Palliative and end-of-life care for patients with pleural mesothelioma: A cohort study

Our plain-English summary of Palliative and end-of-life care for patients with pleural mesothelioma: A cohort study, by D. Wakefield, T. Ward, H. Edge, et al (Palliative Medicine, 2025).

The study

• Authors: D. Wakefield, T. Ward, H. Edge, C.R. Mayland, C. Gardiner
• Journal: Palliative Medicine
• Published: 2025;39(2):286-297
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Pleural mesothelioma is a rare and incurable cancer, with complex physical and psychological symptoms. Despite recent advances in treatment, prognosis remains poor (average 8-15 months) with a lack of research on palliative and end-of-life care.

Aim: To examine markers suggestive of quality palliative and end-of-life care, including receipt of specialist palliative care, advance care planning, fewer unplanned hospital admissions at end-of-life. To compare variables with socio-economic position to identify if inequalities exist.

Design: A cohort study, retrospectively reviewing the medical notes from diagnosis to death for all patients diagnosed with pleural mesothelioma between 01/01/2016 and 31/12/2021.

Setting/participants: Over 5 years, n = 181 patients were diagnosed with pleural mesothelioma across Teesside (north-east England), n = 30 were alive at study commencement and excluded. For the 151-patient cohort, demographics were as follows: 92% male, 79% aged 70-89 years and 26% in the lowest socio-economic quintile (based on area-level deprivation).

Results: Median survival was 246 days. Within the final 90 days of life, 69% of patients had at least 1 unplanned hospital admission, with 20% having 3+ (range 0-7). Those with the highest socio-economic position had less admissions on average. Specialist palliative care was received by patients, at home 34%, in hospital 26%, in hospice 11%. Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions, were in the final 24 h of life for 18% of patients (median 7 days). Disease specific findings included police attendance for expected deaths and lack of signposting.

Conclusion: Patients with pleural mesothelioma have unplanned admissions to hospital towards the end of life, with possible inequalities; they receive late advance care planning and face challenges unique to their disease. It is important that patients receive high quality palliative end-of-life care through accessing specialist palliative care or have guidance/signposting to other potential sources of support.

In plain English

This retrospective cohort study reviewed medical notes of patients diagnosed with pleural mesothelioma at two Teesside hospitals in north-east England from 2016 to 2021. Of 181 patients diagnosed, 30 were still alive when the study began and were excluded, leaving 151. Of these, 92% were male. Median time from diagnosis to death was 246 days. Among patients with admission data (missing for 16), 69% had at least one unplanned admission in their final 90 days and 20% had three or more. Overall differences in admissions by area deprivation were not statistically significant, but a second analysis linked less deprived areas with fewer admissions. Specialist palliative care reached 34% of patients at home, 26% in hospital and 11% in hospice. A do-not-resuscitate decision was documented for 57%, a median of 7 days before death. Compensation discussions were documented in 28% of cases. Police attended 10 expected home deaths occurring out of hours. The authors concluded that there may be regional and socio-economic inequalities in care, and that planning is often left until the final days of life. Missing data limited the analyses.

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 cohort study using routinely collected data in medical notes, followed from diagnosis to death
• Who was studied: 181 patients were diagnosed with pleural mesothelioma at North Tees or South Tees Hospital between 1 January 2016 and 31 December 2021. The 30 still alive at study start (11/05/2022) were excluded, leaving 151. Of these, 92% were male and 79% were aged 70 to 89.
• Exposure: Not an exposure study. Occupation was documented for 70% (105/151). Potential occupational exposure was noted through work at a local chemical manufacturing plant (n = 17), steel works (n = 15), power station (n = 8), shipyards (n = 5) and coal mine (n = 2). No fiber types were reported.
• Main results:
  • Median time from diagnosis to death was 246 days (range 0 to 1520 days) in the 151-patient cohort
  • Among patients with admission data (Table 4 lists 16 of the 151 as missing), 69% had an unplanned hospital admission in the final 90 days of life and 20% had 3 or more
  • Admission data were missing for 16 of the 151 patients
  • There was no statistically significant overall difference between socio-economic position and number of unplanned admissions in the final 90 days (p = 0.066) or final 12 months of life (p = 0.174)
  • Poisson regression indicated an association between higher socio-economic position (quintiles 3, 4 and 5) and fewer unplanned admissions
  • Specialist palliative care was received by 34% of patients at home and 26% in hospital, and 11% were admitted to hospice. 44% (n = 67) received it in any setting.
  • There was no statistically significant difference between socio-economic position and receipt of palliative care
  • Place of death was identified for 101 patients (67%). Home was the most common place of death among them (50%).
  • A DNACPR decision was documented for 57% (86/151) of patients. 18% of DNACPR discussions took place within the 24 hours before death, and the median was 7 days before death.
  • Discussion of the possibility of claiming compensation was documented in 28% of cases
  • For 10 patients whose death at home was expected, police attended as the coroner's representative because the death occurred out of hours
  • There was no evidence in the notes of signposting to the region's mesothelioma specialist nurse
  • 14 patients had documented metastatic disease. This was found in free-text comments and could not be quantified further.
• The authors' conclusion: The authors concluded that prognosis is short, yet future planning is often left until the final days of life. They also concluded that there are potential regional and socio-economic inequalities in aspects of care, and that prospective research is warranted.
• Limitations the authors state:
  • The study was limited to what was clearly documented and accessible in records
  • Poor communication between computer systems led to substantial missing data, limiting inferential analyses
  • Numbers were small, so the authors advise treating statistical significance with caution
  • The study lacked information such as reasons for hospital admission and how symptoms were addressed, and had no patient-reported outcome measures

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, Cohort Study, Prognosis, Median Overall Survival, Hospice.

Related studies

• 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)
• Use of cancer therapy at the end of life in patients with malignant pleural mesothelioma — S.C. Kao, N. van Zandwijk, et al. (2013)
• Symptom burden in mesothelioma patients admitted to home palliative care — S. Mercadante, D. Degiovanni, et al. (2016)
• Involvement of Palliative Care in Malignant Pleural Mesothelioma Patients and Associations with Survival and End-of-Life Outcomes — A. Baird, A. Nasser, et al. (2024)
• Is pleurectomy and decortication superior to palliative care in the treatment of malignant pleural mesothelioma? — I. Zahid, S. Sharif, et al. (2011)
• Efficacy of Cell-Free and Concentrated Ascites Reinfusion Therapy for Palliative Care in a Patient with Malignant Pleural Mesothelioma: A Case Report — K. Hisakane, H. Ohmatsu, et al. (2017)

Browse return to medical research.