Early specialist palliative care on quality of life for malignant pleural mesothelioma: a randomised controlled trial

Abstract

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.

Palliative care in mesothelioma: Are current services RESPECT-able enough?

“…Despite the negative results reported by Brims et al ,9 nihilism for the role of early SPC in MPM would be inappropriate. Rather, early referral to SPC does not appear to be warranted for patients with a good performance status treated at centres with MDT and specialist nurse input with additional access to SPC as indicated.…”

“…It is timely therefore that Brims et al 9 report on the findings of the RESPECT-Meso trial that aimed to provide objective evidence to address if early SPC intervention positively impacts patients with MPM, an area often neglected in large-scale clinical studies. The study design comprised a multicentre, randomised group controlled trial of 174 patients (and 145 main carers) across 19 sites in the UK and a single site in Western Australia.…”

“…Patient survival at 1 year was greater in the early SPC group, however overall survival by log-rank analysis was not significantly different. Brims et al 9 highlight a recent Cochrane review15 including these studies that concludes early SPC input in advanced solid malignancies may slightly increase patient HRQoL and symptoms but effects on mood and survival are uncertain. Notably, the Cochrane review15 grades this evidence as either low or very low for these variables and therefore the results of the well-designed RESPECT-Meso trial (Randomised controlled trial of regular early specialist palliative care on quality of life in malignant pleural mesothelioma),9 while contradictory, cannot be interpreted as completely inconsistent with existing evidence.…”

“…Two main factors appear to contribute to the negative results, as highlighted by the authors. First, the inclusion criteria for the RESPECT-Meso trial9 included patients with a good performance status (ie, ambulatory), and it may be that the benefits of early SPC are more marked for more debilitated patients. Including such patients however would have likely led to significant numbers not completing the trial and the study being underpowered.…”

“…If current demographic and cancer trends continue however, a greater demand for care and a decrease in the supply of informal care could lead to an increased role for early SPC, and such a trial might yield different results in the future. Despite their significant role, few studies report on the needs of carers, and it is commendable therefore that the RESPECT-Meso trial9 includes carer-related secondary endpoints.…”