Early Integration of Palliative Care in Advanced Upper Gastrointestinal Malignancies: A Scoping Review

Background: Patients diagnosed with advanced, metastatic, or incurable upper gastrointestinal (GI) cancers (such as pancreatic, gastric, esophageal, and hepatobiliary cancers) face an exceptionally high symptom burden and poor overall prognosis. While the early integration of palliative care alongside standard disease-modifying therapies is widely recommended by oncological guidelines, its practical implementation remains inconsistent. This scoping review aims to map the existing literature to understand how "early palliative care" (EPC) is defined, delivered, and evaluated in this specific patient population, and to identify the primary barriers and facilitators to its successful integration. Research Questions: How is "early palliative care" chronologically and conceptually defined in the context of advanced upper GI malignancies? What are the specific components and interventions that constitute early palliative care for this patient population? What are the reported clinical and systemic outcomes associated with the early integration of palliative care? What are the primary barriers and facilitators to the implementation of early palliative care from the perspectives of patients, oncologists, and healthcare systems? Methods: Study Design: This scoping review is conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews and follows the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Search Strategy: A systematic search was conducted across two major electronic databases: Web of Science and Scopus. The search spanned literature published between January 1, 2010, and February 28, 2026. The search strings used were as follows: Web of Science: ("upper gastrointestinal" OR "upper GI" OR gastric OR stomach OR esophag* OR oesophag* OR pancreat* OR hepatobiliary OR liver OR biliary) AND (metastatic OR advanced OR "stage IV" OR incurable) AND ("palliative care" OR "palliative medicine" OR "supportive care" OR "early integration") Scopus: ("upper gastrointestinal" OR "upper GI" OR gastric OR stomach OR esophag* OR oesophag* OR pancreat* OR hepatobiliary OR "liver cancer" OR biliary) AND (metastatic OR advanced OR "stage IV" OR incurable) AND ("palliative care" OR "palliative medicine" OR "supportive care" OR "early palliative") Eligibility Criteria: Included studies focused on adult patients with advanced, metastatic, or incurable upper GI cancers. The review included studies investigating the timing, components, and integration of palliative care. Only English-language peer-reviewed articles (including RCTs, observational studies, qualitative studies, and reviews) originating from Western or comparable healthcare contexts (e.g., Europe, USA, Canada, Australia) were included to ensure systemic and cultural comparability regarding end-of-life care communication and infrastructure. Screening and Data Extraction: Following deduplication, records were screened by title and abstract using the Rayyan software. Full texts of potentially relevant articles were then assessed against the inclusion criteria. Data extraction was performed using a standardized charting form in Microsoft Excel. Extracted variables included: first author, year of publication, country of origin, study design, tumor type, sample size, timing of EPC, specific interventions, definitions of EPC, outcomes, barriers, and facilitators. The data charting process will be cross-checked and validated to ensure data accuracy and consistency.