Earlier palliative care for patients with pleural mesothelioma failed to improve quality of life or extend survival time in a recent study presented at the World Conference on Lung Cancer in Yokohama, Japan.
The randomized control study took place in Australia and the United Kingdom, disputing an earlier recommendation by the American Society of Clinical Oncology (ASCO) that called for expanding palliative care for mesothelioma patients.
“Blindly offering palliative care to all, that doesn’t appear to be a benefit,” Dr. Fraser Brims, study presenter from Curtin University in Perth, Australia, told Asbestos.com. “The results really went against what many thought would be the case. It was quite surprising.”
Pleural mesothelioma is a rare and aggressive cancer caused by exposure to asbestos. There is no definitive cure and most patients live less than 18 months after diagnosis.
Palliative care typically focuses on quality of life and relieving symptoms caused by the disease itself or the side effects from the medications used to treat it.
No Difference in Quality of Life
The study involved 174 mesothelioma patients who were randomly assigned standard of care alone or early specialist palliative care, which involved visits every four weeks.
The vast majority of the patients were men with the epithelioid subtype of mesothelioma and had high symptom burden.
Median age was 72.6 years, and 60 percent of those studied had at least one cycle of chemotherapy.
Brims’ study was designed for a 12- and 24-week assessment. It was inspired by a landmark U.S. trial in 2010 that showed early palliative care for lung cancer led to higher quality of life and longer survival.
He expected to find something similar, but was surprised by results of his study.
“At first, I was disappointed at the results,” Brims said. “I intuitively thought [earlier palliative care] would help, but it was fascinating to see that one size does not fit all. You can’t say everybody needs it or benefits from it.”
The results showed virtually no difference in quality of life between the two groups at 12 weeks. The global health status quality-of-life score was 60.2 for the specialist group and 59.5 for the control group.
At 24 weeks, it was 61.3 for the specialist group and 63.7 for the control.
Researchers measured anxiety and depression using a scale called the GHQ-12, which yielded similar results with only a negligible difference in the two groups.
By 24 weeks, 30 of the patients had died.
The median survival in the control group was 12.6 months and 11.5 months in the specialist palliative care group.
Health Care Varies by Country
Brims said the research team saw no noticeable differences in any of the quality-of-life variables with the two groups.
He said his surprising results, in contrast to the earlier lung cancer study, might be attributed to either the health care systems involved or the difference in the diseases.
“I reckon it shows that the current standard of care, at least in the UK and in Australia, is more than adequate. The consensus is that they do a fantastic job already,” Brims said. “That may be different in other centers, other countries.”
In addition to his work as an associate professor at Curtin University, Brims also is the head of the occupational and respiratory health unit at the Institute for Respiratory Health at Sir Charles Gardner Hospital.
“If we look at the current provision of care, we have senior specialists, thoracic cancer nurses and chemotherapy nurses who support the patient in their journey, and that is standard of care now,” Brims said at a World Conference press briefing. “It’s possible that the addition of specialist palliative care to all-comers —regardless of their perceived need — hasn’t made much of a difference.”
The latest ASCO guidelines — first published in the Journal of Clinical Oncology in 2016 — call for palliative care to start nearly immediately after a cancer diagnosis, citing studies that show patients living longer and better lives with the expanded care.
According to those guidelines, palliative care should be performed by a multidisciplinary team using inpatient and outpatient settings. It should be delivered concurrent with active treatment.
The ASCO guidelines did not specifically mention mesothelioma.
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