title: Treatment targeted at underlying disease versus palliative care in terminally ill patients: a systematic review.
abstract: To assess the efficacy of active treatment targeted at underlying disease (TTD)/potentially curative treatments versus palliative care (PC) in improving overall survival (OS) in terminally ill patients.
  
  
  
  We performed a systematic review and meta-analysis of randomised controlled trials (RCT). Methodological quality of included RCTs was assessed using the Cochrane risk of bias tool.
  
  
  
  Medline and Cochrane databases were searched, with no language restriction, from inception to 19 October 2016.
  
  
  
  Any RCT assessing the efficacy of any active TTD versus PC in adult patients with terminal illness with a prognosis of <6-month survival were eligible for inclusion.
  
  
  
  Initial search identified 8252 citations of which 10 RCTs (15 comparisons, 1549 patients) met inclusion criteria. All RCTs included patients with cancer. OS was reported in 7 RCTs (8 comparisons, 1158 patients). The pooled results showed no statistically significant difference in OS between TTD and PC (HR (95% CI) 0.85 (0.71 to 1.02)). The heterogeneity between pooled studies was high (I2=62.1%). Overall rates of adverse events were higher in the TTD arm.
  
  
  
  Our systematic review of available RCTs in patients with terminal illness due to cancer shows that TTD compared with PC did not demonstrably impact OS and is associated with increased toxicity. The results provide assurance to physicians, patients and family that the patients' survival will not be compromised by referral to hospice with focus on PC.
authors.affiliation: Comparative Effectiveness Research, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
authors.forename: Tea
authors.initials: T
authors.lastname: Reljic
authors.affiliation: Comparative Effectiveness Research, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.|Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Ambuj
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Comparative Effectiveness Research, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.
authors.forename: Farina A
authors.initials: FA
authors.lastname: Klocksieben
authors.affiliation: Comparative Effectiveness Research, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA.|Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida, USA.|Department of Malignant Hematology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Djulbegovic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D013727:Terminal Care / Q000379:methods; D019452:Terminally Ill; D016896:Treatment Outcome
keywords: End of life care; PALLIATIVE CARE; Terminal illness