Living with mesothelioma: a systematic review of mental health and well-being impacts and interventions for patients and their informal carers

Our plain-English summary of Living with mesothelioma: a systematic review of mental health and well-being impacts and interventions for patients and their informal carers, by V. Sherborne, S. Ejegi-Memeh, A.M. Tod, et al (BMJ Open, 2024).

The study

• Authors: V. Sherborne, S. Ejegi-Memeh, A.M. Tod, B. Taylor, S. Hargreaves, C. Gardiner
• Journal: BMJ Open
• Published: 2024;14(6):e075071
• Type of article: Systematic review
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: Mesothelioma is an aggressive cancer predominantly affecting the lung and abdominal linings. It can have a unique impact on mental health and well-being (MHWB) due to its incurability, poor prognosis and asbestos-exposure causation. This review's aims were to identify/synthesise international evidence on mesothelioma's MHWB impacts; explore MHWB interventions used by patients and carers; and identify evidence of their effectiveness.

Design: Systematic review.

Data Sources: Databases, searched March 2022 and March 2024, were MEDLINE; CINAHL; PsycINFO; Cochrane Library; ASSIA.

Eligibility Criteria: We included study designs focusing on psychological impacts of living with mesothelioma and MHWB interventions used by patients and informal carers, published in English since January 2002.

Data Extraction And Synthesis: A team of reviewers screened included studies using standardised methods. Quality was assessed using validated tools: Mixed-Methods Appraisal tool for primary research and Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews.

Results: Forty-eight studies met the inclusion criteria: 20 qualitative, 16 quantitative, nine reviews, two mixed-methods, one combined systematic review/qualitative study. UK studies predominated. Many MHWB impacts were reported, including traumatic stress, depression, anxiety and guilt. These were influenced by mesothelioma's causation, communication issues and carer-patient relational interactions. Participants used wide-ranging MHWB interventions, including religious/spiritual practice; talking to mental-health professionals; meaning-making. Some strategies were presented as unhelpful, for example, denial. Participants reported lack of access to support.

Conclusions: Most qualitative studies were rated high quality. The quality of the quantitative studies and reviews varied. The sparse literature regarding MHWB in mesothelioma means more research is needed into impacts on patients and carers, including trauma. To enable access to evidence-based support, research is recommended concerning MHWB interventions' effectiveness in mesothelioma.

Prospero Registration Number: CRD42022302187.

© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

In plain English

This systematic review gathered research on how mesothelioma affects the mental health and well-being of patients and their informal carers, and on what helps them cope. The authors searched five databases in March 2022 and March 2024 for English-language studies from January 2002 onward. They included 48 studies, mostly from the UK (24) and Italy (7). None focused on peritoneal mesothelioma. Reported impacts included shock, anxiety, trauma, frustration and depression. Patients often felt angry about the asbestos cause, sometimes with conflicted loyalty to former employers. In one included study, 50% of participants showed possible clinical anxiety and 33% possible PTSD, with carers scoring higher. Coping strategies included social and spiritual support, finding meaning, gaining a sense of control and talking to mental health professionals. Some strategies, such as denial, were described as unhelpful. Participants reported a lack of support, and the review found no studies testing whether specific interventions work. The authors concluded that more research is needed. They noted that all eligible studies were included regardless of quality, and that including reviews meant some participants were counted more than once.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Systematic review with narrative data synthesis (no meta-analysis)
• Who was studied: 48 published studies (20 qualitative, 16 quantitative, nine reviews, two mixed-methods, one combined review and qualitative study) on adult patients with mesothelioma and their informal carers. Studies were in English, published January 2002 to March 2024, and came mostly from the UK (24) and Italy (7). Databases were searched on 9 March 2022 and again on 28 March 2024.
• Exposure: Living with a mesothelioma diagnosis, either pleural (21 studies) or all types combined (27 studies). No study focused on peritoneal mesothelioma. Fiber types and exposure doses were not studied.
• Main results:
  • Across included studies, mental health impacts included shock, anxiety, trauma, frustration and depression.
  • Asbestos causation added impact: patients often felt angry, sometimes with conflicted loyalty to former employers.
  • In one included mixed-methods study (Sherborne et al 2024), 50% of participants showed possible clinical anxiety.
  • In the same included study, possible PTSD was found in 33% of participants, with carers scoring higher than patients.
  • An included population-based study (Henson et al) found that patients with mesothelioma had the highest suicide risk of all English cancer patients.
  • Strategies used to manage impacts included social and spiritual support, finding meaning, gaining a sense of control, and talking to mental health professionals.
  • Some strategies, including denial, were presented in the studies as dysfunctional.
  • Patients and carers reported a lack of psychological support, with carers receiving less. In one included survey (Darlison et al), 31% of participants were not offered any emotional support.
  • The searches found no studies of the effectiveness of specific mental health interventions for mesothelioma.
• The authors' conclusion: The authors concluded that the literature is sparse. They said more research is needed into mental health impacts on patients and carers, and that research evaluating mental health interventions for mesothelioma is urgently needed.
• Limitations the authors state:
  • All studies meeting the inclusion criteria were included regardless of quality, which may have introduced bias.
  • Including reviews meant some participants were counted multiple times, so some themes may be overemphasised.
  • Almost all articles came from high-income Western countries, giving a potentially narrow view.
  • A single researcher carried out the data synthesis.
  • Established guidance on conducting narrative synthesis was not used.
  • Only English-language searches were run, so relevant articles in other languages may have been missed.
  • The grey literature was not searched because of resource constraints.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Systematic Review, Prognosis, Causation.

Related studies

• What are the psychological effects of mesothelioma on patients and their carers? A scoping review — V. Sherborne, J. Seymour, et al. (2020)
• Psychological Distress in Patients With Asbestos-Related Diseases and Their Families: A Systematic Literature Review — I.G. Franzoi, M.D. Sauta, et al. (2025)
• Effects of Occupational Hazards on Job Stress and Mental Health of Factory Workers and Miners: A Propensity Score Analysis — Y. Lu, Z. Zhang, et al. (2020)
• The mental health of asbestos-exposed subjects with pleural abnormalities — P. Franklin, M. Robinson, et al. (2015)
• Development and validation of a nomogram for predicting the risk of mental health problems of factory workers and miners — Y. Lu, Q. Liu, et al. (2022)
• The psychosocial impact of living with mesothelioma: Experiences and needs of patients and their carers regarding supportive care — A. Prusak, J.M. van der Zwan, et al. (2021)

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