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Early palliative care does not show quality-of-life benefit for newly diagnosed mesothelioma
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Early palliative care did not significantly improve quality-of-life measures among patients newly diagnosed with malignant pleural mesothelioma, according to results of the RESPECT-MESO trial presented at International Association for the Study of Lung Cancer World Conference on Lung Cancer.
“At first, I was disappointed by [the results], but then I got to thinking: Is this a real effect? We think it is a real effect in terms of the trial design and the quality of the data,” Fraser Brims, MBcHB, MRCP, MD, FRACP, deputy director and head of occupational and respiratory health group at Institute for Respiratory Health in Australia, said during a press conference. “If we look at the current provision of care in Australia and the United Kingdom ... we have senior specialists, thoracic cancer nurses and chemotherapy nurses who support the patient in their journey and that is standard care now. It is possible, therefore, that the addition of specialist palliative care to all-comers — regardless of perceived need — hasn’t made much of a difference to a patient’s unmet needs.”
Malignant pleural mesothelioma is caused by exposure to asbestos, has a high symptom burden and is relatively resistant to treatment. Generally, the average survival is less than 1 year, Brims said during his presentation.
In a 2010 study published in The New England Journal of Medicine, Temel and colleagues showed regular palliative care significantly improved quality of life among patients with metastatic non-small cell lung cancer.
To evaluate whether this benefit occurred in patients with mesothelioma, Brims and colleagues randomly assigned 174 patients (median age, 72.6 years; 79.9% men) 1:1 to standard care alone or with early specialist palliative care for up to 24 weeks. Most patients (78.2%) had epithelioid subtype of malignant pleural mesothelioma. Patients had an ECOG performance status of 0 (37.9%) or 1 (62.1%).
Patients in the specialist care group attended four weekly specialist palliative care visits throughout the study period. Researchers used the EORTC 30-item Quality of Life (QLQ-C30) questionnaire to assess quality of life and General Health Questionnaire (GHQ-12) to assess depression and anxiety at baseline and every 4 weeks up to 24 weeks.
Any change in EORTC QLQ-C30 global health status quality-of-life score at 12 weeks from baseline served as the primary endpoint.
At baseline, 77% of patients reported dyspnea and 57.4% had chest pain.
More than half of patients (59.2%) underwent at least one cycle of chemotherapy.
At 12 weeks, 78.2% of patients in the specialist care group had completed all scheduled specialist care visits; this decreased to 52.9% at 24 weeks. Researchers referred 15 patients in the control group to specialist care within 12 weeks and 30 by 24 weeks.
The mean global health status quality-of-life score at 12 weeks was 60.2 for the specialist care group and 59.5 for the control group (mean difference, 1.8; 95% CI, 4-8.5).
At 24 weeks, the mean global health status quality-of-life score was 61.3 for the specialist care group and 63.7 for the control group (mean difference, –2; 95% CI, –8.8 to 4.6).
GHQ-12 results showed anxiety and depression scores appeared similar between control and specialist care patients at 12 weeks (2.6 vs. 2.2; mean difference = –0.6; 95% CI, –1.5 to 0.4) and 24 weeks (2.1 vs. 1.75; mean difference = –0.4; 95% CI, –1.2 to 0.4).
Researchers observed no significant differences in any of the quality-of-life variables between the two groups.
“It’s likely our current standard of care in Australia and the United Kingdom is meeting patients’ needs adequately,” Brims said.
There may be several reasons why this study showed a different outcome than the study published in 2010.
“The different finding of this study as compared to the Temel paper may be explained by the different settings and health care systems the studies were performed in, or perhaps can be explained by the different disease,” Brims said in a press release. “Although the results were surprising — as, intuitively, many of us felt that the intervention was likely to help — they highlight why we need high-quality studies like this.” – by Melinda Stevens
Reference:
Brims F, et al. Abstract 8880. Presented at: International Association for the Study of Lung Cancer World Conference on Lung Cancer; Oct. 15-18, 2017; Yokohama, Japan.
Disclosures: Brims reports no relevant financial disclosures. Please see the abstract for a list of all other authors’ relevant financial disclosures.