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S. Gerry



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    OA 02 - Mesothelioma: Challenges For New Treatment (ID 653)

    • Event: WCLC 2017
    • Type: Oral
    • Track: Mesothelioma
    • Presentations: 1
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      OA 02.05 - RESPECT-MESO: An International Randomised Controlled Trial to Assess Early Specialist Palliative Care in Malignant Pleural Mesothelioma (ID 8880)

      11:00 - 12:30  |  Author(s): S. Gerry

      • Abstract
      • Presentation
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      Background:
      Malignant pleural mesothelioma (MPM) has a high symptom burden and early specialist palliative care (SPC) may have a beneficial role for these patients. We examined the effect of early SPC in patients with MPM.

      Method:
      Participants with newly diagnosed MPM (within the last 6 weeks) were randomised to early SPC integrated with standard care, or standard care alone, in a 1:1 ratio. SPC visits were 4 weekly throughout the study period. 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.

      Result:
      174 participants underwent randomisation with 148 (85.1%) completing the primary outcome. The two groups were well matched after randomisation. Median (IQR) age was 72.6 (68.5-78.3) years and 139 (79.9%) were male. Epithelioid was the most common MPM subtype in 136 (78.2%) cases, ECOG PS was 0 in 66 (37.9%) and 1 in 108 (62.1%) participants. At randomisation, 134 (77.0%) participants reported dyspnoea and 100 (57.4%) had chest pain. At least 1 cycle of chemotherapy was completed in 103 (59.2%) participants. At 24 weeks 30 (17.2%) participants had died. Table 1 presents the primary and secondary outcome data. 68 (78.2%) participants in the intervention arm completed all scheduled monthly SPC visits at 12 weeks, and 46 (52.9%) at 24 weeks. 15 (17.2%) participants in the control arm were referred to SPC within 12 weeks, and 30 (34.5%) by 24 weeks.

      Table 1. Primary and secondary outcomes
      Control SPC Mean difference* p=
      Mean (SD) GHS QoL 12 weeks 59.5 (SD 21.2) 60.2 (23.6) 1.8 (95% CI -4.0 to 8.5) 0.60
      Mean (SD) GHS QoL 24 weeks 63.7 (SD 19.8) 61.3 (20.8) -2.0 (-8.8 to 4.6) 0.55
      Mean (SD) GHQ-12 anxiety / depression scores 12 weeks 2.6 (3.2) 2.2 (3.0) -0.6 (-1.5 to 0.4) 0.24
      Mean (SD) GHQ-12 anxiety / depression scores 24 weeks 2.1 (2.55) 1.75 (2.5) -0.4 (-1.2 to 0.4) 0.28
      Median (95% CI) survival (months) 12.6 (10.7-19.7) 11.5 (9.8-15.9) - 0.51
      Mean (SD) GHS QoL alive after 6 months of randomisation 60.9 (20.9) (n=66) 64.3 (19.9) (n=63) - -
      Mean (SD) GHS QoL in those who died within 6 months of randomisation 46.4 (21.4) (n=7) 38.9 (30.6) (n=12) 3.9 (-2.8 to 10.7)** 0.25
      * adjusted for baseline score; ** post hoc analysis SPC = specialist palliative care; SD = standard deviation; CI = confidence interval; GHS = Global Health Status (from EORTC QLQ–C30; higher score – better QoL); GHQ = General Health Questionnaire (higher score - higher depression/anxiety)


      Conclusion:
      Provision of early palliative care for all patients with recently diagnosed MPM is not associated with beneficial changes in quality of life as compared to palliative care review based on symptom burden.

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