Symptom burden in mesothelioma patients admitted to home palliative care

Our plain-English summary of Symptom burden in mesothelioma patients admitted to home palliative care, by S. Mercadante, D. Degiovanni, A. Casuccio (Current Medical Research and Opinion, 2016).

The study

• Authors: S. Mercadante, D. Degiovanni, A. Casuccio
• Journal: Current Medical Research and Opinion
• Published: 2016;32(12):1985-1988
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Context: Mesothelioma is a very aggressive cancer that is brought on by asbestos exposure. Because there is a long latency period between exposure to asbestos and symptoms of disease, most patients with mesothelioma present with advanced disease and survive an average of 8-12 months. Thus, best supportive care should be considered critical to optimally manage these patients.

Aim: The aim of this study was to examine the epidemiological characteristics and symptom burden of mesothelioma patients when admitted to home palliative care.

Methods: The charts of a consecutive sample of patients admitted to the home palliative care program with a diagnosis of mesothelioma in an endemic industrialized area were reviewed. The estimated survival time was about two months from admission. Epidemiological characteristics were collected. Karnofsky status, characteristics of pain and analgesic treatment at time of admission were recorded. ESAS (Edmonton Symptom Assessment System) and other clinical problems reported in the charts at admission time were also recorded.

Results: Of the 674 charts reviewed, 56 patients (8.3%) had a diagnosis of mesothelioma. About three quarters of those had pain, with 18 and 2 patients with moderate and severe pain, respectively, despite receiving medium to high doses of opioids. The principal pain site was the chest. Pain was significantly associated with opioid consumption (p < .0005) and dyspnea (p = .049). Symptom burden was relevant, with a global ESAS of about 40. Pain, weakness, poor appetite, poor well-being, and dyspnea were the most frequent symptoms with the highest intensity; cough and pleural effusion were more frequently present as clinical problems.

Conclusion: This study shows that mesothelioma is a devastating cancer with a relevant symptom burden, and that patients were referred to palliative care late in the course of their disease, suggesting that earlier integration of palliative care should be considered to relieve suffering in all disease stages - not only at the end of life.

In plain English

This retrospective chart review looked at patients with mesothelioma when they were admitted to the home palliative care program of Casale Monferrato, Italy, in 2013 and 2014. The article describes Casale Monferrato as an area with a history of asbestos industry, which stopped in June 1986. Of 674 patients admitted, 56 (8.3%) had mesothelioma. Their mean age was 73.7 years, and 35 were men and 21 women. On average they stayed in home care for 54.8 days, which for almost all of them was their remaining survival time. Pain was recorded in 44 of the 56 patients (78.6%). Eighteen had moderate pain and 2 had severe pain, despite receiving medium-high doses of opioids. The chest was the main pain site. The mean total symptom score on the ESAS (Edmonton Symptom Assessment System) was 38.7. Higher pain was statistically associated with higher opioid doses and with breathlessness (dyspnea). The authors concluded that these patients were referred to palliative care late. They wrote that because symptoms exist at diagnosis, relief should be considered from the onset. The authors noted that the study was retrospective and recorded patients only once, at admission.

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: Retrospective, cross-sectional review of patient charts (brief report)
• Who was studied: 56 patients with mesothelioma, out of 674 consecutive patients whose charts were reviewed, admitted to the home palliative care program of Casale Monferrato, Italy, in 2013 and 2014. Mean age 73.7 (SD 11.4) years; 35 men and 21 women; mean Karnofsky performance score 45.6 (SD 9.9). The article does not say whether the mesotheliomas were pleural or peritoneal.
• Exposure: The study did not record individual asbestos exposure, fiber types or jobs. The article describes Casale Monferrato as an area where mesothelioma deaths rose among industrial workers directly exposed to asbestos and among the general population, and where the industrial activity stopped in June 1986.
• Main results:
  • Of the 674 patients admitted to home palliative care during the study period, 56 (8.3%) had a diagnosis of mesothelioma.
  • Mean duration of home care was 54.8 (SD 76) days. The authors state this corresponded to the patients' survival time, except for two patients who stopped home care.
  • Pain was present in 44 of 56 patients (78.6%). Of these, 18 had moderate pain and 2 had severe pain, despite medium-high opioid doses.
  • The chest was the principal pain site (32 patients, per Table 2).
  • At admission, the mean sum of ESAS symptom scores was 38.7 (SD 9.3).
  • Pain, weakness, poor appetite, poor well-being and dyspnea were the most frequent and most intense symptoms. Cough and pleural effusion were more often recorded as other clinical problems (cough 39%, pleural effusion 32%, per Table 3).
  • In linear regression, pain was statistically significantly associated with opioid dose in oral morphine equivalents (B coefficient 0.002, 95% CI 0.001 to 0.002, p less than 0.0005). It was also associated with dyspnea (B coefficient 0.395, 95% CI 0.001 to 0.790, p equal to 0.049).
• The authors' conclusion: The authors concluded that, in areas with high mesothelioma prevalence, palliative care specialists are still involved only in the final weeks or months of the illness. Because a relevant symptom burden exists from diagnosis, they wrote that relief of suffering should be considered from the onset.
• Limitations the authors state:
  • The study was retrospective.
  • Data were collected only at admission to home palliative care (cross-sectional design), with no later evaluations after palliative care began.

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, Palliative Care, Asbestos Exposure, Latency, Endemic, Dyspnea, Pleural Effusion.

Related studies

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• 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)
• Survival after conservative (palliative) management of pleural malignant mesothelioma — N. Merritt, C.J. Blewett, et al. (2001)
• Re-evaluating the role of palliative radiotherapy in malignant pleural mesothelioma — P. Jenkins, R. Milliner, et al. (2011)
• High-dose palliative radiotherapy for malignant pleural mesothelioma — F. Foroudi, J.G. Smith, et al. (2017)

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