Patterns of care and survival of older patients with malignant pleural mesothelioma

Our plain-English summary of Patterns of care and survival of older patients with malignant pleural mesothelioma, by A. Linton, P. Blinman, S. Kao, et al (Journal of Geriatric Oncology, 2019).

The study

• Authors: A. Linton, P. Blinman, S. Kao, N. van Zandwijk
• Journal: Journal of Geriatric Oncology
• Published: 2019;10(4):573-576
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: Malignant pleural mesothelioma (MPM) is a cancer that primarily affects older adults. However this patient population is frequently under-represented in clinical studies. Therefore, we studied the impact of advancing age on treatment utilisation and clinical outcomes in an extensive series of minimally selected MPM patients.

Materials And Methods: Patients with MPM receiving compensation from the New South Wales (NSW) Dust Diseases Authority (2002-2009) were assessed. They were categorised by age (<70 years, 70-80 years or > 80 years) and chi-square testing was used to assess the relationship between clinical and demographic variables, age, treatment and overall survival (OS).

Results: We identified 910 patients; 41% were aged <70 years, 40% were aged 70-80 years, and 19% were aged >80 years old. Median OS decreased with increasing age: 13.5 months in <70 years, 9.5 months in 70-80 years and 7.1 months in >80 years as did chemotherapy use (66%, 35% and 8% respectively). Radical surgical intervention, adjuvant, and palliative radiotherapy were less frequently used with advanced age. A Kaplan Meier analysis revealed that there was a significant survival advantage (p < .001) for patients <70 and 70-80 years receiving chemotherapy (16.8 vs 7.0 months; 13.9 vs 5.8 months respectively), but not for patients >80 years.

Conclusion: Advancing age group of NSW patients with MPM was associated with reduced treatment utilisation and a decline in OS. Prospective studies are warranted to verify if current treatment guidelines are relevant for the older adults with MPM.

Copyright © 2019. Published by Elsevier Ltd.

In plain English

This study looked back at 910 people with malignant pleural mesothelioma, a cancer of the lung lining. All had been compensated for work-related asbestos disease by the New South Wales Dust Diseases Authority, Australia, after registering in 2002 to 2009. The authors grouped patients by age (under 70: 374; 70 to 79: 363; 80 or older: 173) and compared treatment and survival. Median survival fell with age: 13.5, 9.5 and 7.1 months. Chemotherapy use fell from 63% to 35% to 8%. Extrapleural pneumonectomy (removal of a lung and its lining) and radiotherapy were also used less with age. Patients given chemotherapy lived longer than those not given it among under-70s (median 16.8 vs 7.0 months) and 70-to-79-year-olds (13.9 vs 5.8 months), but not among those 80 or older (7.0 vs 7.1 months), where only 14 had chemotherapy, too few, the authors said, to interpret easily. The authors concluded that older age was associated with less treatment and shorter survival, and called for prospective studies. They noted that fitness and other illnesses could not be reliably assessed, and that people exposed outside work were excluded.

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 case series analysis of a compensation authority's records, comparing treatment and survival across age groups (chi-square tests and Kaplan Meier survival analysis)
• Who was studied: 910 patients with malignant pleural mesothelioma registered with the New South Wales Dust Diseases Authority, Australia, between 1 January 2002 and 31 December 2009 and awarded compensation. Of 1121 eligible patients identified, 204 living or treated outside NSW were excluded, along with small numbers with peritoneal mesothelioma or missing data. By age group, as the tables define them: under 70, 41% (n = 374); 70 to 79, 40% (n = 363); 80 or older, 19% (n = 173). Follow-up ran to 27 June 2012.
• Exposure: The factors compared were age group and treatment received (chemotherapy, extrapleural pneumonectomy, adjuvant and palliative radiotherapy). All patients had been compensated for asbestos-related disease acquired at work. Fiber types, products and jobs are not reported.
• Main results:
  • Median overall survival fell with increasing age group: 13.5 months under 70, 9.5 months at 70 to 79, and 7.1 months at 80 or older (p less than .001).
  • Chemotherapy use fell from 63% (n = 234) under 70, to 35% (n = 127) at 70 to 79, to 8% (n = 14) at 80 or older (p less than .001).
  • Among patients who had chemotherapy, at least 3 cycles were given to 84% (n = 197) under 70 and 77% (n = 98) at 70 to 79, but to 43% (n = 6) at 80 or older.
  • Each treatment was used less in older groups (under 70 vs 70 to 79 vs 80 or older). Extrapleural pneumonectomy: 14.4% vs 1.1% vs 0.6% (p less than .001). Adjuvant radiotherapy: 8.6% vs 1.1% vs 0% (p less than .001). Palliative radiotherapy: 23.3% vs 19.6% vs 12.1% (p = .01).
  • Receiving chemotherapy was associated with longer median survival under 70 (16.8 vs 7.0 months, p less than 0.001) and at 70 to 79 (13.9 vs 5.8 months, p less than 0.001). These figures are from Table 3; the text rounds them to 17 vs 7 and 14 vs 6.
  • In patients aged 80 or older, survival did not differ between those who did and did not receive chemotherapy (median 7.0 vs 7.1 months; p = .72). Only 14 patients in this group had chemotherapy.
  • Patients under 50 (n = 25) had a median survival of 27.1 months. The effect of age group on survival persisted when they were removed from the analysis.
  • Patients in the oldest group more often had less well-defined histological diagnoses (p = .001) and limited staging data (p = .05).
  • Low blood albumin (below 35 g/L) became more frequent with age: 33.7% under 70, 46.2% at 70 to 79, and 54.4% at 80 or older (p less than .001).
• The authors' conclusion: The authors concluded that older age group among NSW patients with malignant pleural mesothelioma was associated with less use of treatment and a decline in overall survival. They called for prospective studies to check whether current treatment guidelines are relevant for older adults.
• Limitations the authors state:
  • Because the analysis was retrospective, performance status and other illnesses (comorbidities) could not be reliably assessed. The authors said this affects how the chemotherapy findings can be interpreted.
  • Very few patients in the oldest group received chemotherapy, which makes it difficult to judge whether chemotherapy is appropriate in that group.
  • Selection bias: only patients known to the Dust Diseases Authority were included, so patients exposed outside work, for example during home renovations, were left out.

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, Overall Survival, Chemotherapy, Palliative Care.

Related studies

• Treatment patterns among patients with malignant pleural mesothelioma: An Italian, population-based nationwide study — A. Trama, C. Proto, et al. (2020)
• Extrapleural pneumonectomy or supportive care: treatment of malignant pleural mesothelioma? — S. Sharif, I. Zahid, et al. (2011)
• Factors associated with survival in a large series of patients with malignant pleural mesothelioma in New South Wales — A. Linton, N. Pavlakis, et al. (2014)
• Hyperthermic intraoperative pleural cisplatin chemotherapy extends interval to recurrence and survival among low-risk patients with malignant pleural mesothelioma undergoing surgical macroscopic complete resection — D.J. Sugarbaker, R.R. Gill, et al. (2013)
• Patterns of care and survival among patients with malignant mesothelioma in the United States — L. Enewold, E. Sharon, et al. (2017)
• Is pleurectomy and decortication superior to palliative care in the treatment of malignant pleural mesothelioma? — I. Zahid, S. Sharif, et al. (2011)

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