A randomised controlled trial to assess the impact of regular early specialist symptom control treatment on quality of life in malignant mesothelioma - 'RESPECT-Meso'

Abstract

Background: Malignant pleural mesothelioma (MPM) is a cancer with a high symptom burden and a median survival of less than one year. Evidence from other cancer types suggests there may be some benefit in health related quality of life (HRQoL) with the integration of early specialist palliative care (SPC) with existing oncological services, but the level of certainty of evidence is low. Method: Participants with newly diagnosed MPM were randomised to early SPC integrated with standard care, or standard care alone, in a 1:1 ratio. Main carers were recruited additionally. Quality of life (QoL) and mood were assessed at baseline and every 4 weeks for up to 24 weeks with the EORTC QLQ–C30 questionnaire for QoL and General Health Questionnaire (GHQ-12) for anxiety/depression. The primary outcome was the change in EORTC C30 Global Health Status (GHS) QoL 12 weeks after randomisation. Results: Between April 2014 and October 2016 we randomised 174 participants. The two groups were well matched after randomisation. There was no significant between group difference in QoL score at 12 weeks (mean difference adjusted for baseline between groups 1.8 (95% CI: -4.9 to 8.5; p = 0.59)). QoL did not differ at 24 weeks (mean difference adjusted for baseline -2.0 (95% CI: -8.6 to 4.6; p = 0.54)). There was no difference in depression/anxiety scores at 12 or 24 weeks. In carers there was no between group difference quality of life and mood at 12 or 24 weeks, although there was a consistent preference for care, favouring the intervention arm. Conclusion: There is no role for routine referral to SPC soon after diagnosis of MPM for patients who are cared for in specialist centres with good access to SPC when required.