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Early specialist palliative care on quality of life for malignant pleural mesothelioma: a randomised controlled trial
  1. Fraser Brims1,2,
  2. Samal Gunatilake3,
  3. Iain Lawrie4,
  4. Laura Marshall5,
  5. Carole Fogg6,
  6. Cathy Qi7,
  7. Lorraine Creech8,
  8. Nicola Holtom9,
  9. Stephanie Killick10,
  10. Bernard Yung11,
  11. David Cooper12,
  12. Louise Stadon13,
  13. Peter Cook14,
  14. Elizabeth Fuller15,
  15. Julie Walther16,
  16. Claire Plunkett17,
  17. Andrew Bates18,
  18. Carolyn Mackinlay19,
  19. Anil Tandon20,
  20. Nicholas A Maskell21,22,
  21. Karen Forbes23,
  22. Najib M Rahman24,
  23. Stephen Gerry25,
  24. Anoop J Chauhan26
  25. on behalf of the RESPECT-Meso investigators
    1. 1 Respiratory Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
    2. 2 Curtin Medical School, Curtin University, Perth, Western Australia, Australia
    3. 3 Department of Respiratory Medicine, Portsmouth Hospitals NHS Trust, Portsmouth, UK
    4. 4 Department of Palliative Medicine, North Manchester General Hospital, Manchester, Manchester, UK
    5. 5 Research and Innovation Department, Portsmouth Hospitals NHS Trust, Portsmouth, UK
    6. 6 School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK
    7. 7 Centre for Statistics in Medicine, University of Oxford, Oxford, UK
    8. 8 University Hospital of South Manchester NHS Foundation Trust, Manchester, Manchester, UK
    9. 9 Department of Palliative Care, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
    10. 10 Department of Palliative Care, Hampshire Hospitals NHS Foundation Trust, Winchester, Hampshire, UK
    11. 11 Department of Respiratory Medicine, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, Essex, UK
    12. 12 Northumbria Healthcare NHS Foundation Trust, North Shields, Tyne and Wear, UK
    13. 13 North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK
    14. 14 Department of Respiratory Medicine, County Durham and Darlington NHS Foundation Trust, Darlington, UK
    15. 15 Department of Respiratory Medicine, South Tyneside NHS Foundation Trust, South Shields, South Tyneside, UK
    16. 16 Haematology, Oncology and Palliative Care, Taunton and Somerset NHS Foundation Trust, Taunton, UK
    17. 17 Department of Palliative Medicine, Mid Essex Hospital Services NHS Trust, Chelmsford, UK
    18. 18 Department of Clinical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, Southampton, UK
    19. 19 Great Western Hospitals NHS Foundation Trust, Swindon, Swindon, UK
    20. 20 Department of Palliative Care, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
    21. 21 North Bristol Lung Centre, Southmead Hospital, Bristol, UK
    22. 22 Academic Respiratory Unit, Department of Clinical Sciences, Bristol University, Bristol, UK
    23. 23 Department of Palliative Medicine, Bristol University, Bristol, UK
    24. 24 Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK
    25. 25 Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
    26. 26 Department of Respiratory, Queen Alexandra Hospital, Portsmouth, Hampshire, UK
    1. Correspondence to Professor Fraser Brims, Curtin Medical School, Curtin University, Perth, Western Australia, Australia; fraser.brims{at}


    Purpose Malignant pleural mesothelioma (MPM) has a high symptom burden and poor survival. Evidence from other cancer types suggests some benefit in health-related quality of life (HRQoL) with early specialist palliative care (SPC) integrated with oncological services, but the certainty of evidence is low.

    Methods We performed a multicentre, randomised, parallel group controlled trial comparing early referral to SPC versus standard care across 19 hospital sites in the UK and one large site in Western Australia. Participants had newly diagnosed MPM; main carers were additionally recruited. Intervention: review by SPC within 3 weeks of allocation and every 4 weeks throughout the study. HRQoL was assessed at baseline and every 4 weeks with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30. Primary outcome: change in EORTC C30 Global Health Status 12 weeks after randomisation.

    Results Between April 2014 and October 2016, 174 participants were randomised. There was no significant between group difference in HRQoL score at 12 weeks (mean difference 1.8 (95% CI −4.9 to 8.5; p=0.59)). HRQoL did not differ at 24 weeks (mean difference −2.0 (95% CI −8.6 to 4.6; p=0.54)). There was no difference in depression/anxiety scores at 12 weeks or 24 weeks. In carers, there was no difference in HRQoL or mood at 12 weeks 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 centres with good access to SPC when required.

    Trial registration number ISRCTN18955704.

    • mesothelioma
    • palliative care

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    • Contributors FB: study conception, study design, data collection, analysis, interpretation and writing. SG: study design and data collection. IL: study design, data collection, analysis, interpretation and literature search. LM: study design, study conduct and data collection. CF: study design and conduct. CQ and SG: statistical analysis. LC, NH, SK, BY, DC, PC, EF, JW, CP, AB, CM, AT and LS: recruitment and data collection. NM: study design, data collection, analysis and interpretation. KF: study design, analysis and interpretation. AC: study design, data collection, analysis, interpretation and writing.

    • Funding British Lung Foundation and Australian Communities Grant.

    • Disclaimer The British Lung Foundation and the Australian Communities Foundation had no role in the study design, data collection, data analysis, data interpretation or writing of the report.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval Ethical approval for this study was granted by the National Research Ethics Service Committee, London (Hampstead, UK), reference 12/LO/0078.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

    • Collaborators RESPECT-Meso investigators: Andrew Bateman, Melissa Dobson, Richard Hopgood, Samuel King, Angela Morgan, Stephen Morris, Alice Mortlock, Neal Navani, Anna Nowak, Michael Peake, Mark Roberts, Lynne Squibb, Paul Taylor.

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