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Conway RJH, Symonds J, Walton D, Probets J, Comins C, Stadon L, Harvey JE, Blyth KG, Maskell NA, Bibby AC. Protocol for a prospective observational cohort study collecting data on demographics, symptoms and biomarkers in people with mesothelioma (ASSESS-meso). BMJ Open 2022; 12:e060850. [PMID: 36357003 PMCID: PMC9660577 DOI: 10.1136/bmjopen-2022-060850] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 10/05/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Mesothelioma is a heterogeneous disease that can be challenging to monitor and prognosticate. ASSESS-meso is a multicentre, prospective, longitudinal observational cohort study of patients with mesothelioma. The primary aim is to describe different clinical phenotypes and investigate predictive and prognostic factors, including biomarkers from blood and pleural fluid. The secondary aim is to provide a resource for future trials and substudies. METHODS AND ANALYSIS We aim to recruit 700 patients with a histological, cytological or clinicopathological diagnosis of mesothelioma, at any anatomical site (pleural, peritoneal, pericardial, etc). Longitudinal data will be collected, including clinical information, radiological investigations, blood tests and patient-reported outcome measures for breathlessness, chest pain and sweats. Preplanned analyses will use Cox proportional hazards method to evaluate factors associated with survival, linear and logistic regression models to investigate associations with symptoms, and analysis of variance modelling to explore changes in symptoms over time. ETHICS AND DISSEMINATION Ethical approval has been granted by the Research Ethics Committee South West-Central Bristol (17-SW-0019) and Health Research Authority (IRAS ID 220360). A study steering committee has been established and results will be published OpenAccess in peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN: 61861764.
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Affiliation(s)
- Ruairi J H Conway
- Department of Medicine, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - Jenny Symonds
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Department of Respiratory Medicine, North Bristol NHS Trust, Westbury on Trym, UK
| | - Deborah Walton
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Department of Respiratory Medicine, North Bristol NHS Trust, Westbury on Trym, UK
| | - Janet Probets
- Department of Respiratory Medicine, North Bristol NHS Trust, Westbury on Trym, UK
| | - Charles Comins
- Bristol Haematology and Oncology Centre, Bristol Royal Infirmary, Bristol, UK
| | - Louise Stadon
- Department of Respiratory Medicine, North Bristol NHS Trust, Westbury on Trym, UK
| | - John E Harvey
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Department of Respiratory Medicine, North Bristol NHS Trust, Westbury on Trym, UK
| | - Kevin G Blyth
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- Beatson Institute, Cancer Research UK Beatson Institute, Glasgow, UK
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Department of Respiratory Medicine, North Bristol NHS Trust, Westbury on Trym, UK
| | - Anna C Bibby
- Academic Respiratory Unit, University of Bristol, Bristol, UK
- Department of Respiratory Medicine, North Bristol NHS Trust, Westbury on Trym, UK
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Bibby AC, Zahan-Evans N, Keenan E, Comins C, Harvey JE, Day H, Rahman NM, Fallon JE, Gooberman-Hill R, Maskell NA. A trial of intra-pleural bacterial immunotherapy in malignant pleural mesothelioma (TILT) - a randomised feasibility study using the trial within a cohort (TwiC) methodology. Pilot Feasibility Stud 2022; 8:196. [PMID: 36057634 PMCID: PMC9440504 DOI: 10.1186/s40814-022-01156-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/24/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) is an aggressive thoracic malignancy with a poor prognosis. Systemic immunotherapy is an effective frontline treatment for MPM, and there is a scientific rationale supporting the possible efficacy of local, i.e. intra-pleural immune modulators. Trial of intra-pleural bacterial immunotherapy (TILT) investigated the feasibility of performing a randomised trial of intra-pleural bacterial immunotherapy in people with MPM, using the trials within cohorts (TwiC) methodology. METHODS TILT was a multicentre, three-armed, randomised, feasibility TwiC of intra-pleural OK432, BCG, or usual care in people with MPM. Eligible participants were identified from within the ASSESS-meso study, a prospective, longitudinal, observational cohort study, and were randomly selected to be offered a single dose of OK432 or BCG, via an indwelling pleural catheter. The primary outcome was feasibility, evaluated against prespecified recruitment, attrition and data completeness targets. The acceptability of trial processes and interventions was assessed during qualitative interviews with participants and family members at the end of the trial. TILT was registered prospectively on the European Clinical Trials Registry (EudraCT number 2016-004,727-23) and the ISRCTN Register on 04 December 2017. RESULTS Seven participants were randomised from a planned sample size of 12; thus, the 66% recruitment rate target was not met. Two participants withdrew after randomisation, breaching the pre-stated attrition threshold of 10%. It was not possible to maintain blinding of control participants, which negated a fundamental tenet of the TwiC design. The trial processes and methodology were generally acceptable to participants and relatives, despite several recipients of intra-pleural bacterial agents experiencing significant local and systemic inflammatory responses. CONCLUSION It was possible to design a clinical trial of an investigational medicinal product based on the TwiC design and to obtain the necessary regulatory approvals. However, whilst acceptable to participants and relatives, the TwiC design was not a feasible method of investigating intra-pleural bacterial immunotherapy in people with MPM. Future trials investigating this topic should consider the eligibility constraints and recruitment difficulties encountered. TRIAL REGISTRATION TILT was registered prospectively on the European Clinical Trials Registry (EudraCT number 2016-004727-23 ) and the ISRCTN Register ( 10432197 ) on 04 December 2017.
