Pain management in patients with malignant mesothelioma: challenges and solutions

Our plain-English summary of Pain management in patients with malignant mesothelioma: challenges and solutions, by J. Saunders, M. Ashton, C. Hall, et al (Lung Cancer, 2019).

The study

• Authors: J. Saunders, M. Ashton, C. Hall, B. Laird, N. MacLeod
• Journal: Lung Cancer
• Published: 2019;10:37-46
• Type of article: Review
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is an aggressive cancer with a considerable symptom burden and poor prognosis. Focus on maintaining patients' quality of life and pain control is therefore paramount. Pain management in MPM is complex due to its multifactorial etiology resulting from direct tumor infiltration of the surrounding soft tissue, bone, and encasement of the intercostal nerves. A variety of treatment modalities, including pharmacological and non-pharmacological options, are often required to achieve adequate pain control in this challenging disease. This review article examines the current challenges and solutions available for pain management in MPM.

In plain English

This article was a review, not a new study of patients. The authors described why pain in malignant pleural mesothelioma (MPM) is complex and hard to control. They reviewed published research and guidelines on ways to relieve it: pain medicines, radiotherapy, nerve procedures such as cordotomy, surgery, and anticancer drug treatment. Asbestos exposure was mentioned only as the reason cases continue to rise in the UK. Among the studies the authors described, the SYSTEMS radiotherapy study recruited 40 patients. Of the 30 patients who could be assessed at week 5, 47% had a clinically significant pain response, with minimal side effects. A systematic review of nine case series involving 160 patients found good pain relief from cordotomy in the majority. In the MAPS trial, adding bevacizumab to cisplatin and pemetrexed significantly improved pain (HR 0.81, 95% CI 0.67 to 0.99). The authors noted that little research has looked at chemotherapy's effect on pain and that the best radiotherapy dose is unknown. The authors concluded that, although medicines can give effective pain control, many patients need several kinds of treatment to get relief.

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: Narrative review of published research and guidelines on pain management in malignant pleural mesothelioma
• Who was studied: No patients were studied directly; the review covered literature on pain and its treatment in patients with malignant pleural mesothelioma (MPM)
• Exposure: Asbestos exposure was not studied; it was mentioned only as the explanation for rising MPM incidence in the UK. No fiber types were named.
• Main results:
  • Cited SYSTEMS study (radiotherapy for pain in MPM): 40 patients were recruited from three centers
  • Cited SYSTEMS study: 30 of the recruited patients were assessable at week 5
  • Cited SYSTEMS study: of the 30 patients assessable at week 5, 47% had a clinically significant pain response with minimal toxicity
  • Cited 2013 systematic review of cordotomy for mesothelioma-related pain: across nine case series involving 160 patients, all studies showed good pain relief in the majority
  • Cited MAPS trial quality-of-life results: adding bevacizumab to cisplatin and pemetrexed significantly improved patients' pain (HR 0.81, 95% CI 0.67 to 0.99; P=0.041)
  • Cited SMART and Prophylactic Irradiation of Tracts trials: neither found a significant difference in tract site metastases between patients given preventive radiotherapy and comparison groups
• The authors' conclusion: The authors concluded that, although effective pain control can be gained through medicines, many patients with MPM need multiple treatment approaches to achieve symptom relief
• Limitations the authors state:
  • The authors noted that few data address chemotherapy's effect on pain control
  • The authors noted that the optimal radiotherapy dose and fractionation for pain control is unknown

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pleural Mesothelioma, Prognosis, Quality of Life, Etiology.

Related studies

• Interventional options for the management of refractory cancer pain--what is the evidence? — P. Vayne-Bossert, B. Afsharimani, et al. (2016)
• Ultrasound guided continuous erector spinae plane block for pain management in pulmonary malignancy — T. Aydın, O. Balaban, et al. (2018)
• Opioids in pain management of mesothelioma and lung cancer patients — E.K. Salminen, M. Silvoniemi, et al. (2013)
• SYSTEMS-2: A randomised phase II study of radiotherapy dose escalation for pain control in malignant pleural mesothelioma — M. Ashton, N. O'Rourke, et al. (2018)
• Malignant pleural mesothelioma: the standard of care and challenges for future management — J.P. van Meerbeeck, A. Scherpereel, et al. (2011)
• Radiotherapy for the treatment of pain in malignant pleural mesothelioma: a systematic review — N. Macleod, A. Price, et al. (2014)

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