Pain in malignant pleural mesothelioma

Why did we conduct this research?

Mesothelioma is a type of cancer which tends to affect the lining of the lung and is often associated with exposure to asbestos. Patients with mesothelioma can develop a number of symptoms including pain. Sometimes the pain can be complex and variable in its severity and nature due to the mesothelioma affecting the chest wall and the nerves. As well as medications, particular treatments, such as radiotherapy, may be needed to help control pain. Occasionally, more complicated procedures, such as specific nerve injections undertaken by specialist doctors, are required to help manage pain. Previous research studies have shown that these procedures are safe and effective in reducing pain. They are often undertaken late in the course of the patient’s illness, however, on average about four to six weeks before the patient dies. At present, it is hard to know which patients with mesothelioma develop severe pain, at what point during their illness and who might need more support and interventions to help control the pain.

What did we do?

We worked with an existing research team to conduct a smaller research study to see if it is possible to learn more about the pain which affects patients with mesothelioma. For example, we wanted to see if we can find out more about which patients develop pain, at what point during their illness, how severe the pain is, and what impact the pain has on patients quality of life. Finding out this information will help us know when in a patient’s illness the pain is more problematic and when we need to be more proactive in using more complex techniques to control the pain. It will also help determine whether or not further study into this area would be beneficial. 

Who did we recruit? 

We were able to recruit 150 participants (from 14 different UK hospitals). Almost three-quarters of the participants were men. The average age was 74 years and approximately 1 in 5 lived alone. Over three-quarters were able to recall asbestos exposure. Sadly, almost half of the participants died during the 12-month follow-up period.   

What did we find out?

At the start of the study, the most common issue was breathlessness with over 8 out of 10 participants reporting this symptom. Cough, weight loss, chest pain and tiredness were also reported although not as commonly as breathlessness. 

Pain

This figure shows the prevalences of pain over time. Only 21 (out of the 150 participants) reported moderate or severe chest pain at any point during the 12-month follow-up. This was defined as being greater or equal to 40/100 (moderate) or 70/100 (severe) on a 100mm scoring chart. These groups were combined and named the ‘pain group’. Over the course of the illness, the pain fluctuated in severity. Eight participants reported moderate/severe pain on their final assessment prior to their death (see Figure 1). None of the participants in the ‘pain group’ were on strong opioids. 

Participants in the ‘pain group’ reported more interference with daily activities. This included activities such as ‘walking ability’ and ‘relations with other people.’ The difference was greatest at the 9–12-month follow-up period. 

Quality of life 

Those in the ‘pain group’ reported poorer quality of life across the study period. The greatest difference was seen at the 9–12-month follow-up period. 

Mood  

There weren’t any different patterns seen for how common anxiety and depression were between the ‘pain’ and ‘no pain’ groups.

What this means? 

To our knowledge, this is the largest study looking at pain over time in those affected by mesothelioma. Although a relatively small proportion of participants reported moderate or severe pain, this still had a significant impact on participants’ quality of life. 

Having a way to ‘flag’ those experiencing more severe pain, would help ensure that timely input is provided. Improving healthcare workers knowledge about pain management is important. For example, knowing when to use strong opioid medications or when to ask for help from specialist teams. Specialist Palliative Care teams need to be targeted to help those most in need. 

If you are interested in knowing more, please contact:

Dr Catriona R Mayland
c.r.mayland@sheffield.ac.uk