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Affiliation(s)
- Anna C Bibby
- Academic Respiratory Unit, University of Bristol Medical School, Bristol, UK.
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK.
| | | | - Emma Keenan
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK
| | - Charles Comins
- Bristol Haematology & Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - John E Harvey
- Academic Respiratory Unit, University of Bristol Medical School, Bristol, UK
| | - Helen Day
- Academic Respiratory Unit, University of Bristol Medical School, Bristol, UK
| | - Najib M Rahman
- Oxford Respiratory Trials Unit, Nuffield Department of Experimental Medicine, University of Oxford, Oxford, UK
| | - Janet E Fallon
- Respiratory Department, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, UK
| | - Rachael Gooberman-Hill
- NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol Medical School, Bristol, UK
- North Bristol Lung Centre, North Bristol NHS Trust, Bristol, UK
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Nagamatsu Y, Sakyo Y, Barroga E, Koni R, Natori Y, Miyashita M. Bereaved Family Members’ Perspectives of Good Death and Quality of End-of-Life Care for Malignant Pleural Mesothelioma Patients: A Cross-Sectional Study. J Clin Med 2022; 11:jcm11092541. [PMID: 35566667 PMCID: PMC9099626 DOI: 10.3390/jcm11092541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/25/2022] [Accepted: 04/28/2022] [Indexed: 12/10/2022] Open
Abstract
Objective: This study investigated whether malignant pleural mesothelioma (MPM) patients achieved good deaths and good quality of end-of-life care compared with other cancer patients from the perspective of bereaved family members in Japan. Methods: This cross-sectional study was part of a larger study on the achievement of good deaths of MPM patients and the bereavement of their family members. Bereaved family members of MPM patients in Japan (n = 72) were surveyed. The Good Death Inventory (GDI) was used to assess the achievement of good death. The short version of the Care Evaluation Scale (CES) version 2 was used to assess the quality of end-of-life care. The GDI and CES scores of MPM patients were compared with those of a Japanese cancer population from a previous study. Results: MPM patients failed to achieve good deaths. Only 12.5% of the MPM patients were free from physical pain. The GDI scores of most of the MPM patients were significantly lower than those of the Japanese cancer population. The CES scores indicated a significantly poorer quality of end-of-life care for the MPM patients than the Japanese cancer population. The total GDI and CES scores were correlated (r = 0.55). Conclusions: The quality of end-of-life care for MPM patients remains poor. Moreover, MPM patients do not achieve good deaths from the perspective of their bereaved family members.
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Affiliation(s)
- Yasuko Nagamatsu
- Graduate School of Nursing Science, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan; (Y.S.); (E.B.)
- Correspondence: ; Tel./Fax: +81-3-5550-2262
| | - Yumi Sakyo
- Graduate School of Nursing Science, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan; (Y.S.); (E.B.)
| | - Edward Barroga
- Graduate School of Nursing Science, St. Luke’s International University, 10-1 Akashi-cho, Chuo-ku, Tokyo 104-0044, Japan; (Y.S.); (E.B.)
