A mixed-methods approach to characterizing symptoms in patients with malignant pleural mesothelioma (MPM) was investigated in a pilot study. One finding of the study was that the Lung Cancer Symptom Scale for Mesothelioma (LCSS-Meso) captured many symptoms experienced by patients with MPM, but the scale did not always reflect symptom severity or the presence of some symptoms. Results of the study were reported in the journal Oncology Nursing Forum.

MPM is rare and carries a poor prognosis, also involving significant symptoms. However, the researchers explained there has been little research on MPM symptoms using mixed-methods approaches, combining both quantitative and qualitative assessments.

“Mixed-methods approaches can offer an opportunity to comprehensively describe symptoms experienced by people with MPM by integrating quantitative data with qualitative accounts that would be missed by quantitative data alone,” the researchers explained in their report.

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Participants in the study were patients with MPM who had been recruited from an academic medical center in the US. The researchers evaluated MPM symptoms using the LCSS-Meso as a quantitative approach and semistructured interviews of patients as a qualitative approach. Interview questions related to how participants would describe the experience of mesothelioma; how it felt to learn of their diagnosis; and issues they have experienced in terms of physical functioning, symptoms, and emotions.

The 7 pilot study participants completed both quantitative and qualitative components. Patients were mean age 71.57 years (SD, 7.18; range, 58 to 79) and mean time since diagnosis was 27.86 months (SD, 27.29; range, 2 to 84).

The LCSS-Meso includes 5 possible symptoms of MPM — cough, dyspnea, fatigue, loss of appetite, and pain — which were reported by participants in interviews. However, the interviews revealed that the LCSS-Meso missed some symptoms or did not seem to accurately reflect symptom severity.

Using the LCSS-Meso scale, for example, dyspnea was given the highest mean score (64.43), with 100 reflecting the greatest severity on the patient questionnaire. However, the researchers reported that qualitative descriptions of dyspnea severity seemed to not match its scores. Pain was given the second-lowest mean score (27.57), yet participants discussed this symptom more than others and often described it as severe.

Distress and sleep disturbance were symptoms that participants described in interviews but are not on the LCSS-Meso scale. Distress was a commonly reported theme, and several participants spoke of sleep disturbance as a symptom.

The researchers considered symptom assessment to be an important consideration for nurses caring for patients with MPM. “People with MPM may either under- or overreport symptoms on symptom assessment tools, and these tools may miss other individually relevant symptoms,” concluded the researchers.


Walker SL, Dickson VV, Cacchione PZ. A pilot mixed-methods study of malignant pleural mesothelioma symptoms. Oncol Nurs Forum. 2022;49(6):615-623. doi:10.1188/22.ONF.615-623

This article originally appeared on Oncology Nurse Advisor