Lung cancer

No urgency to bring in early palliative care for mesothelioma


Early specialist palliative care for patients recently diagnosed with malignant pleural mesothelioma does not improve quality of life or mood over standard care.

The findings, presented recently at the 18th World Conference on Lung Cancer, reinforce usual practice to refer patients for palliative care on the basis of symptom burden and clinical judgment.

Associate Professor Fraser Brims, a respiratory physician from Curtin University, said 2010 research in non-small cell lung cancer had shown early palliative care was beneficial.

“On the face it these are similar patient groups – both with complex chest cancer.

However the NEJM paper was a single centre study in the US which has a different health care system, and importantly, is not supported by a network of specialist nurses.”

The multicentre UK and Australian study randomised 174 patients with mesothelioma to either standard care or palliative care integrated into standard care.

Health related quality of life and anxiety and depression scores did not differ between the two groups of patients at either 12 or 24 weeks.

“This isn’t about whether palliative care works, it’s about when it has a role,” Associate Professor Brims said.

He said about one in six patients in the control arm of the study actually crossed over to receive palliative care.

“There is still a definite need for palliative care driven by clinical review. But if we offer it to everyone regardless of perceived need, is it helpful? The answer is no it’s not.”

He said the findings possibly reflect the work done by specialist cancer nurses who step up to provide some of the holistic care patients might need.

“It shows the standard care arm is more than adequate. Palliative care is not useful for all comers but most will need it at some point,” he said.

“Clinicians should continue to be vigilant and aware of that holistic need including psychological and spiritual needs.”

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