| | - Riwa Koni
- St. Luke’s International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560, Japan;
| | - Yuji Natori
- Hirano Kameido Himawari Clinic, 7-10-1 Kameido, Koto-ku, Tokyo 136-0071, Japan;
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryomachi, Aoba-ku, Sendai 980-8575, Japan;
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Bibby AC, Morley AJ, Keenan E, Maskell NA, Gooberman-Hill R. The priorities of people with mesothelioma and their carers: A qualitative interview study of trial participation and treatment decisions. Eur J Oncol Nurs 2022; 57:102111. [DOI: 10.1016/j.ejon.2022.102111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/02/2022] [Accepted: 02/11/2022] [Indexed: 12/29/2022]
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Harrison M, Gardiner C, Taylor B, Ejegi-Memeh S, Darlison L. Understanding the palliative care needs and experiences of people with mesothelioma and their family carers: An integrative systematic review. Palliat Med 2021; 35:1039-1051. [PMID: 33829930 PMCID: PMC8188997 DOI: 10.1177/02692163211007379] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND People with mesothelioma and their families have palliative care needs throughout the relatively short trajectory of their illness. AIM To describe the palliative care needs and experiences of people with mesothelioma and their family carers. DESIGN Integrative systematic review with narrative synthesis (PROSPERO: CRD42020190115). DATA SOURCES MEDLINE, CINAHL, PsycINFO and the Cochrane Library were searched for articles published between 01 January 2000 and 10 May 2020. Articles were included if they presented empirical studies or comprehensive reviews including information about the palliative care needs and experiences of people with mesothelioma and their family carers. RESULTS The search yielded 508 articles, 14 were included in the analysis. A cross cutting theme of 'uncertainty' was identified encompassing five themes: (1) organisation and co-ordination of services, (2) communication and information needs, (3) management of care needs and high symptom burden, (4) consideration of the impact of seeking compensation and (5) family carer needs. Our findings demonstrate that people with mesothelioma want a co-ordinated, team-based approach to palliative care with a named point of contact. Whilst carers value and benefit from early referral to specialist palliative care, this does not necessarily reflect the outcomes and views of patients. CONCLUSION The evidence base around the palliative care needs and experiences of people with mesothelioma and their carers needs to be strengthened. The results of this review support the need to develop a greater understanding about the role non-specialist palliative care clinicians' play in providing generalist palliative care for people with mesothelioma and their carers.
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Affiliation(s)
- Madeleine Harrison
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Clare Gardiner
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Bethany Taylor
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Stephanie Ejegi-Memeh
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Liz Darlison
- The Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
- Mesothelioma UK, Leicester, UK
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Murphy DC, Mount A, Starkie F, Taylor L, Aujayeb A. A review of malignant pleural mesothelioma in a large North East UK pleural centre. Pleura Peritoneum 2020; 6:20200144. [PMID: 33506102 PMCID: PMC7790177 DOI: 10.1515/pp-2020-0144] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/02/2020] [Indexed: 01/20/2023] Open
Abstract
Objectives The National Mesothelioma Audit 2020 showed Northumbria to have low rates of histopathological confirmation, treatment and one-year survival rates for malignant pleural mesothelioma (MPM). We hypothesized that an internal analysis over a 10-year period provides valuable insights into presentation, diagnosis, treatment and outcomes. Methods A single-centre retrospective case series of all confirmed MPM patients between 1 January 2009 and 31 December 2019 was performed. Demographics, clinical, radiological and histopathological characteristics and outcomes were collected. Statistical analysis was performed using SPSS V26.0. Results A total of 247 patients had MPM. About 86% were male, mean age 75.7 years. Dyspnoea (77.4%) and chest pain (38.5%) were commonest symptoms. 64.9 and 71.4% had pleural thickening and effusion, respectively. About 86.8% had at least one attempt to obtain a tissue biopsy, but histopathological confirmation in only 108 (43.7%). About 66.3% with PS 0 and 1 (62.7% of total cohort) had at least one anti-cancer therapy. Death within 12 months was associated with disease progression within 6 months (p≤0.001). Chemotherapy (p≤0.001) and epithelioid histological subtype (p=0.01) were protective. Conclusions This study confirms known epidemiology of MPM, demonstrates variability in practices and highlights how some NMA recommendations are not met. This provides the incentive for a regional mesothelioma multi-disciplinary meeting.
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Affiliation(s)
- Declan C. Murphy
- Northumbria HealthCare NHS Foundation Trust, Care of Tracy Groom, Cramlington, Northumberland, UK
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Alexander Mount
- Northumbria HealthCare NHS Foundation Trust, Care of Tracy Groom, Cramlington, Northumberland, UK
| | - Fiona Starkie
- Northumbria HealthCare NHS Foundation Trust, Care of Tracy Groom, Cramlington, Northumberland, UK
| | - Leah Taylor
- Northumbria HealthCare NHS Foundation Trust, Care of Tracy Groom, Cramlington, Northumberland, UK
| | - Avinash Aujayeb
- Northumbria HealthCare NHS Foundation Trust, Care of Tracy Groom, Cramlington, Northumberland, UK
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