Physical function and health-related quality of life in the convalescent phase in surgically treated patients with malignant pleural mesothelioma

Our plain-English summary of Physical function and health-related quality of life in the convalescent phase in surgically treated patients with malignant pleural mesothelioma, by T. Tanaka, S. Morishita, M. Hashimoto, et al (Supportive Care in Cancer, 2019).

The study

• Authors: T. Tanaka, S. Morishita, M. Hashimoto, T. Nakamichi, Y. Uchiyama, S. Hasegawa, K. Domen
• Journal: Supportive Care in Cancer
• Published: 2019;27(11):4107-4113
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: According to reports, patients with lung cancer have decreased pulmonary function and exercise capacity after surgery. However, to date, physical function and health-related quality of life (HRQOL) after surgery for malignant pleural mesothelioma (MPM) have not been evaluated in detail in the convalescent phase. This study aimed to assess physical function and HRQOL of MPM patients following pleurectomy/decortication (P/D) in the convalescent phase.

Methods: The study included 16 male MPM patients who underwent P/D between September 2014 and August 2016. Physical function was assessed based on handgrip and knee extensor strengths, the six-minute walk distance (6MWD), and pulmonary function, including forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). HRQOL was assessed using the Medical Outcome Study 36-item Short Form Health Survey (SF-36). The assessment was performed preoperatively, postoperatively, and 1-year after surgery.

Results: The 6MWD, FVC, and FEV1 values 1-year postoperatively improved significantly compared with baseline (P < 0.05 all). Additionally, the scores of six of the eight SF-36 domains were significantly improved 1 year after P/D: physical functioning, body pain, general health, vitality, social functioning, and mental health (all P < 0.05). 6MWD, FVC, and FEV1 were correlated with vitality, mental health, and physical functioning (P < 0.05 all).

Conclusions: Patients with MPM who underwent P/D showed improved physical function and HRQOL compared with postoperative values in the convalescent phase. Physicians, nurses, and rehabilitation staff should note these findings, which may provide insight into the development of customized rehabilitation strategies in the convalescent phase for such patients.

In plain English

This prospective observational study followed 16 men with malignant pleural mesothelioma who had lung-sparing surgery (pleurectomy/decortication) at Hyogo College of Medicine Hospital in Japan between September 2014 and August 2016. Strength, a six-minute walk test, breathing tests and a quality-of-life questionnaire (SF-36) were done before surgery, after surgery and one year later. The study did not examine asbestos exposure. After surgery, walking distance, lung function, body weight and several quality-of-life scores fell. At one year, average walking distance (475.4 m) did not differ significantly from before surgery (457.1 m). Lung function improved from the post-surgery level but stayed significantly below the pre-surgery level: average forced vital capacity was 3.53 L before, 1.93 L after and 2.51 L at one year. Changes in grip and leg strength were not significant. Six of eight quality-of-life areas improved significantly between surgery and one year, and none differed significantly from before surgery. The authors concluded that function and quality of life improved compared with post-surgery values. They named the small sample as a limitation. The abstract and parts of the text contradict the article's own tables.

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, with measurements before surgery, after surgery and 1 year after surgery
• Who was studied: 16 male patients with malignant pleural mesothelioma who underwent pleurectomy/decortication at Hyogo College of Medicine Hospital, Nishinomiya, Japan, between September 2014 and August 2016. Disease stage was I in 12, II in 3 and III in 1.
• Exposure: Not asbestos. The study examined surgery (pleurectomy/decortication, which spares the lung), followed by early in-hospital physiotherapy. No rehabilitation was given after discharge. Asbestos exposure was not measured.
• Main results:
  • Six-minute walk distance averaged 457.1 m before surgery, 356.8 m after surgery and 475.4 m at 1 year. The post-surgery value was significantly lower than both the pre-surgery and 1-year values (P < 0.001 each). The 1-year value did not differ significantly from the pre-surgery value (P = 0.441).
  • Average forced vital capacity was 3.53 L before surgery, 1.93 L after surgery and 2.51 L at 1 year. Average FEV1 was 2.65 L, 1.59 L and 2.00 L. Post-surgery values were significantly lower than pre-surgery values (P < 0.001 both). Table 2 shows the 1-year values were significantly higher than post-surgery values (FVC P < 0.001, FEV1 P = 0.002) but still significantly lower than pre-surgery values (P < 0.001 both).
  • Body weight fell significantly after surgery (69.2 kg to 66.2 kg, P = 0.008). Changes in handgrip and knee extension strength at any time point were not statistically significant.
  • Compared with before surgery, post-surgery SF-36 scores fell significantly for role-physical, bodily pain, general health, vitality, role-emotional and the physical component summary. Between post-surgery and 1 year, Table 3 shows significant increases in physical functioning, bodily pain, general health, vitality, social functioning, mental health and both summary scores. No domain differed significantly between before surgery and 1 year.
  • The authors tested correlations between the changes in each measure. For changes from before surgery to 1 year, the text reports that knee extension was correlated with general health, vitality, mental health and the mental component summary. FVC was correlated with vitality, social functioning and mental health. FEV1 was correlated with vitality, mental health and the mental component summary.
• The authors' conclusion: The authors concluded that patients with malignant pleural mesothelioma who underwent pleurectomy/decortication showed improved physical function and health-related quality of life compared with post-surgery values in the convalescent phase. They suggested the findings may inform customized rehabilitation strategies.
• Limitations the authors state:
  • Small sample, which could affect how far the results apply to other patients
  • Not an interventional study, so the effects of rehabilitation could not be judged as causes
  • The factors behind poor lung function before and after surgery were not investigated
  • The effects of disease type and stage on recovery were not investigated (the authors wrote 'lung cancer' here)
  • Daytime physical activity and activities of daily living were not measured

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, Pleurectomy/Decortication (P/D), Six-Minute Walk Test, FEV1.

Related studies

• 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)
• 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)
• Quality of life of patients with end-stage peritoneal metastasis treated with Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) — K. Odendahl, W. Solass, et al. (2015)

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