Early Palliative Care for People with Primary Malignant Brain Tumors: A Systematic Review

Abstract

In some populations with advanced cancers, early palliative care (ePC) has been shown to improve quality of life (QoL) and reduce aggressive interventions, but its role and timing in primary malignant brain tumors (PMBT) remains poorly defined. This systematic review assessed existing definitions of ePC in PMBT, trends in its use, and associations between palliative care (PC) timing and patient outcomes. A systematic search was conducted (PROSPERO CRD420251020915). Eligible studies included peer-reviewed, full-text articles reporting outcomes related to PC timing in PMBT. Data on study design, patient characteristics, definitions of ePC, and outcomes were extracted. Study quality was assessed using the risk of bias in non-randomized studies-of interventions tool and the Methodological Index for Non-randomized Studies, as applicable. Of 5115 references, 5 studies met inclusion criteria, encompassing 11,721 people with PMBT. Most studies were retrospective; one was prospective. Definitions of ePC varied with “early” defined relative to diagnosis, treatment milestones, or death. Across studies, a minority of patients received PC (15%–40%), with most referrals occurring late in the disease course. Earlier PC was associated with reduced aggressiveness of EoL care, decreased health care utilization, and, in some cases, longer survival. Demographic factors were not consistent predictors of ePC referral; comorbidity burden was associated with PC use. The prospective feasibility trial demonstrated structured ePC integration was achievable. Evidence suggests ePC for PMBT is infrequently implemented yet feasible and may reduce aggressive EoL care and improve outcomes. However, definitions of “early” vary. Prospective trials are needed to further define and clarify the impact of ePC integration on QoL, survival, and health care utilization in this population.