbook for Systematic Reviews of Interventions version 6.5 (updated August 2024). Cochrane, 2024. www.training.cochrane.org/handbook (accessed 14 April 2025).

24.

Finucane

O’Donnell

Lugton

, et al. Digital health interventions in palliative care: a systematic meta-review. NPJ Digit Med 2021; 4(1): 64.

25.

World Health Organization. Consolidated telemedicine implementation guide, https://www.who.int/publications/i/item/9789240059184 (2022, accessed 14 April 2025).

26.

Kavalieratos

Corbelli

Zhang

, et al. Association between palliative care and patient and caregiver outcomes: a systematic review and meta-analysis. JAMA 2016; 316(20): 2104–2114.

27.

Ferrell

Twaddle

Melnick

, et al. National Consensus Project Clinical Practice Guidelines for Quality Palliative Care Guidelines, 4th edition. J Palliat Med 2018; 21(12): 1684–1689.

28.

American Cancer Society. What are advanced and metastatic cancers?, https://www.cancer.org/cancer/managing-cancer/advanced-cancer/what-is.html (2024, accessed 14 April 2025).

29.

Haun

Estel

Rücker

, et al. Early palliative care for adults with advanced cancer. Cochrane Database Syst Rev 2017; 6(6): CD011129.

30.

Gomes

Calanzani

Curiale

, et al. Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database Syst Rev 2013; 2013: CD007760.

31.

Sterne

JAC

Savović

Page

, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: l4898.

32.

Higgins

JPT

Morgan

Rooney

, et al. A tool to assess risk of bias in non-randomized follow-up studies of exposure effects (ROBINS-E). Environ Int 2024; 186: 108602.

33.

Higgins

Thompson

Deeks

, et al. Measuring inconsistency in meta-analyses. BMJ 2003; 327(7414): 557–560.

34.

Alcalde Castro

Zaig

Nissim

, et al. Telehealth outpatient palliative care in the COVID-19 pandemic: patient experience qualitative study. BMJ Support Palliat Care 2023; 14: e1512.

35.

Bakitas

Tosteson

, et al. Early versus delayed initiation of concurrent palliative oncology care: patient outcomes in the ENABLE III randomized controlled trial. J Clin Oncol 2015; 33(13): 1438–1445.

36.

Bernhardt

Bückmann

Krüger

, et al. Telemedicine plus standard care versus standard care only in specialized outpatient palliative care: a randomized controlled noninferiority trial. Telemed J E Health 2024; 30(5): 1459–1469.

37.

Bhargava

Keating

Isenberg

, et al. RELIEF: A digital health tool for the remote self-reporting of symptoms in patients with cancer to address palliative care needs and minimize emergency department visits. Curr Oncol 2021; 28(6): 4273–4280.

38.

Cascella

Schiavo

Grizzuti

, et al. Implementation of a hybrid care model for telemedicine-based cancer pain management at the Cancer Center of Naples, Italy: A cohort study. In Vivo 2023; 37(1): 385–392.

39.

Castillo Padrós

Pastor

Altarriba Paracolls

, et al. A smart system for remote monitoring of patients in palliative care (HumanITcare Platform): mixed methods study. JMIR Form Res 2023; 7: e45654.

40.

Chávarri-Guerra

Ramos-López

Covarrubias-Gómez

, et al. Providing supportive and palliative care using telemedicine for patients with advanced cancer during the COVID-19 pandemic in Mexico. Oncologist 2021; 26(3): e512–e515.

41.

Cherny

Parrinello

Kwiatkowsky

, et al. Feasibility of large-scale implementation of an electronic patient-reported outcome remote monitoring system for patients on active treatment at a community cancer center. JCO Oncol Pract 2022; 18(12): e1918–e1926.

42.

Chow

Wong

Connolly

, et al. Prospective assessment of symptom palliation for patients attending a rapid response radiotherapy program: feasibility of telephone follow-up. J Pain Symptom Manag 2001; 22(2): 649–656.

43.

Chua

Olmsted

Plotke

, et al. Video and in-person palliative care delivery challenges before and during the COVID-19 pandemic. J Pain Symptom Manag 2022; 64(6): 577–587.

44.

Chumbler

Mkanta

Richardson

, et al. Remote patient–provider communication and quality of life: empirical test of a dialogic model of cancer care. J Telemed Telecare 2007; 13(1): 20–25.

45.

Cleeland

Wang

Shi

, et al. Automated symptom alerts reduce postoperative symptom severity after cancer surgery: a randomized controlled clinical trial. J Clin Oncol 2011; 29(8): 994–1000.

