Health-related quality of life and inflammatory markers in malignant pleural mesothelioma

Our plain-English summary of Health-related quality of life and inflammatory markers in malignant pleural mesothelioma, by S.C. Kao, J. Vardy, R. Harvie, et al (Supportive Care in Cancer, 2013).

The study

• Authors: S.C. Kao, J. Vardy, R. Harvie, M. Chatfield, N. van Zandwijk, S. Clarke, N. Pavlakis
• Journal: Supportive Care in Cancer
• Published: 2013;21(3):697-705
• Cited by: 38 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: Malignant pleural mesothelioma (MPM) is a highly aggressive and symptomatic disease. We examined the relationship between health-related quality of life (HRQoL) and inflammatory markers, and the prognostic role of HRQoL in MPM patients.

Methods: MPM patients from two parallel phase II studies (thalidomide alone or thalidomide with chemotherapy) were included. HRQoL was assessed at baseline using the modified Lung Cancer Symptom Scale (LCSS). Baseline inflammatory markers and cytokines were measured. Spearman correlation was used to examine the relationship between inflammatory markers and HRQoL measures. The prognostic value of the HRQoL domains was examined using Cox proportional hazard model.

Results: Sixty-three patients were included: median age 61 years (range 44-79); 82% male; 77% Eastern Cooperative Oncology Group (ECOG) performance status 0-1; 44% epithelial histology subtype. Baseline systemic symptoms of anorexia and fatigue, the summation symptoms of overall symptomatic distress, interference with normal activity and global QoL and the aggregate score of total LCSS score were all associated with elevated neutrophil-to-lymphocyte ratio, C-reactive protein and vascular endothelial growth factor levels at baseline (rho ≥ 0.25; p < 0.05). Baseline anorexia, fatigue, cough, dyspnoea, pain, overall symptomatic distress, interference with normal activity, global QoL and total LCSS score were all significantly related to survival (p < 0.05) after adjusting for established prognostic factors (age, gender, histological subtype and performance status) and treatment effect.

Conclusions: In conclusion, HRQoL seems to relate to a patient's systemic inflammatory status and is associated with survival in MPM patients.

In plain English

This study examined 63 patients with advanced, inoperable malignant pleural mesothelioma enrolled in two parallel phase II treatment studies in Sydney, Australia, from 2001 to 2003. Of these, 34 received thalidomide with cisplatin and gemcitabine and 29 received thalidomide alone. Before treatment, patients rated their symptoms and quality of life on a modified Lung Cancer Symptom Scale, and blood markers of inflammation were measured. Asbestos exposure was not studied. Worse appetite loss, fatigue, overall symptom distress, interference with normal activity, global quality of life and total score were correlated with higher neutrophil-to-lymphocyte ratio (NLR), C-reactive protein and VEGF. Cough, breathlessness and pain were not consistently linked to these markers. Median survival for the whole group was 9.5 months (95% confidence interval 3.7 to 15.3 months). After allowing for age, sex, tumour subtype, performance status and treatment, all nine scores were linked to survival. With NLR also included, five remained linked. The authors concluded that quality of life may add prognostic information in these patients. They noted the small number of patients and the limited range of markers measured.

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: Analysis of baseline quality-of-life scores, blood inflammatory markers and survival in patients pooled from two parallel phase II treatment studies (correlation analysis and Cox proportional hazard models)
• Who was studied: 63 patients with histologically confirmed advanced (inoperable) malignant pleural mesothelioma, recruited April 2001 to August 2003 (ethics approval at Royal North Shore Hospital, Sydney). 34 received thalidomide with cisplatin and gemcitabine (arm A) and 29 received thalidomide alone (arm B). Median age 61 years (range 44 to 78); 83% male; 78% ECOG performance status 0-1; 44% epithelial subtype.
• Exposure: No asbestos exposure was assessed. The factors studied were baseline blood inflammatory markers (NLR, CRP, IL6, IL6 soluble receptor, VEGF) and baseline health-related quality of life measured by the modified Lung Cancer Symptom Scale (five symptom items, three summation items and a total score).
• Main results:
  • In all 63 patients, anorexia, fatigue, overall symptomatic distress, interference with normal activity, global QoL and total LCSS score were correlated with NLR, CRP and VEGF levels (Spearman correlation above 0.25, p less than 0.05).
  • Local symptoms (cough, dyspnoea, pain) were not consistently associated with the inflammatory markers. IL6-SR levels were not associated with any quality-of-life domain.
  • Median survival for the entire cohort was 9.5 months (95% CI 3.7 to 15.3 months).
  • After adjusting for age, gender, histological subtype, performance status and treatment, all nine LCSS items were significantly related to survival. Examples: total LCSS score HR 1.34 (95% CI 1.13 to 1.59), p=0.001; global QoL HR 1.23 (1.09 to 1.40), p=0.001. Hazard ratios are per 10-point increase in score.
  • When NLR was added to the model, NLR remained significant. Only cough, overall symptomatic distress, interference with normal activity, global QoL and total LCSS score remained independent predictors of survival. The effect of NLR was reduced by at most 20% when a quality-of-life domain was included.
• The authors' conclusion: The authors concluded that health-related quality of life may have additional prognostic value in malignant pleural mesothelioma patients. They also stated that systemic symptoms such as fatigue and anorexia are related to an exaggerated systemic inflammatory response, evident in elevated NLR and CRP.
• Limitations the authors state:
  • The number of participants was relatively small.
  • Only a limited number of cytokines was measured.
  • Few patients had repeated measurements, so changes over time and treatment effects on these measures could not be assessed.

Topics

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

Medical terms in this study, explained in our Lexicon: Quality of Life, Pleural Mesothelioma, Chemotherapy, Lung Cancer, Cytokine, Performance Status, Histology, Histological Subtype.

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