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

Thorax. 2019 Jan 19. pii: thoraxjnl-2018-212380. doi: 10.1136/thoraxjnl-2018-212380. [Epub ahead of print]

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

Brims F1,2, Gunatilake S3, Lawrie I4, Marshall L5, Fogg C6, Qi C7, Creech L8, Holtom N9, Killick S10, Yung B11, Cooper D12, Stadon L13, Cook P14, Fuller E15, Walther J16, Plunkett C17, Bates A18, Mackinlay C19, Tandon A20, Maskell NA21,22, Forbes K23, Rahman NM24, Gerry S25, Chauhan AJ26; RESPECT-Meso investigators.

Collaborators (13)

Author information

1

Respiratory Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.

2

Curtin Medical School, Curtin University, Perth, Western Australia, Australia.

3

Department of Respiratory Medicine, Portsmouth Hospitals NHS Trust, Portsmouth, UK.

4

Department of Palliative Medicine, North Manchester General Hospital, Manchester, Manchester, UK.

5

Research and Innovation Department, Portsmouth Hospitals NHS Trust, Portsmouth, UK.

6

School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK.

7

Centre for Statistics in Medicine, University of Oxford, Oxford, UK.

8

University Hospital of South Manchester NHS Foundation Trust, Manchester, Manchester, UK.

9

Department of Palliative Care, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK.

10

Department of Palliative Care, Hampshire Hospitals NHS Foundation Trust, Winchester, Hampshire, UK.

11

Department of Respiratory Medicine, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, Essex, UK.

12

Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, UK.

13

North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK.

14

Department of Respiratory Medicine, County Durham and Darlington NHS Foundation Trust, Darlington, UK.

15

Department of Respiratory Medicine, South Tyneside NHS Foundation Trust, South Shields, South Tyneside, UK.

16

Haematology, Oncology and Palliative Care, Taunton and Somerset NHS Foundation Trust, Taunton, UK.

17

Department of Palliative Medicine, Mid Essex Hospital Services NHS Trust, Chelmsford, UK.

18

Department of Clinical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, Southampton, UK.

19

Great Western Hospitals NHS Foundation Trust, Swindon, Swindon, UK.

20

Department of Palliative Care, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.

21

North Bristol Lung Centre, Southmead Hospital, Bristol, UK.

22

Academic Respiratory Unit, Department of Clinical Sciences, Bristol University, Bristol, UK.

23

Department of Palliative Medicine, Bristol University, Bristol, UK.

24

Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK.

25

Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.

26

Department of Respiratory, Queen Alexandra Hospital, Portsmouth, Hampshire, UK.

Abstract

PURPOSE:

Malignant 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.

METHODS:

We 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.

RESULTS:

Between 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.

CONCLUSION:

There 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.