46.

Cornetta

Nyariki

Manji

, et al. Telehospice for cancer patients discharged from a tertiary care hospital in Western Kenya. J Pain Symptom Manag 2023; 65(5): 378–387.

47.

Formica

Fossile

Pellegrino

, et al. The Medical Care Continuity (MCC) project. A pilot study of video-assisted home care within the eTEN European Community program. The Italian experience. Support Care Cancer 2009; 17(5): 471–478.

48.

Howard

Medhurst

Manhas

, et al. The usefulness of patient-reported outcomes and the influence on palliative oncology patients and health services: a qualitative study of the prospective outcomes and support initiative. Cancer Nurs 2021; 44(5): 388–397.

49.

Hennemann-Krause

Lopes

Araújo

, et al. The assessment of telemedicine to support outpatient palliative care in advanced cancer. Palliat Support Care 2015; 13(4): 1025–1030.

50.

Hoek

Schers

Bronkhorst

, et al. The effect of weekly specialist palliative care teleconsultations in patients with advanced cancer –a randomized clinical trial. BMC Med 2017; 15: 119.

51.

Johnsen

Petersen

Sjøgren

, et al. Exploratory analyses of the Danish Palliative Care Trial (DanPaCT): a randomized trial of early specialized palliative care plus standard care versus standard care in advanced cancer patients. Support Care Cancer 2020; 28(5): 2145–2155.

52.

Lefresne

Olson

Cashman

, et al. Prospective analysis of patient reported symptoms and quality of life in patients with incurable lung cancer treated in a rapid access clinic. Lung Cancer 2017; 112: 35–40.

53.

Mir

Ferrua

Fourcade

, et al. Digital remote monitoring plus usual care versus usual care in patients treated with oral anticancer agents: the randomized phase 3 CAPRI trial. Nat Med 2022; 28(6): 1224–1231.

54.

Mkanta

Chumbler

Richardson

, et al. Age-related differences in quality of life in cancer patients: a pilot study of a cancer care coordination/home-telehealth program. Cancer Nurs 2007; 30(6): 434–440.

55.

Nemecek

Huber

Schur

, et al. Telemedically augmented palliative care : empowerment for patients with advanced cancer and their family caregivers. Wien Klin Wochenschr 2019; 131(23-24): 620–626.

56.

Oelschlägel

Christensen

Moen

, et al. Patients’ experiences with a welfare technology application for remote home care: a longitudinal study. J Clin Nurs 2023; 32(17-18): 6545–6558.

57.

Pimentel

Yennurajalingam

Chisholm

, et al. The frequency and factors associated with the use of a dedicated supportive care center telephone triaging program in patients with advanced cancer at a comprehensive cancer center. J Pain Symptom Manag 2015; 49(5): 939–944.

58.

Pozzar

Enzinger

Poort

, et al. Developing and field testing BOLSTER: A nurse-led care management intervention to support patients and caregivers following hospitalization for gynecologic cancer-associated peritoneal carcinomatosis. J Palliat Med 2022; 25(9): 1367–1375.

59.

Pozzar

Enzinger

Howard

, et al. Feasibility and acceptability of a nurse-led telehealth intervention (BOLSTER) to support patients with peritoneal carcinomatosis and their caregivers: a pilot randomized clinical trial. Gynecol Oncol 2024; 188: 1–7.

60.

Reinke

Sullivan

Slatore

, et al. A randomized trial of a nurse-led palliative care intervention for patients with newly diagnosed lung cancer. J Palliat Med 2022; 25(11): 1668–1676.

61.

Shepherd

Goldstein

Whitford

, et al. The utility of videoconferencing to provide innovative delivery of psychological treatment for rural cancer patients: results of a pilot study. J Pain Symptom Manag 2006; 32(5): 453–461.

62.

Steel

Geller

Kim

, et al. Web-based collaborative care intervention to manage cancer-related symptoms in the palliative care setting. Cancer 2016; 122(8): 1270–1282.

63.

Steel

George

Terhorst

, et al. Patient, family caregiver, and economic outcomes of an integrated screening and novel stepped collaborative care intervention in the oncology setting in the USA (CARES): a randomised, parallel, phase 3 trial. Lancet 2024; 403(10434): 1351–1361.

64.

Valenti

Rossi

Scarpi

, et al. Nurse-led telephone follow-up for early palliative care patients with advanced cancer. J Clin Nurs 2023; 32(11-12): 2846–2853.

