Influence of Pleurectomy and Decortication in Health-Related Quality of Life Among Patients with Malignant Pleural Mesothelioma

Our plain-English summary of Influence of Pleurectomy and Decortication in Health-Related Quality of Life Among Patients with Malignant Pleural Mesothelioma, by W.T. Vigneswaran, D.Y. Kircheva, A.E. Rodrigues, et al (World Journal of Surgery, 2018).

The study

• Authors: W.T. Vigneswaran, D.Y. Kircheva, A.E. Rodrigues, S. Watson, A.D. Celauro, B. Rose, H.L. Kindler, A.N. Husain
• Journal: World Journal of Surgery
• Published: 2018;42(4):1036-1045
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Complete macroscopic resection surgery, pleurectomy and decortication (PD) improve survival in selected patients with malignant pleural mesothelioma (MPM). Yet its value has been questioned because of concern that this extensive surgical procedure may disrupt health-related quality of life (HRQoL).

Methods: HRQoL was studied in patients undergoing PD surgery for MPM using EORTC QLQ-C30 instrument at baseline (prior to surgery), 1, 4-5, 7-8, and 10-11 months following surgery. Global health and variables in function and symptom domains were investigated. Sub-groups analyses were performed for ECOG performance status (PS), histological sub-types and pathological tumor volume (pTV). Within-patient comparisons to baseline scores were made using Wilcoxon signed-rank test. Trends over time were evaluated using Cuzick's nonparametric test.

Results: There were 114 patients with median age of 70 years (range: 50-88) and PS 0: 35 (30.7%), epithelioid histology: 61 (53.5%) and volume <600 ml: 58 (50.9%). Patients with good PS (PS 0), epithelioid histology and small pTV had greater level of functioning and were less symptomatic at baseline. Overall global health worsened at the first postoperative month (p = 0.0005) with subsequent improvement. Non-epithelioid histology and patients with large pTV demonstrated greater improvement in global health, function and symptoms domains following a PD.

Conclusions: At baseline, the overall health-related quality of life, function and symptom domains were adversely affected in non-epithelioid histology and patients with large pTV. However, greatest improvement in global health, symptom and function domains were observed first month after PD and during the follow-up in these sub-groups.

In plain English

This single-center study looked at quality of life in people with malignant pleural mesothelioma who had a lung-sparing operation called pleurectomy and decortication. Between November 2008 and December 2015, 114 patients agreed to take part. Their median age was 70, and 80% were men. Patients completed a standard cancer quality-of-life questionnaire (EORTC QLQ-C30) before surgery and at 1, 4–5, 7–8 and 10–11 months afterward. Six patients who died within 30 days of surgery were excluded. Overall global health was worse one month after surgery and then improved. At later visits it was not significantly different from before surgery. Before surgery, patients with non-epithelioid tumors and with larger tumors (600 ml or more) had worse functioning and more symptoms. At one month, these groups showed no significant change in global health. The epithelioid and smaller-tumor groups declined. Median survival after surgery was 15.21 months. The authors concluded that the non-epithelioid and large-tumor groups showed the greatest improvement. They named limits including a single institution, sample size and varied chemotherapy. The article does not discuss asbestos.

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: Prospective single-center study of quality of life before and after pleurectomy and decortication (patients approached and consented over time, questionnaires repeated at fixed intervals)
• Who was studied: 114 patients with biopsy-confirmed malignant pleural mesothelioma (120 approached), treated at one center (University of Chicago Medicine) between November 2008 and December 2015. 91 men (80%), median age 70 (range 50–88). 61 had epithelioid, 2 sarcomatoid and 51 biphasic histology. 6 patients (5.3%) who died within 30 days of surgery were excluded.
• Exposure: The article studies a surgical treatment, not asbestos exposure: pleurectomy and decortication, performed by a single surgeon. 28 patients (24.6%) had chemotherapy before surgery and 77 (67.5%) had chemotherapy after. Asbestos is not mentioned.
• Main results:
  • For all patients, overall global health was worse at the first month after surgery (p = 0.0005) and improved afterward.
  • For all patients, the change in global health from before surgery was not statistically significant at later visits: minus 0.7 at 4–5 months (p = 0.55), 1.17 at 7–8 months (p = 0.68) and minus 3.61 at 10–11 months (p = 0.26).
  • Before surgery, global health was better in patients with epithelioid histology (p less than 0.01). It was not significantly affected by tumor volume (p = 0.13).
  • At one month, global health did not change significantly in the non-epithelioid group (minus 2.64, p = 0.28) or the larger-tumor group (minus 1.22, p = 0.45). It declined significantly in the epithelioid group (minus 11.22) and the smaller-tumor group (minus 12.26).
  • Emotional functioning scores for all patients were higher than before surgery at 1 month (3.77, p = 0.028) and at 7–8 months (8.16, p = 0.0037).
  • Median survival after surgery was 15.21 months overall. Survival was significantly longer with epithelioid histology (19.9 months, p less than 0.0001), performance status 0 (19.1 months, p = 0.031) and tumor volume under 600 ml (19.1 months, p less than 0.001).
• The authors' conclusion: The authors concluded that before surgery, quality of life, functioning and symptoms were worse in patients with non-epithelioid histology and large tumor volume. They also concluded that these sub-groups showed the greatest improvement after pleurectomy and decortication.
• Limitations the authors state:
  • The study was done at a single institution.
  • The authors called sample size the major limitation.
  • Many patients had chemotherapy before or after surgery, which likely added to symptoms such as nausea and fatigue.
  • The questionnaire used was not specifically designed for patients having surgery for mesothelioma.
  • The study was not designed to compare this operation with other surgery or with non-surgical treatment.

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: Quality of Life, Pleural Mesothelioma, ECOG Performance Status, Epithelioid, Histology, Non-epithelioid.

Related studies

• Effects of extended pleurectomy and decortication on quality of life and pulmonary function in patients with malignant pleural mesothelioma — D. Burkholder, D. Hadi, et al. (2015)
• Quality of life after radical pleurectomy decortication for malignant pleural mesothelioma — N.M. Mollberg, Y. Vigneswaran, et al. (2012)
• Physical function and health-related quality of life in patients undergoing surgical treatment for malignant pleural mesothelioma — T. Tanaka, S. Morishita, et al. (2017)
• Health-related quality of life and inflammatory markers in malignant pleural mesothelioma — S.C. Kao, J. Vardy, et al. (2013)
• Health-related quality of life in patients with lung cancer: validation of the Mexican-Spanish version and association with prognosis of the EORTC QLQ-LC13 questionnaire — Ó. Arrieta, C. Núñez-Valencia, et al. (2012)
• Functional exercise capacity and health-related quality of life in people with asbestos related pleural disease: an observational study — M.T. Dale, Z.J. McKeough, et al. (2013)

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