A survey of opinions and beliefs concerning surgery for malignant pleural mesothelioma amongst 802 members of the European Association for Cardio-Thoracic Surgery (EACTS), the European Society of Thoracic Surgeons (ESTS) and the Society of Thoracic Surgeons (STS)

Our plain-English summary of A survey of opinions and beliefs concerning surgery for malignant pleural mesothelioma amongst 802 members of the European Association for Cardio-Thoracic Surgery (EACTS), the European Society of Thoracic Surgeons (ESTS) and the Society of Thoracic Surgeons (STS), by T. Treasure, E. Internullo, F. Fiorentino, et al (Interactive Cardiovascular and Thoracic Surgery, 2011).

The study

• Authors: T. Treasure, E. Internullo, F. Fiorentino, D. Van Raemdonck, P. Van Schil, M. Decamp, D. Wood, M. Utley
• Journal: Interactive Cardiovascular and Thoracic Surgery
• Published: 2011;12(3):341-6
• Type of article: Editorial
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

The authors surveyed thoracic surgeons' opinions and beliefs about surgery for malignant pleural mesothelioma to gauge prior beliefs for planning future clinical trials. The survey was completed before the results of the MARS and EORTC 08031 trials were known. A 50-question online questionnaire was piloted among 7 members of the EACTS Thoracic Domain. Members of EACTS, ESTS and STS were then invited to complete it anonymously. It opened between 5 August and 10 September 2009 and closed on 24 November 2009. Questions covered extrapleural pneumonectomy (EPP), pleurectomy/decortication (PD) and debulking, alone or with multimodality therapy. They asked about cure, prolongation of life and improvement in breathing in epithelioid and sarcomatoid mesothelioma, and also collected demographic data. There were 802 responses, of which 235 came from ESTS members (about a quarter of its membership), 341 from EACTS members and 348 from STS members. An overall response rate could not be calculated. Surgeons believed EPP was more effective than PD, and that adjuvant and multimodality therapy increased the chance of cure. Beliefs differed little between those who did and did not perform each operation, or by type of practice or seniority. In all, 91% (637/700) believed that EPP within multimodality therapy prolongs life, and 12% (86/700) believed that PD alone can achieve cure. Answers to many questions were split about 70:30. The largest difference was geographical: 45% of US respondents believed EPP alone could cure epithelioid mesothelioma, compared with 23% in Europe. No significance tests were performed. The authors noted that this difference reflects differing North American and European guidance.

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In plain English

This article reported an online survey of thoracic surgeons' opinions and beliefs about surgery for malignant pleural mesothelioma. It did not study asbestos exposure or patients. In 2009, members of three surgical societies (EACTS, ESTS and STS) were invited to answer an anonymous 50-question questionnaire. It asked about extrapleural pneumonectomy (EPP), pleurectomy/decortication (PD) and debulking, alone or with other treatments, mainly for epithelioid mesothelioma. There were 802 responses, but the authors could not give an overall response rate. More respondents believed cure and longer life were achievable with EPP than with PD, and with added therapy than without. On one question, 91% (637 of 700) believed EPP within multimodality therapy prolongs life. On another, 12% (86 of 700) believed PD alone can achieve cure. Forty-five percent of respondents from the USA, compared with 23% in Europe, believed EPP alone could cure epithelioid mesothelioma, the largest difference found. The authors offered no tests of statistical significance and did not judge the beliefs against evidence. They noted that the American and European difference matched differing North American and European guidance on EPP.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Anonymous online questionnaire survey (50 questions) of surgeons' opinions and beliefs
• Who was studied: 802 responses from members of the European Association for Cardio-Thoracic Surgery (341 responses), the European Society of Thoracic Surgeons (235 responses, about a quarter of its membership) and the Society of Thoracic Surgeons (348 responses). 122 of 802 respondents belonged to more than one organisation. The survey opened between 5 August and 10 September 2009 and closed on 24 November 2009. Responses came from Europe, the USA and other parts of the world.
• Exposure: Not an asbestos exposure study. Respondents were asked about surgical treatments for malignant pleural mesothelioma: extrapleural pneumonectomy (EPP), pleurectomy/decortication (PD) and debulking, each alone or within multimodality therapy. Questions covered cure, prolongation of life and improvement in breathing for epithelioid mesothelioma, with an abbreviated question set for sarcomatoid mesothelioma.
• Main results:
  • For both cure and prolongation of life, more surgeons believed these were achievable with EPP than with PD, and more likely with adjuvant therapy than without.
  • These beliefs were a little more frequently held, but not markedly so, by surgeons who perform the operation than by those who do not.
  • 45% of responders from the USA believed EPP alone could cure epithelioid mesothelioma, compared with 23% in Europe. This was the largest difference found in any comparison.
  • 91% (637 of 700) of respondents believed EPP within multimodality therapy prolongs life.
  • 12% (86 of 700) of respondents believed PD alone can achieve cure.
  • The cure rate for epithelioid mesothelioma was believed to be greater with EPP than PD, to rise with added adjuvant treatment, and to be highest when EPP is part of trimodality therapy.
  • There was little evident difference in belief by type of practice or seniority for most questions.
  • For many questions respondents were relatively evenly divided, commonly with splits of about 70:30.
• The authors' conclusion: The authors reported the beliefs impartially and did not test them against evidence. They summarised that EPP was believed more effective than PD and that adjuvant and multimodality therapy were believed to increase the chance of cure. They added that American surgeons were twice as likely as European surgeons to believe EPP alone can cure mesothelioma (45% vs. 23%), which they related to differing North American and European guidance on EPP.
• Limitations the authors state:
  • Because EACTS and STS include many cardiac surgeons who did not see the survey as relevant, the authors could not determine the denominator or give an overall response rate.
  • Double voting by members of more than one society could not be excluded without breaking anonymity.
  • No tests of statistical significance were offered, given the very large number of possible comparisons.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Thoracic Surgery, Clinical Trial, Extrapleural Pneumonectomy (EPP), Pleurectomy/Decortication (P/D), Multimodal Therapy, Epithelioid, Sarcomatoid.

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