Determinants of malignant pleural mesothelioma survival and burden of disease in France: a national cohort analysis

Our plain-English summary of Determinants of malignant pleural mesothelioma survival and burden of disease in France: a national cohort analysis, by C. Chouaid, J.B. Assié, P. Andujar, et al (Cancer Medicine, 2018).

The study

• Authors: C. Chouaid, J.B. Assié, P. Andujar, C. Blein, C. Tournier, A. Vainchtock, A. Scherpereel, I. Monnet, J.C. Pairon
• Journal: Cancer Medicine
• Published: 2018;7(4):1102-1109
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

This study was undertaken to determine the healthcare burden of malignant pleural mesothelioma (MPM) in France and to analyze its associations with socioeconomic deprivation, population density, and management outcomes. A national hospital database was used to extract incident MPM patients in years 2011 and 2012. Cox models were used to analyze 1- and 2-year survival according to sex, age, co-morbidities, management, population-density index, and social deprivation index. The analysis included 1,890 patients (76% men; age: 73.6 ± 10.0 years; 84% with significant co-morbidities; 57% living in urban zones; 53% in highly underprivileged areas). Only 1% underwent curative surgical procedure; 65% received at least one chemotherapy cycle, 72% of them with at least one pemetrexed and/or bevacizumab administration. One- and 2-year survival rates were 64% and 48%, respectively. Median survival was 14.9 (95% CI: 13.7-15.7) months. The mean cost per patient was 27,624 ± 17,263 euros (31% representing pemetrexed and bevacizumab costs). Multivariate analyses retained men, age >70 years, chronic renal failure, chronic respiratory failure, and never receiving pemetrexed as factors of poor prognosis. After adjusting the analysis to age, sex, and co-morbidities, living in rural/semi-rural area was associated with better 2-year survival (HR: 0.83 [95% CI: 0.73-0.94]; P < 0.01); social deprivation index was not significantly associated with survival. With approximately 1,000 new cases per year in France, MPMs represents a significant national health care burden. Co-morbidities, sex, age, and living place appear to be significant factors of prognosis.

© 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

In plain English

This retrospective study used France's national hospital database to identify 1,890 people newly diagnosed with malignant pleural mesothelioma in 2011 and 2012, followed for at least two years. Asbestos exposure was not measured. Most patients (76%) were men; 65% received chemotherapy and 1% had curative surgery. Survival was 64% at one year and 48% at two years. Median survival was 14.9 months (95% CI 13.7 to 15.7). It was 18.2 months for women (95% CI 15.1 to 21.7) and 14.1 months for men (95% CI 13.2 to 15.3). In adjusted analyses, male sex, age over 70, chronic renal insufficiency and chronic pulmonary insufficiency predicted poorer two-year outcomes. Rural or semi-rural residence was associated with better two-year survival than semi-urban or urban residence (hazard ratio 0.83, 95% CI 0.73 to 0.94). The area social deprivation index was not significantly associated with survival. Among patients whose chemotherapy was all given in the public sector, those not given pemetrexed had a higher two-year risk of death (hazard ratio 2.39, 95% CI 1.69 to 3.40). Mean direct cost was €27,624 per patient. The authors noted hospital data could not capture quality of life or indirect costs.

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: Retrospective, longitudinal analysis of the French national hospital (DRG) database, linked to census-based socioeconomic data for each patient's home locality
• Who was studied: 1,890 patients newly diagnosed with malignant pleural mesothelioma (incident cases) in French hospitals in 2011 and 2012, each followed for at least 2 years; 76% were men
• Exposure: Asbestos exposure was not measured. The factors studied were age, sex, co-morbidities, treatment (including chemotherapy with pemetrexed and/or bevacizumab), the population density of the home locality (rural, semi-rural, semi-urban, urban) and a locality social deprivation index
• Main results:
  • 76% of the 1,890 patients were men
  • 65% of patients received at least one chemotherapy cycle
  • Only 1% of patients underwent curative surgery
  • In the whole cohort, survival was 64% at 1 year and 48% at 2 years
  • Median overall survival in the whole cohort was 14.9 months (95% CI 13.7 to 15.7)
  • Median overall survival was significantly longer for women (18.2 months, 95% CI 15.1 to 21.7) than for men (14.1 months, 95% CI 13.2 to 15.3)
  • In multivariate analysis, male sex, age over 70, chronic renal insufficiency and chronic pulmonary insufficiency were predictive of poor outcome at 2 years
  • Patients living in rural or semi-rural areas had better 2-year survival than those in semi-urban or urban areas after adjustment for age, sex and co-morbidities (HR 0.83, 95% CI 0.73 to 0.94, P less than 0.01)
  • The social deprivation index of the home locality was not significantly associated with survival
  • Among patients whose chemotherapy was all given in the public sector, median overall survival was 18.5 months (95% CI 17.2 to 20.3) for those treated with pemetrexed and 7.5 months (95% CI 5.3 to 15.3) for those not given it
  • In the same public-sector group, after adjustment for age, sex and co-morbidities, patients not given pemetrexed had a higher risk of death at 2 years than pemetrexed-treated patients (HR 2.39, 95% CI 1.69 to 3.40)
  • The mean direct cost was €27,624 per patient (plus or minus 17,263)
  • Pemetrexed and bevacizumab accounted for 31% of that cost
• The authors' conclusion: The authors concluded that, with about 1,000 new cases a year, malignant pleural mesothelioma is a significant burden on the French healthcare system. They found that co-morbidities, sex, age and place of residence appeared to be significant factors predicting outcome, while the social deprivation index had no significant impact on survival.
• Limitations the authors state:
  • The study relied on hospital databases
  • The database analysis could not assess patients' quality of life or indirect costs
  • The type of chemotherapy is not recorded for the private sector, so the pemetrexed analysis was restricted to patients treated entirely in the public sector
  • The authors had no clear explanation for the longer survival of patients living in rural or semi-rural areas

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Chemotherapy, Pemetrexed (Alimta), Bevacizumab, Median Survival, Prognosis.

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