PurposeMalignant pleural mesothelioma (MPM) has a high symptom burden and poor survival. Evidence from other cancer types suggests some benefit in health-related quality of life (HRQoL) with early specialist palliative care (SPC) integrated with oncological services, but the certainty of evidence is low.MethodsWe performed a multicentre, randomised, parallel group controlled trial comparing early referral to SPC versus standard care across 19 hospital sites in the UK and one large site in Western Australia. Participants had newly diagnosed MPM; main carers were additionally recruited. Intervention: review by SPC within 3 weeks of allocation and every 4 weeks throughout the study. HRQoL was assessed at baseline and every 4 weeks with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30. Primary outcome: change in EORTC C30 Global Health Status 12 weeks after randomisation.ResultsBetween April 2014 and October 2016, 174 participants were randomised. There was no significant between group difference in HRQoL score at 12 weeks (mean difference 1.8 (95% CI −4.9 to 8.5; p=0.59)). HRQoL did not differ at 24 weeks (mean difference −2.0 (95% CI −8.6 to 4.6; p=0.54)). There was no difference in depression/anxiety scores at 12 weeks or 24 weeks. In carers, there was no difference in HRQoL or mood at 12 weeks or 24 weeks, although there was a consistent preference for care, favouring the intervention arm.ConclusionThere is no role for routine referral to SPC soon after diagnosis of MPM for patients who are cared for in centres with good access to SPC when required.Trial registration number
ISRCTN18955704.
AimCancer research in the National Health Service has increased by 10·5% in 3 years since the formation of the National Cancer Research networks in 2000. The initial enthusiasm from clinical staffs to embark on a project has to be balanced against the implications of resources, costs and other developments. There is no standardised method to assess the impact of research projects on clinical practice. The aim of this project was to develop and implement a Radiotherapy Research Activity Assessment Tool (RAAT) to assess the feasibility of newly proposed projects within clinical settings.Methods and materialsA multi-step development method was used. The steps involved the principles of quality function deployment. The consecutive steps involved developing a user-friendly and replicable tool and would fit on one A4 page. The process involved multi-professionals and patients throughout the design process. The tool was preliminary tested on usability among eight stakeholders on a ten-point scale (1=poor; 10=very good). Percentage agreement was evaluated at 6 month post initial RAAT assessment scoring by the seven multi-disciplinary team (MDT) members.FindingsThe RAAT was developed in an e-form available in Microsoft Excel. The tool scored a mode of 6 for usability. Interrater reliability testing between the radiotherapy MDT resulted in 88% agreement. The RAAT seems to be feasible in clinical practice, and provide a framework to guide the decision-making process. The study calls for further testing of usability and review of long-term implications on all stakeholders.
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