Quality Matters: Effect of High-Quality Early Palliative Care in Advanced Cancer

Abstract

Context: Early palliative care (EPC) is an integral treatment for advanced cancer patients, improving quality of life and symptom management, but the impact of its quality on outcomes is less understood. Objectives: This study aimed to quantify the quality of EPC and analyze its longitudinal association with depression levels, quality of life (QoL), patient survival, and self-management strategies in patients with advanced cancer. Methods: This secondary analysis included 144 advanced cancer patients from a randomized controlled trial in South Korea. Participants were stratified into high-quality (N = 76) and low-quality (N = 68) EPC groups based on Quality Care Questionnaire–Palliative Care scores. Outcomes including QoL (McGill Quality of Life Questionnaire, EORTC QLQ-C15-PAL), depression (PHQ-9), and self-management strategies (SMASH Assessment Tool Short Form) were assessed at baseline, 12, 18, and 24 weeks. Two-year overall survival was analyzed using Kaplan–Meier curves and log-rank tests, while repeated measures used generalized estimating equations and linear mixed-effects models. Results: The high-quality EPC group demonstrated a significantly lower prevalence of depression at 24 weeks (14.7% vs. 39.1%, P = 0.036) and a higher 2-year survival rate (P = 0.006) compared to the low-quality group. Significant improvements were observed in existential and social burden (MQOL) and self-management preparation and implementation strategies (SAT-SF) at 18 and 24 weeks in the high-quality EPC group. Overall QoL measured by EORTC QLQ-C15-PAL showed minimal group differences. Conclusion: The quality of EPC services significantly impacts depression, patient survival, aspects of QoL, and self-management capabilities. These findings emphasize the importance of high-quality EPC beyond mere provision.