Estimation of an optimal chemotherapy utilization rate for malignant pleural mesothelioma: an evidence-based benchmark for cancer care

Our plain-English summary of Estimation of an optimal chemotherapy utilization rate for malignant pleural mesothelioma: an evidence-based benchmark for cancer care, by S.C. Kao, N. van Zandwijk, S. Clarke, et al (Asia-Pacific Journal of Clinical Oncology, 2015).

The study

• Authors: S.C. Kao, N. van Zandwijk, S. Clarke, J. Vardy, S. Lumba, A. Tognela, W. Ng
• Journal: Asia-Pacific Journal of Clinical Oncology
• Published: 2015;11(1):85-92
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aims: Chemotherapy with cisplatin and pemetrexed has been shown to provide a survival benefit and improvement in quality of life in patients with malignant pleural mesothelioma (MPM). The reported chemotherapy utilization rates range from 18% to 61%. This study aimed to estimate the proportion of MPM patients that should receive chemotherapy based on best available evidence.

Methods: An optimal chemotherapy utilization model for MPM was constructed using indications for chemotherapy identified from evidence-based MPM treatment guidelines. Epidemiological data on the proportion of patients and their tumor-related attributes were combined with the chemotherapy indications to estimate the optimal chemotherapy utilization rate using decision analysis software (TreeAge Pro 2007). Sensitivity analyses were performed to assess the impact of major variations in the epidemiological data on the optimal chemotherapy utilization rate. The optimal rate was compared with the actual rate reported in the literature.

Results: Chemotherapy is recommended at least once during the disease trajectory in 65% of MPM patients. Sensitivity analyses indicate an optimal utilization rate ranging from 50% to 65%. This optimal rate is relatively comparable to the rates mentioned in contemporary reports from Canada (61% between 2003 and 2005) and Australia (54% between 2007 and 2009) and high when compared with data from the Netherlands (36% during 2005-2006).

Conclusion: An evidence-based model provided an optimal chemotherapy utilization rate of 65% for patients with MPM. Chemotherapy for MPM may be underutilized and barriers are likely multifactorial.

© 2014 Wiley Publishing Asia Pty Ltd.

In plain English

This study used a computer decision model, not a study of patients, to estimate what share of people with malignant pleural mesothelioma should receive chemotherapy at least once if published treatment guidelines were followed. The authors combined guideline recommendations with published figures on how many patients had operable disease, good general fitness (performance status) and severe other illnesses. The model found chemotherapy was recommended in 65% of patients, mostly as palliative treatment for inoperable disease. When patients with severe other illnesses were excluded, the figure fell to 50%. The authors compared this with actual rates reported elsewhere. Canada (61%) and Australia (54%) were closer to the estimate. The UK (18%) and the Netherlands (36%) were lower. The authors concluded that chemotherapy for this disease may be underused and that the barriers are likely multifactorial. They noted that data on patient fitness came from one UK study that may not be representative, and that patients' age and preferences were not included in the model.

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: Decision-analysis modelling study (optimal chemotherapy utilization tree built in TreeAge Pro 2007 from guideline recommendations and published epidemiological data), with sensitivity analysis and comparison against published actual utilization rates
• Who was studied: No patients were studied directly. The model represented patients with malignant pleural mesothelioma, using published proportions: good performance status (ECOG 0 to 2) 65% and severe comorbidity 24% (both from a UK study), and resectable disease 9% (from an Australian study).
• Exposure: No asbestos exposure was studied. What the model assessed was chemotherapy (neoadjuvant or adjuvant for resectable disease, palliative for unresectable disease), including but not limited to pemetrexed-based chemotherapy.
• Main results:
  • In the model, chemotherapy was recommended at least once during the course of the disease in 65% of patients with malignant pleural mesothelioma.
  • The indications identified were neoadjuvant or adjuvant chemotherapy for resectable disease and palliative chemotherapy for advanced or unresectable disease.
  • In the sensitivity analysis, the optimal proportion fell from 65% to 50% if patients with severe comorbidities were excluded from chemotherapy.
  • Published actual rates closer to the optimal rate were 61% in Canada and 54% in Australia.
  • Actual rates in the UK (18%, 2002 to 2005) and the Netherlands (36%, 2005 to 2006) were described by the authors as significantly lower than the optimal rate.
• The authors' conclusion: The authors concluded that their evidence-based model shows 65% of patients with malignant pleural mesothelioma should have chemotherapy at least once during their illness. They also concluded that chemotherapy may be underutilized and that the barriers are likely multifactorial.
• Limitations the authors state:
  • Performance status data came only from one UK study that may not be representative, so the 65% good-performance-status figure may be an underestimate.
  • Patients' age was not addressed in the model.
  • There is no literature on patient preferences for chemotherapy in this disease, so their effect on the optimal rate could not be determined.
  • Real-world situations, such as an overrepresentation of elderly patients, were not taken into account.
  • The model is restricted by the limited data available in the mesothelioma literature.

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: Chemotherapy, Pleural Mesothelioma, Cisplatin, Pemetrexed (Alimta), Quality of Life.

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