The Organization of Home Palliative Cancer Care by Primary Health Care: A Systematic Review

Background: Home-based palliative cancer care coordinated by primary care has been proposed as a strategy to improve access, continuity, and alignment with patient preferences, but its organizational characteristics and effects remain insufficiently synthesized. Aim: The aim was to characterize the organizational components of home-based palliative care models for patients with advanced cancer coordinated by primary care and to evaluate the effects of these models on patient-related and health system outcomes. Methods: Following a Cochrane review protocol, primary studies were searched in MEDLINE, Scopus, LILACS, Web of Science, the Cochrane Library, and CINAHL to identify randomized controlled trials and analytical observational studies published between January 2018 and May 2026. Results: The narrative synthesis included seven analytical observational studies conducted in high-income countries, most classified as 4b—settings with advanced and integrated palliative care. Across these studies, recurrent organizational components included case management, structured care pathways prioritizing home-based care, and mechanisms linking primary care with specialized palliative care teams. Reported outcomes were associated with potential system-level benefits, such as fewer emergency department visits and higher proportions of home death, but these findings are subject to residual confounding, heterogeneity, and indirectness, which limit confidence in the evidence. Conclusion: The available evidence, which was restricted to seven observational studies conducted in countries with highly developed palliative care systems, suggests that certain organizational components may support home-based palliative cancer care coordinated by primary care. However, substantial methodological limitations, the absence of patient-centred outcomes, and the lack of studies from low- and middle-income countries indicate that further research is needed before drawing practice or policy recommendations.