Palliative Care Did Not Improve QOL for Malignant Pleural Mesothelioma

Quality of life was not improved with the use of early palliative care for patients recently diagnosed with malignant pleural mesothelioma (MPM), according to data (abstract 8880) presented at the International Association for the Study of Lung Cancer 18th World Conference on Lung Cancer, held October 15–18 in Yokohama, Japan.

“Regular early specialist palliative care for all patients with recently diagnosed mesothelioma is not associated with beneficial changes in quality of life, and, therefore, it is likely that our current standard of care in Australia and United Kingdom is meeting patient’s needs adequately,” said Fraser Brims, MD, Curtin University, Australia, who presented the results.

According to Brims, MPM is associated with a high symptom burden, is relatively resistant to treatment, and has an average survival of less than 1 year. Because of this, he sought to determine if starting palliative care early would positively affect quality of life. A prior single-center study by Temel et al had success improving quality of life by introducing early palliative care in patients with metastatic non–small-cell lung cancer.

The mesothelioma study randomly assigned 174 patients with MPM diagnosed within the last 6 weeks to either an intervention group that received both early specialist palliative care and standard care, or standard care alone. The intervention group had an initial assessment and a palliative care visit every 4 weeks throughout the study. Quality of life was measured using the EORTC QLQ-C30 questionnaire and the General Health Questionnaire (GHQ-12) for anxiety/depression measures. The primary outcome was the change in EORTC C30 Global Health Status quality of life 12 weeks after randomization.

At 24 weeks, 17% of study participants had died. At 12 weeks, there was no significant difference in quality of life or anxiety/depression scores between the two groups. The same was true at 24 weeks follow-up. No difference in survival was found between the two groups.

According to Brims, his initial reaction to study results was disappointment. However, he and colleagues examined the data to try to determine why there was no difference in quality of life.

“Primarily, if we look at the current provision of care in the Australia and United Kingdom, as well as expert clinicians, we have senior specialist thoracic cancer nurses, chemotherapy nurses, who support the patient in their journey, and that is standard care now,” Brims said. “It is possible, therefore, that the addition of specialist palliative care to all-comers, regardless of perceived need, just hasn’t made that much difference to the patient’s unmet needs.”

Brims noted that-as compared to the Temel study-the different setting, healthcare systems, and disease type could account for the differing results observed. “While 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,” he said.