Involvement of Palliative Care in Malignant Pleural Mesothelioma Patients and Associations with Survival and End-of-Life Outcomes

Our plain-English summary of Involvement of Palliative Care in Malignant Pleural Mesothelioma Patients and Associations with Survival and End-of-Life Outcomes, by A. Baird, A. Nasser, P. Tanuseputro, et al (Current Oncology, 2024).

The study

• Authors: A. Baird, A. Nasser, P. Tanuseputro, C. Webber, P. Wheatley-Price, C. Munro
• Journal: Current Oncology
• Published: 2024;31(2):1028-1034
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma is a rare, aggressive, and incurable cancer with a poor prognosis and high symptom burden. For these patients, little is known about the impact of palliative care consultation on outcomes such as mortality, hospital admissions, or emergency department visits. The aim of this study is to determine if referral to supportive and palliative care in patients with malignant pleural mesothelioma is associated with survival and decreased hospital admissions and emergency department visits. This is a retrospective chart review. Study participants include all malignant pleural mesothelioma patients seen at The Ottawa Hospital-an acute care tertiary center-between January 2002 and March 2019. In total, 223 patients were included in the study. The mean age at diagnosis was 72.4 years and 82.5% were male. Of the patients diagnosed between 2002 and 2010, only 11 (9.6%) were referred to palliative care. By comparison, of those diagnosed between 2011 and 2019, 49 (45.4%) were referred to palliative care. Median time from diagnosis to referral was 4.1 months. There was no significant difference in the median survival of patients referred for palliative care compared to those who did not receive palliative care (p = 0.46). We found no association between receiving palliative care and the mean number of hospital admissions (1.04 vs. 0.91) from diagnosis to death, and an increase in mean number of emergency department visits in the palliative care group (2.30 vs. 1.18). Although there was increased utilization of palliative care services, more than half of the MPM patients did not receive palliative care despite their limited survival. There was an increase in emergency department visits in the palliative care group; this may represent an increase in the symptom burden (i.e., indication bias) in those referred to palliative care.

In plain English

This retrospective chart review covered all 223 adults with malignant pleural mesothelioma diagnosed and followed at The Ottawa Hospital, Canada, from January 2002 to March 2019. It asked whether palliative care referral was linked to survival, hospital admissions and emergency visits. Of these patients, 57.0% had known asbestos exposure. Referral rose from 11 of 115 patients (9.6%) diagnosed in 2002 to 2010 to 49 of 108 (45.4%) diagnosed in 2011 to 2019. Median time from diagnosis to referral was 4.12 months, and from referral to death 1.65 months. Median overall survival from diagnosis was 10.0 months (95% CI 7.2 to 16.2) with palliative care and 9.3 months (95% CI 7.9 to 12.4) without it. This difference was not statistically significant (p = 0.46). After adjustment for other factors, the hazard ratio was 0.77 (95% CI 0.53 to 1.13). Hospital admissions were similar between groups. The palliative care group had more emergency department visits (mean 2.30 vs. 1.21). The authors suggested this may reflect poorer health among those referred (indication bias). They noted the study was small, retrospective and single-center.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective chart review (single-center cohort)
• Who was studied: All 223 adult patients with malignant pleural mesothelioma diagnosed and followed at The Ottawa Hospital, Ottawa, Ontario, Canada, January 2002 to March 2019. Mean age at diagnosis was 72.4 years and 82.5% were male. Non-pleural mesothelioma was excluded.
• Exposure: The factor studied was referral to specialist palliative care (yes or no). Asbestos exposure was recorded as a patient characteristic: 57.0% had known asbestos exposure. No fiber types are named.
• Main results:
  • Referral to specialist palliative care rose from 11 of 115 patients (9.6%) diagnosed 2002 to 2010 to 49 of 108 patients (45.4%) diagnosed 2011 to 2019.
  • Among referred patients, the median time from diagnosis to referral was 4.12 months, and the median time from referral to death was 1.65 months.
  • For all patients, median overall survival was 9.4 (8.1 to 12.3) months from diagnosis.
  • Median overall survival from diagnosis was 10.0 (7.2 to 16.2) months for patients who received palliative care and 9.3 (7.9 to 12.4) months for those who did not. The difference was not statistically significant (p = 0.46).
  • In the adjusted Cox model, receiving palliative care was not associated with a significant difference in survival: HR = 0.77, 95% CI 0.53 to 1.13, p = 0.2.
  • Mean hospital admissions from diagnosis to death or study end were similar: 0.91 in the palliative group and 1.0 in the non-palliative group. In adjusted analysis, palliative care was not a predictor of hospital admissions (beta = 0.38, SE = 0.232, p = 0.11).
  • The palliative care group had more emergency department visits than the non-palliative group (mean 2.30 vs. 1.21). In adjusted analysis, palliative care was an independent predictor of increased emergency department visits (beta = 1.16, SE = 0.46, p = 0.013).
• The authors' conclusion: The authors concluded that palliative care involvement was not associated with a decline in survival, and that referral had increased over time. They suggested the extra emergency department visits may reflect poorer performance status and later referral among those referred. They expressed hope for earlier integration of palliative care for patients with malignant pleural mesothelioma.
• Limitations the authors state:
  • Small sample size and retrospective design.
  • Patient-oriented outcomes such as psychosocial well-being, pain and symptom management were not measured.
  • Hospital charts may not fully record regional palliative care resources used, including family physicians.
  • The level of palliative care involvement was not measured.
  • Long-term care, home care and informal care were not captured.
  • Likely indication bias: patients referred to palliative care often had poorer performance status.
  • Single-center study, which may limit generalizability.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Palliative Care, Pleural Mesothelioma, Prognosis, Median Overall Survival.

Related studies

• Palliative and end-of-life care for patients with pleural mesothelioma: A cohort study — D. Wakefield, T. Ward, et al. (2025)
• Understanding the Experiences of end of Life Care for Patients with Mesothelioma from the Perspective of Bereaved Family Caregivers in the UK: A Qualitative Analysis — M. Harrison, L. Darlison, et al. (2022)
• Symptom burden in mesothelioma patients admitted to home palliative care — S. Mercadante, D. Degiovanni, et al. (2016)
• Understanding the palliative care needs and experiences of people with mesothelioma and their family carers: An integrative systematic review — M. Harrison, C. Gardiner, et al. (2021)
• Is pleurectomy and decortication superior to palliative care in the treatment of malignant pleural mesothelioma? — I. Zahid, S. Sharif, et al. (2011)
• Clinical nurse specialist role in providing generalist and specialist palliative care: A qualitative study of mesothelioma clinical nurse specialists — C. Gardiner, M. Harrison, et al. (2022)

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