338eP Immunotherapy with or without chemotherapy for first line treatment of unresectable pleural mesothelioma (PM): A systematic review and meta-analysis

Background: Malignant Pleural Mesothelioma (MPM) is associated with severe psychological morbidity due to its aggressive prognosis and occupational etiology.The psychological distress experienced by patients with aggressive cancers, such as lung cancer, is notably high, with approximately 35% of patients exhibiting symptoms of anxiety or depression warranting clinical attention (HADS score 8).Integration of psychosocial support into routine care is lacking, underscoring a critical unmet need for improving patient-reported quality of life (QoL).Methods: A total of 60 newly diagnosed patients with unresectable MPM were randomized 1:1 into the MBI Group (n=30), receiving weekly sessions of mindfulness and guided imagery, or the BSC Group (n=30).Patients were assessed at baseline, post-intervention (Week 8), and at 3-month follow-up using the Hospital Anxiety and Depression Scale (HADS) and the EORTC QLQ-C30.The primary endpoint was the change in HADS-Anxiety score at Week 8.Results: At baseline, the mean HADS-Anxiety score for the entire cohort was 7.1 3.2, with 38.3% (n=23) of patients scoring 8 on either the anxiety or depression subscale, confirming a high psychological burden.At Week 8, the MBI Group demonstrated a mean reduction in HADS-Anxiety score of 2.5 points (from 7.2 at baseline to 4.7 post-intervention), compared to a reduction of only 0.4 points in the BSC Group (from 7.0 to 6.6).This difference was statistically significant (p < 0.001) and exceeded the minimal clinically important difference of 1.5 points.The proportion of patients with clinically significant anxiety (HADS-A 11) decreased by 65% in the MBI Group (from 20% to 7%), versus a 5% decrease in the BSC Group.Furthermore, the MBI Group reported a significant improvement in the Emotional Functioning domain of the QoL assessment (p = 0.012).No safety concerns or adverse events related to the MBI were reported. Conclusions:A structured, eight-week Mind-Body Intervention is a safe and highly effective non-pharmacological adjunct treatment for MPM patients.It resulted in a clinically and statistically significant reduction in anxiety & primary source of distress.