Symptom Burden and Unmet Needs in Malignant Pleural Mesothelioma: Exploratory Analyses From the RESPECT-Meso Study

Our plain-English summary of Symptom Burden and Unmet Needs in Malignant Pleural Mesothelioma: Exploratory Analyses From the RESPECT-Meso Study, by S.N. Hoon, I. Lawrie, C. Qi, et al (Journal of Palliative Care, 2021).

The study

• Authors: S.N. Hoon, I. Lawrie, C. Qi, N. Rahman, N. Maskell, K. Forbes, S. Gerry, L. Monterosso, A. Chauhan, F.J.H. Brims
• Journal: Journal of Palliative Care
• Published: 2021;36(2):113-120
• Type of article: Randomized trial
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: Malignant Pleural Mesothelioma (MPM) has a poor prognosis and high symptom burden. RESPECT-Meso was a multicenter randomized study examining the role of early specialist palliative care (SPC) on quality of life (QoL) with MPM. This is a post-hoc exploratory analysis of the symptom burden and unmet needs identified from RESPECT-Meso participants.

Methods: Exploratory analysis from 174 participants using the General Health Status (GHS) measure (from the EORTC QLQ-C30 QoL questionnaire) and 87 participants using validated assessment questionnaires in those randomized to SPC. Eligibility for the study included confirmed MPM with diagnosis <6 weeks prior, performance score (PS) 0 or 1, no significant physical or psychological comorbidity. Cox proportional hazards models were derived to examine for relationships with survival. Free text was assessed using content analysis, looking for common themes and words.

Results: Participants were predominantly male (79.9%), mean age 72.8 years, PS was 0 in 38%, 78% of MPM was epithelioid. At least 3 symptoms were reported in 69.8% of participants, including fatigue (81%), dyspnea (73.3%), pain (61.2%), weight loss (59.3%). Anxiety was reported by 54.7% of participants, 52.3% low mood and 48.8% anhedonia symptoms. After multivariable adjustment, only pain remained statistically significant with a hazard ratio (HR) 2.9 (95% CI 1.3-6.7; p = 0.01). For each 1 unit increase in GHS score, the HR for death was 0.987 (0.978-0.996; p = 0.006), indicating a worse reported QoL is related to shorter survival. Unmet needs were common: 25.9% wanted more information about their condition, 24.7% about their care and 21.2% about their treatment. 79.1% were concerned about the effect of their illness on family.

Conclusion: There is a high symptom burden in mesothelioma despite good baseline performance status. A worse QoL is associated with a worse survival. Unmet needs are common, perhaps highlighting a need for improved communication and information sharing.

In plain English

This article reported exploratory analyses from RESPECT-Meso, a randomized trial of early specialist palliative care in newly diagnosed malignant pleural mesothelioma. The trial enrolled 174 participants with good performance status from 19 UK hospitals and 1 Western Australian hospital. No asbestos-exposure measurements are reported in this analysis. Of 86 palliative-care-arm participants completing a symptom questionnaire, 69.8% reported 3 or more symptoms, most often fatigue, breathlessness and pain. On another questionnaire, 55% reported anxiety. Across all participants, each 1-unit rise in quality-of-life (GHS) score carried a hazard ratio for death of 0.987 (95% CI 0.978 to 0.996). Among the physical symptoms tested, only pain stayed statistically significant after adjustment for other factors, with a hazard ratio for death of 2.9 (95% CI 1.3 to 6.7). In the palliative care arm, 79.1% worried about their illness's effect on family, and just 7 mentioned asbestos or mesothelioma support groups. The authors concluded that symptom burden was high even early on and that worse symptoms and quality of life were associated with poorer survival. They noted that participants were relatively fit and may not reflect all people with mesothelioma.

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: Exploratory analysis of data from RESPECT-Meso, a multicenter, randomized, non-blinded, parallel group-controlled trial comparing early specialist palliative care with standard care. The article text calls the analyses planned; the PubMed abstract calls them post-hoc.
• Who was studied: 174 adults with a new diagnosis of malignant pleural mesothelioma and ECOG performance status 0 to 1, randomized 87 to each arm. They were recruited from 19 UK hospitals and 1 Western Australian hospital. Mean age was 73.2 in the standard care arm and 72.4 in the early palliative care arm. 72 of 87 and 67 of 87 were male. Study dates are not given.
• Exposure: No asbestos-exposure measurements are reported in this analysis. The study examined symptom and quality-of-life scores (EORTC QLQ-C30, ESAS, SPARC) in relation to survival and unmet needs. The trial intervention was referral to specialist palliative care within 6 weeks of diagnosis, with visits every 4 weeks.
• Main results:
  • On the ESAS questionnaire in the intervention arm (N = 86), 60 participants (69.8%) had 3 or more symptoms. The most common were fatigue (81.4%), dyspnea (73%) and pain (60%).
  • Among all participants, pain was reported by 100 of 174 (57%) at baseline, 84 of 154 (55%) at 12 weeks and 74 of 127 (58%) at 24 weeks.
  • Higher baseline quality-of-life (GHS) score was associated with longer survival. For each 1-unit increase in GHS, the hazard ratio for death was 0.987 (95% CI 0.978 to 0.996), p = 0.006.
  • Compared with participants reporting low (no or a little) dyspnea or pain, those reporting high (quite or very much) dyspnea or pain had a hazard ratio for death of 1.7 (95% CI 1.1 to 2.6). For fatigue the hazard ratio was 1.9 (95% CI 1.3 to 3.0).
  • In one model, the unadjusted hazard ratio for pain was 1.5 (0.8 to 2.9; p = 0.19). After adjustment for age, gender, performance status, chemotherapy, sarcomatoid-containing histology, comorbidities and baseline GHS, only pain among the physical symptoms tested remained statistically significant: HR 2.9 (95% CI 1.3 to 6.7; p = 0.01).
  • On the SPARC questionnaire in the intervention arm, 47 of 86 (55%) reported anxiety, mostly at a low level, and 45 (52%) reported low mood.
  • In the intervention arm, 79.1% (68 participants) were worried about the effect of their illness on their families.
  • In the intervention arm, 22 participants wanted more information about their condition and 21 wanted more about their care.
  • Only 7 participants mentioned seeking support from asbestos disease or mesothelioma support groups.
• The authors' conclusion: The authors concluded that patients with mesothelioma have a high symptom burden even at an early stage. They also concluded that increasing physical symptoms and lower quality-of-life scores are associated with poor survival, and that unmet needs are common.
• Limitations the authors state:
  • Participants were selected for relatively good performance status, so the results may not reflect the wider population with malignant pleural mesothelioma.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Prognosis, Palliative Care, Quality of Life, Epithelioid, Dyspnea, Hazard Ratio, Mesothelioma.

Related studies

• 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)
• Content validity and electronic PRO (ePRO) usability of the Lung Cancer Symptom Scale-Mesothelioma (LCSS-Meso) in mesothelioma patients — H.L. Gelhorn, A.M. Skalicky, et al. (2018)
• Palliative care in mesothelioma: Are current services RESPECT-able enough? — N. Kumar, D. Alrifai, et al. (2019)
• Symptom burden in mesothelioma patients admitted to home palliative care — S. Mercadante, D. Degiovanni, et al. (2016)
• Treatment patterns and humanistic burden of malignant pleural mesothelioma in Spain — S. Cedres, J. Calvete, et al. (2025)
• The psychological distress and care needs of mesothelioma patients and asbestos-exposed subjects: A systematic review of published studies — M. Bonafede, M. Ghelli, et al. (2018)

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