Understanding pain in malignant mesothelioma: a prospective, longitudinal cohort study

Our plain-English summary of Understanding pain in malignant mesothelioma: a prospective, longitudinal cohort study, by C.R. Mayland, M. Collinson, S.H. Ahmedzai, et al (BMC Palliative Care, 2026).

The study

• Authors: C.R. Mayland, M. Collinson, S.H. Ahmedzai, J. Lucas, J. Gath, L. Darlison, D. Defonseka, B. Laird, H. Stanley, S. Danson, C. Gardiner, A.C. Bibby, ASSESS-meso collaborative
• Journal: BMC Palliative Care
• Published: 2026;25(1)
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Pain associated with malignant mesothelioma can be complex. The natural course of pain over the disease trajectory is not well studied. The aim of this study was to explore the prevalence, severity, impact and clinical course of pain for people with mesothelioma over a 12-month period.

Methods: A prospective observational study was conducted as a component of a larger national, multi-centre cohort study on mesothelioma - ASSESS-meso (A prospective obServational cohort Study collecting data on dEmographics, Symptoms and biomarkerS in people with mesothelioma) (ISRCTN: 61,861,764). Adults (> = 18 years) newly diagnosed with mesothelioma were recruited from out-patient clinics in 20 hospitals. Baseline demographic and clinical data were recorded. Frequency, severity and impact of pain, quality of life and mood were collected using Patient-Reported Outcome Measures (e.g., EORTC Quality of Life Questionnaire Core Questionnaire PALliative Cancer [QLQ-C15-PAL], Brief Pain Inventory [BPI]). Follow-up occurred 3-monthly for 12-months.

Results: Among the 150 participants recruited, mean age was 72.4 years (SD 8.1), with 112 (74.7%) being men. Baseline assessments showed a greater proportion of participants were affected by dyspnoea compared with pain. Overall, twenty-one (14.0%) participants reported moderate or severe chest pain (defined as > = 40/100) although none were receiving strong opioids. Median pain duration was 14.1 weeks (IQR 10-24.1). At 9-12 months, quality of life was poorer in those reporting moderate or severe pain (mean overall QLQ-C15-PAL score 41.7 [SD = 20.4] vs. 71.6 [SD = 19.5]) and this pain interfered more with daily activities (mean BPI interference index, 29.1 [SD = 19.1] vs. 14.4 [SD = 14.5]). Sixty-six (44.0%) participants died during the 12-months follow-up period.

Conclusions: Participants reporting moderate or severe chest pain experienced poorer quality of life and none were receiving strong opioids. Given the limited prognosis, early identification of 'high risk' mesothelioma patients i.e. those who are most likely to have high symptom burden and poor prognosis, would help ensure timely input is given to implement pain management strategies. This includes Specialist Palliative Care guidance about opioid prescribing and interventional procedures. Future research should be directed towards the optimum ways to assess and improve breathlessness, without neglecting the smaller group of people who experience severe pain.

© 2026. The Author(s).

In plain English

This study followed 150 adults newly diagnosed with mesothelioma, recruited in 2021 and 2022 at 20 UK hospitals, for up to 12 months as part of the larger ASSESS-meso cohort. Most (141) had pleural mesothelioma, and 119 (79.3%) recalled asbestos exposure. At baseline, breathlessness was more common (82.0%) than chest pain (26.7%). During follow-up, 21 participants (14.0%) reported moderate or severe chest pain, meaning a score of 40 or more on a 0 to 100 scale. None of them were on strong opioids. At 9 to 12 months, those with such pain had lower average quality-of-life scores (41.7 vs 71.6) and more pain interference with daily activities (29.1 vs 14.4) than those with no or mild pain, though fewer people had data at later timepoints. Sixty-six participants (44.0%) died within 12 months. The authors concluded that although few participants had moderate or severe chest pain, its impact on quality of life was substantial. They noted that deaths and COVID-19 disruption left incomplete data at later timepoints.

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: Prospective observational (cohort) sub-study within the larger national, multi-centre ASSESS-meso cohort; descriptive and exploratory, with no formal sample size calculation
• Who was studied: 150 adults newly diagnosed with mesothelioma, recruited from out-patient clinics at 20 UK hospitals between 1 July 2021 and 30 November 2022 and followed for up to 12 months; 141 (94.0%) had pleural disease
• Exposure: This was a study of pain, not of asbestos exposure as a cause. Asbestos exposure history was recorded: 119 participants (79.3%) recalled exposure, and 62 (41.3%) described direct exposure. No fiber types are named.
• Main results:
  • At baseline, breathlessness was the most common symptom (123 participants, 82.0%), followed by cough (48, 32.0%), weight loss (46, 30.7%) and chest pain (40, 26.7%)
  • 21 of 150 participants (14.0%) reported moderate or severe chest pain (score of 40 or more out of 100) during follow-up; none of these 21 were receiving strong opioids
  • Among those with moderate or severe chest pain, median pain duration was 14.1 weeks (IQR 10 to 24.1)
  • Of the 21 with moderate or severe chest pain, 9 (42.9%) had it at baseline. Eight died during follow-up, and 7 of these 8 (87.5%) reported this pain at their final assessment before death
  • Among participants without moderate or severe pain, ten were on strong opioids and nine on weak opioids. In the moderate or severe pain group, three were on weak opioids and none on strong opioids
  • At 9 to 12 months, mean overall QLQ-C15-PAL quality-of-life score was 41.7 (SD 20.4) in those with moderate or severe pain vs 71.6 (SD 19.5) in those with no or mild pain. The table shows 6 and 51 respondents for this item at that timepoint
  • At 9 to 12 months, mean BPI pain interference index was 29.1 (SD 19.1) in those with moderate or severe pain vs 14.4 (SD 14.5) in those with no or mild pain. The table shows 7 and 24 respondents at that timepoint
  • Specialist Palliative Care input was received by 4 of 21 participants with moderate or severe chest pain and by 12 of 129 with no or mild pain
  • Of 340 HADS assessments, 33 (9.7%) showed clinically relevant anxiety and 31 (9.1%) clinically relevant depression
  • 66 of the 150 participants (44.0%) died during the 12-month follow-up
• The authors' conclusion: The authors concluded that although a relatively small proportion of participants reported moderate or severe chest pain, its impact on quality of life for those affected was substantial. They called for future research on breathlessness without neglecting the smaller group with severe pain.
• Limitations the authors state:
  • Many participants died before the end of follow-up, so fewer data points were available at later timepoints
  • COVID-19 disruption made follow-up irregular, leaving incomplete data at each timepoint and especially low numbers at 3 months
  • The study was an exploratory sub-study with no formal sample size calculation
  • No information was recorded on the reasons for starting or stopping pain medication
  • Specialist Palliative Care services differed between sites and their make-up was not recorded
  • The sample was predominantly White British

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Cohort Study, Biomarker, Quality of Life, Palliative Care, Prognosis.

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