Palliative care in mesothelioma: Are current services RESPECT-able enough?

Malignant pleural mesothelioma (MPM) remains a devastating disease with a poor prognosis; median survival ranges from just 8 to 14 months from diagnosis.1 The incidence is the highest in the UK and Australia and while this is expected to peak by 2020, the global incidence is predicted to increase for several decades particularly in emerging economies. Treatment options remain limited. Chemotherapy using third-generation antifolate agents is the only treatment modality that has been shown to improve survival in MPM.2 Standard first-line treatment is combination pemetrexed and cisplatin (or carboplatin), however response rates to these regimens are low. An evaluation of over 1700 patients who received pemetrexed with either cisplatin or carboplatin demonstrated response rates of 26.3% and 21.7%, respectively.3 Surgical management is controversial with a lack of robust randomised trial data. Novel treatments are however on the horizon. The genomic era has led to the early development of precision therapies, and as with several other cancers, immunotherapy may hold promise.4 Alongside a paucity of current effective treatments, patients with MPM are also subject to a high symptom burden. In a study of 495 patients,5 92% reported three or more symptoms at diagnosis with fatigue (94%), dyspnoea (89%), chest pain (85%), appetite loss (87%) and cough (75%) being the most common. The psychological burden of a diagnosis of MPM can be equally distressing with patients reporting feelings of uncertainty and lack of control.6 Carers of patients with MPM similarly report an emotional and physical toll.7 Arguably, MPM is therefore the archetypal disease necessitating effective palliative care, defined by the WHO as ‘an approach that improves the quality of life of patients and their families facing life-threatening illness, through the prevention and relief of suffering by early identification and impeccable assessment and treatment of pain …