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

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2026年6月13日

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Catriona R. Mayland,
Michelle Collinson,
Sam H. Ahmedzai,
Joseph Lucas,
Jacqui Gath,
Liz Darlison,
Duneesha Defonseka,
Barry Laird,
Helena Stanley,
Sarah Danson,
Clare Gardiner,
Anna C. Bibby,
Anna Bibby,
Najib Rahman,
Bethan Pugh,
Liz Darlison,
James Walters,
Janet Fallon,
John P Corcoran,
Mairead Dixon,
Kate Slaven,
Avinash Aujayeb,
Louise Brown,
Paul Beckett,
Kevin Blyth,
Selina Tsim,
John Maclay,
Giles Cox,
Paul Shaw,
Naomi Chamberlin,
Malcolm Lawson,
Dipak Mukherjee,
Gairin Dancey,
Rafiqul Islam,
Duneesha de Fonseka,
Eleanor Mishra,
Beth Sage,
Charlotte Barr,
Tony Pope,
Sam Guglani,
Saif Yousif,
Andrew Stanton,
Helen Day,
Anna Morley,
Kerra James,
Sonia Patole,
Emeka Azubuike-Dyer,
Emma Tucker,
Jenny Symonds,
Nick Maskell,
Rahul Bhatnagar,
Steven Walker,
David Arnold,
Amelia Clive,
Geraldine A Lynch,
Jasmin Sadler-Ladell,
Tine Panduro,
Dawn Redwood,
Tania Wainwright,
Joanna Tilley,
Christine Jones,
Matthew Mills,
Lyndsey Holt,
Karl Jackson,
Lorell Dismore,
Leah Taylor,
Helen Wallace,
Mercy Korley,
Zita Ibatuliniene,
Alexandra Macpherson,
Stephanie Hughes,
Megan O’Hare,
Charlene Dunne,
Margaret Flynn,
Susan Smith,
Laurie Jones,
Nadia Elkaram,
Lesley Nichols,
Debbie Shea,
Kerry Goodsell,
Lisa Hudig,
Anna Roberson,
Anglise Addison,
Masuma Begum,
Melissa Bagshaw,
Hilary Thatcher,
Sarah Cotter,
Kate McRoberts

摘要

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.