IASLC 2017: Early Palliative Care Provides No Quality-of-Life Benefits for Patients With Recently Diagnosed Malignant Pleural Mesothelioma
Early specialist palliative care for patients that were recently diagnosed with malignant pleural mesothelioma does not impact quality-of-life measures, according to research presented by Fraser Brims, MBcHB, MRCP, MD, FRACP, of Curtin University in Australia, at the International Association for the Study of Lung Cancer (IASLC) 18th World Conference on Lung Cancer in Yokohama, Japan.
Because of the high symptom burden often associated with malignant pleural mesothelioma, Dr. Brims sought to determine whether starting palliative care early would impact quality of life. Additionally, a 2010 study by Temel et al published in The New England Journal of Medicine demonstrated a significant difference in reported quality of life in patients with advanced lung cancer who had regular palliative care as compared to control therapy alone. This led Dr. Brims to consider whether this intervention could lead to similar findings in patients with malignant pleural mesothelioma.
Key Findings
The team randomized patients diagnosed with malignant pleural mesothelioma within the past 6 weeks into two groups—the intervention group received both early specialist palliative care and standard care, while the other group received standard care alone. Those receiving the early specialist palliative care had a visit every 4 weeks throughout the study.
To determine the impact of the intervention, the researchers used the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire for quality-of-life measurements and the General Health Questionnaire (GHQ-12) for anxiety/depression measurements. The primary outcome they studied was the change in EORTC QLQ-C30 global health status quality of life 12 weeks after randomization.
The results of the international multicenter study indicate that there is no role for routine early referral to palliative care, regardless of symptoms, as there was no impact on quality of life (or mood) in the recently diagnosed malignant pleural mesothelioma patients in the intervention group. Because the study doesn't provide clear results on what the optimal timing for referral is, that decision should continue to be based on clinicians' judgment. Future research into this question may be useful to review this practice to ensure optimal use of health-care resources.
"The different finding of this study as compared to the Temel paper may be explained by the different settings and health-care systems the studies were performed in, or perhaps can be explained by the different disease," said Dr. Brims. "While the results were surprising, as intuitively many of us felt that the intervention was likely to help, they highlight why we need high-quality studies like this."
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
