Abstract / Summary
Patients with cancer on palliative treatment often have dynamic and multidimensional symptoms like pain, fatigue, anorexia, cognitive changes, and emotional distress that significantly impact functional capacity and quality of life. Traditional symptom management is largely reactive, based on patient self-report or clinician recognition after deterioration, leading to delayed interventions and avoidable suffering.
The aim of this systematic review was to review the evidence on nurse-led predictive symptom-management strategies in oncology palliative care, with a focus on the role of laboratory biomarkers and clinical judgment in the early detection of deterioration and better quality of care.
A systematic search was performed in PubMed, CINAHL, Scopus, Embase, and the Cochrane Library through November 2025. Keywords included "nurse-led," "predictive symptom management," "palliative care," "oncology," "biomarkers," and "clinical judgment." Both qualitative and quantitative studies were included in the review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram: 1,482 records identified, 346 duplicates removed, 1,136 screened, 128 full texts assessed, and 14 eligible studies selected based on PRISMA 2020 statements. The review protocol was registered in advance in the International Prospective Register of Systematic Reviews (PROSPERO; Registration No. CRD420261432500).
The included studies (Randomised Controlled Trials (RCTs), cohorts, modeling studies, and telehealth interventions) demonstrated that biomarkers such as C-reactive protein, neutrophil-lymphocyte ratio, albumin, ferritin, and electrolytes predicted symptom exacerbation and clinical decline. Nurse-led approaches including biomarkers with clinical assessment improved the management of symptoms, decreased emergency department visits, and improved continuity of care. Predictive models were promising but limited in clinical integration.
Nurse-led predictive approaches support a shift from reactive to proactive palliative care. Further research is needed to embed predictive tools into routine practice and to validate their effectiveness in real-world settings.