Physical function and health-related quality of life in patients undergoing surgical treatment for malignant pleural mesothelioma

Our plain-English summary of Physical function and health-related quality of life in patients undergoing surgical treatment for malignant pleural mesothelioma, by T. Tanaka, S. Morishita, M. Hashimoto, et al (Supportive Care in Cancer, 2017).

The study

• Authors: T. Tanaka, S. Morishita, M. Hashimoto, Y. Itani, S. Mabuchi, N. Kodama, S. Hasegawa, K. Domen
• Journal: Supportive Care in Cancer
• Published: 2017;25(8):2569-2575
• Cited by: 12 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Malignant pleural mesothelioma (MPM) is a rare cancer that affects the thin cell wall lining of internal organs and structures. Studies have shown that patients with lung cancer have decreased pulmonary function and exercise capacity after pneumonectomy. However, to date, physical function and health-related quality of life (HRQOL) in surgically treated MPM patients have not been evaluated in detail. The aim of this study was to assess physical function and HRQOL of MPM patients following pleurectomy/decortication (P/D).

Methods: The subjects were 22 MPM patients (20 men and 2 women) who completed P/D between December 2013 and March 2015. Physical function was assessed using handgrip strength and knee extensor strength tests, the 6-min walk distance (6MWD), and pulmonary function tests, including forced expiratory vital capacity (FVC) and forced expiratory volume in 1 s (FEV1). HRQOL was assessed using the Medical Outcome Study 36-item Short Form Health Survey (SF-36).

Results: The handgrip strength (P < 0.05), 6MWD, FVC, and FEV1 values following P/D decreased significantly compared to baseline (P < 0.001 for each comparison). Additionally, scores of three of the eight SF-36 domains were significantly lower following P/D: physical functioning (P < 0.001), body pain (P = 0.002), and vitality (P = 0.005). 6MWD correlated role physical (P < 0.05) and vitality (P < 0.01). Significant correlations were also observed between FEV1 and physical functioning (P < 0.05) and social functioning (P < 0.05).

Conclusion: Patients with MPM who completed P/D have decreased physical function and HRQOL. Following surgery, exercise capacity and pulmonary function decreased more than limb muscle strength. Physicians, nurses, and rehabilitation staff should note these findings, which may provide insight into the development of customized rehabilitation strategies for patients with MPM who completed P/D.

In plain English

This prospective observational study at Hyogo College of Medicine Hospital in Japan measured physical function and health-related quality of life in 22 patients with malignant pleural mesothelioma (20 men, 2 women). They were tested before and after pleurectomy/decortication, a lung-sparing operation that removes the pleura, done between December 2013 and March 2015. The article does not report the patients' asbestos exposure. After surgery, average 6-minute walk distance fell from 470.6 to 399.7 meters. FVC, a measure of lung capacity, was 41.5% lower and FEV1 was 33.2% lower (all P less than 0.001). Handgrip strength fell 5.5% (P less than 0.05). Knee extensor strength did not change significantly. On the SF-36 questionnaire, physical functioning, bodily pain, vitality and physical component summary scores were significantly lower. The other SF-36 domains, and the mental component summary score, did not change significantly. Changes in walk distance and lung function correlated with changes in some quality-of-life scores. The authors concluded that exercise tolerance, lung function and the physical side of quality of life declined after surgery. They noted their sample was small.

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 observational study comparing measurements taken before and after surgery in the same patients
• Who was studied: 22 patients with malignant pleural mesothelioma (20 men, 2 women) who underwent pleurectomy/decortication between December 2013 and March 2015 at Hyogo College of Medicine Hospital, Nishinomiya, Hyogo, Japan. Disease stage at surgery: stage I in 12, stage II in 8, stage III in 2.
• Exposure: The exposure studied was the operation itself: pleurectomy/decortication (P/D), a lung-sparing surgery that removes the parietal and visceral pleura. Patients had a median of three chemotherapy cycles before P/D and began physiotherapy the day after surgery. The article does not report asbestos exposure, fiber types or occupations for these patients.
• Main results:
  • Body weight in the 22 patients was 4.7% lower after P/D than before (mean 64.4 kg before, 61.4 kg after; P less than 0.001).
  • Handgrip strength fell significantly after P/D (34.5 to 32.6 kgf, minus 5.5%, P less than 0.05). Knee extensor strength did not differ significantly (38.5 to 37.2 kgf, P = 0.256).
  • Mean 6-minute walk distance fell from 470.6 m before P/D to 399.7 m after (P less than 0.001). The authors describe this as a 15% decrease.
  • Lung function was lower after P/D. FVC was 41.5% lower (3.28 L to 1.92 L) and FEV1 was 33.2% lower (2.35 L to 1.57 L), both P less than 0.001.
  • On the SF-36 quality-of-life questionnaire, scores fell significantly after P/D for:
• physical functioning (83.6 to 66.1, P less than 0.001)
• bodily pain (67.2 to 45.1, P = 0.002)
• vitality (62.0 to 47.2, P = 0.005)
• the physical component summary (43.2 to 29.0, P less than 0.001)
  Changes in the other domains were not statistically significant.
  • The SF-36 mental component summary score did not change significantly (48.1 before, 46.0 after, P = 0.171).
  • Before-to-after changes were correlated as follows:
• 6-minute walk distance with role-physical (0.458) and vitality (0.564)
• FVC with social functioning and the physical component summary
• FEV1 with physical functioning and social functioning
• The authors' conclusion: The authors concluded that patients undergoing P/D had reduced exercise tolerance and lung function after surgery compared with before. They also had lower health-related quality of life, particularly in its physical components. The authors suggested that early exercise tolerance testing may be important for these patients.
• Limitations the authors state:
  • The sample was small, which the authors say could limit how far the results apply to other patients.
  • The study was not an interventional study, so it could not estimate the effects of rehabilitation.
  • Air leakage after P/D was not investigated.
  • Daytime physical activity and activities of daily living were not evaluated.

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, Lung Cancer, Pneumonectomy, Pleurectomy/Decortication (P/D), Pulmonary Function Test (PFT), FEV1.

Related studies

• Physical function and health-related quality of life in the convalescent phase in surgically treated patients with malignant pleural mesothelioma — T. Tanaka, S. Morishita, et al. (2019)
• Influence of Pleurectomy and Decortication in Health-Related Quality of Life Among Patients with Malignant Pleural Mesothelioma — W.T. Vigneswaran, D.Y. Kircheva, et al. (2018)
• 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)
• 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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