65.

van Gurp

van Selm

Vissers

, et al. How outpatient palliative care teleconsultation facilitates empathic patient-professional relationships: a qualitative study. PLoS One 2015; 10(4): e0124387.

66.

Viitala

Åstedt-Kurki

Lehto

, et al. Online follow-up with a mobile device improves incurable cancer patients’ coping - a qualitative study. Eur J Oncol Nurs 2021; 55: 102047.

67.

Wall

Pozzar

Enzinger

, et al. Improving the palliative-procedure decision-making process for patients with peritoneal carcinomatosis: a secondary analysis. Gynecol Oncol 2024; 188: 125–130.

68.

Yount

Rothrock

Bass

, et al. A randomized trial of weekly symptom telemonitoring in advanced lung cancer. J Pain Symptom Manag 2014; 47(6): 973–989.

69.

Bergerot

Razavi

, et al. Telehealth geriatric assessment and supportive care intervention (GAIN-S) Program: a randomized clinical trial. J Natl Compr Canc Netw 2025; 23(6): 219–226.

70.

Jang

Wang

Hou

, et al. Tele-assisted home-based palliative care reduces health care costs for terminal cancer patients: real-world evidence from a regional hospital in Taiwan. J Palliat Med 2024; 27(11): 1450–1458.

71.

Kim

Tang

Taylor

, et al. Factors associated with cancer patients’ preferences for telemedicine or in-person palliative care. J Pain Symptom Manag 2025; 70(2): e159–e166.

72.

Neo

Mok

, et al. Enhancing palliative care for advanced cancer patients: evaluating implementation and impact of a virtual nurse-led symptom monitoring and telehealth initiative. BMC Palliat Care 2024; 23(1): 238.

73.

Rosa

Epstein

Lauria

, et al. Post-acute transition to home with supportive care (PATHS): a novel nurse practitioner-led telehealth intervention to improve end-of-life oncology care. J Pain Symptom Manag 2025; 69(5): 496–506.

74.

Patel

Kapphahn

Dewland

, et al. Effect of a community health worker intervention on acute care use, advance care planning, and patient-reported outcomes among adults with advanced stages of cancer: a randomized clinical trial. JAMA Oncol 2022; 8(8): 1139–1148.

75.

Spoelstra

Given

, et al. An intervention to improve adherence and management of symptoms for patients prescribed oral chemotherapy agents: an exploratory study. Cancer Nurs 2013; 36(1): 18–28.

76.

Aghdam

MRF

Vodovnik

Hameed

. Role of telemedicine in multidisciplinary team meetings. J Pathol Inf 2019; 10: 35.

77.

Chien

Roberts

Soto Perez de-Celis

, et al. Telehealth in geriatric oncology: a novel approach to deliver multidisciplinary care for older adults with cancer. J Geriatr Oncol 2020; 11(2): 197–199.

78.

Basile

Consolo

Colombo

, et al. Technology to support older adults in home palliative care: a scoping review. Am J Hosp Palliat Care 2024; 41(6): 673–690.

79.

Tarbi

Schuler

Ambrose

, et al. Telehealth for the study of palliative care communication: opportunities, methodological challenges, and recommendations. BMC Palliat Care 2025; 24(1): 55.

80.

World Health Organization, International Telecommunication Union. WHO-ITU global standard for accessibility of telehealth 81services [Internet]. Geneva: World Health Organization and International Telecommunication Union, https://www.who.int/publications/i/item/9789240050464 (2022, accessed 18 April 2025).

81.

Webb

Hurley

Gentry

, et al. Best practices for using telehealth in hospice and palliative care. J Hosp Palliat Nurs 2021; 23(3): 277–285.

82.

Hutchinson

Chiu

Belin

, et al. How is telehealth used to increase access to specialty palliative care? A systematic review. J Pain Symptom Manag 2025; 69(4): e303–e314.

83.

Damschroder

Aron

Keith

, et al. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 2009; 4: 50.

84.

Dixit

Van Sebille

Crawford

, et al. Disparities in telehealth use: how should the supportive care community respond? Support Care Cancer 2022; 30(2): 1007–1010.

85.

Bakitas

Gazaway

Underwood

, et al. Palliative video consultation and symptom distress among rural inpatients: a randomized clinical trial. JAMA Netw Open 2025; 8(7): e2519426.

86.

Kesecioglu

Rusinova

Alampi

, et al. European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit. Intensive Care Med 2024; 50(11): 1740–1766.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.13 MB

0.00 MB