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

Our plain-English summary of Palliative care in mesothelioma: Are current services RESPECT-able enough?, by N. Kumar, D. Alrifai, I. Psallidas (Thorax, 2019).

The study

• Authors: N. Kumar, D. Alrifai, I. Psallidas
• Journal: Thorax
• Published: 2019;74(4):326-327
• Type of article: Editorial, Comment
• Read it: PubMed · Publisher

In plain English

This is an editorial, not a new study. The authors commented on a separate trial, RESPECT-Meso by Brims and colleagues, which tested early specialist palliative care for people with malignant pleural mesothelioma. In that trial, 174 patients and 145 main carers at 19 UK sites and one in Western Australia took part. One group saw palliative care specialists within 3 weeks, then every 4 weeks, plus standard care. The other got standard care. The editorial reports the trial found no statistically significant benefit to patients' quality of life at 12 weeks, the main measure. It also found none for 24-week quality of life, mood or survival, but found a positive effect on carers' mood and satisfaction with end-of-life care. By 24 weeks, 34.5% of the standard-care group had received specialist palliative care. The authors noted the trial included only ambulatory patients in the UK and Australia. They concluded that early referral does not appear warranted for such patients at centres with team and specialist nurse support plus access to specialist palliative care as needed. They said its role outside that setting remains unclear, and that dismissing it would be inappropriate.

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: Editorial (commissioned commentary) on a separately published randomised controlled trial (RESPECT-Meso, Brims et al); not original research
• Who was studied: As described by the editorial, the RESPECT-Meso trial enrolled 174 patients with malignant pleural mesothelioma and 145 main carers at 19 sites in the UK and one site in Western Australia
• Exposure: No asbestos exposure is discussed. The intervention in the trial was early specialist palliative care (review within 3 weeks, then every 4 weeks for at least 24 weeks) alongside standard care, compared with standard care alone
• Main results:
  • As reported by the editorial, the trial found no statistically significant benefit to patients for the primary endpoint, change in health-related quality of life at 12 weeks
  • As reported by the editorial, the trial found no significant benefit for patient quality of life at 24 weeks, mood at 12 and 24 weeks, or overall survival
  • As reported by the editorial, the trial found a positive impact on carer mood and on carer satisfaction with end-of-life care
  • 21.8% of patients did not complete all three specialist palliative care visits within 12 weeks. 17.2% of the control arm received specialist palliative care by 12 weeks, rising to 34.5% at 24 weeks
• The authors' conclusion: The editorial authors concluded that dismissing early specialist palliative care in malignant pleural mesothelioma would be inappropriate. In their view, early referral does not appear warranted for patients with good performance status treated at centres with multidisciplinary team and specialist nurse input and with access to specialist palliative care as indicated. They said the role of early specialist palliative care outside this setting remains unclear.
• Limitations the authors state:
  • The trial included only patients with good performance status (ambulatory), and the benefits of early specialist palliative care may be greater in more debilitated patients
  • The trial assessed only patients in the UK and Australia, both of which have public healthcare systems and existing palliative care referral pathways
  • Incomplete specialist palliative care visits in the intervention group and specialist palliative care use in the control group diluted the effect

Topics

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

Medical terms in this study, explained in our Lexicon: Palliative Care, Mesothelioma.

Related studies

• Current Asbestos Exposure and Future Need for Palliative Care in India — A.V. Jadhav, N.C. Gawde (2019)
• Symptom burden in mesothelioma patients admitted to home palliative care — S. Mercadante, D. Degiovanni, et al. (2016)
• Understanding the palliative care needs and experiences of people with mesothelioma and their family carers: An integrative systematic review — M. Harrison, C. Gardiner, et al. (2021)
• Is pleurectomy and decortication superior to palliative care in the treatment of malignant pleural mesothelioma? — I. Zahid, S. Sharif, et al. (2011)
• Efficacy of Cell-Free and Concentrated Ascites Reinfusion Therapy for Palliative Care in a Patient with Malignant Pleural Mesothelioma: A Case Report — K. Hisakane, H. Ohmatsu, et al. (2017)
• A multicentre non-blinded randomised controlled trial to assess the impact of regular early specialist symptom control treatment on quality of life in malignant mesothelioma (RESPECT-MESO): study protocol for a randomised controlled trial — S. Gunatilake, F.J. Brims, et al. (2014)

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