Quality of life after radical pleurectomy decortication for malignant pleural mesothelioma

Our plain-English summary of Quality of life after radical pleurectomy decortication for malignant pleural mesothelioma, by N.M. Mollberg, Y. Vigneswaran, H.L. Kindler, et al (The Annals of Thoracic Surgery, 2012).

The study

• Authors: N.M. Mollberg, Y. Vigneswaran, H.L. Kindler, C. Warnes, R. Salgia, A.N. Husain, W.T. Vigneswaran
• Journal: The Annals of Thoracic Surgery
• Published: 2012;94(4):1086-92
• Cited by: 30 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: Malignant pleural mesothelioma is an aggressive malignancy in which radical surgical treatment appears to improve survival. It is unknown, however, if radical surgical treatment affects quality of life (QoL) adversely. Our objective was to assess patient-reported symptoms of health-related QoL after radical pleurectomy decortication (PD).

Methods: Patients with malignant pleural mesothelioma were prospectively enrolled between 2010 and 2011 to determine the effects of PD on baseline QoL. Health-related QoL was assessed using the European Organization for Research and Treatment of Cancer core Quality of Life Questionnaire-C30 tool (EORTC QLQ-C30) before operation and at 1, 5 to 6, and 8 to 9 months postoperatively. Patients were grouped based on World Health Organization baseline performance status (PS) and compared.

Results: Of the 28 patients enrolled, 16 (57.1%) and 12 (42.9%) were World Health Organization PS 0 and PS 1, respectively. At baseline, PS 1 patients had significantly worse global QoL functional and symptom scores at baseline. At 5 to 6 months' follow-up, PS 0 patients had no significant change in global QoL or functional domain scores. PS 1 patients had significant improvement in global QoL (p=0.038), symptoms of fatigue (p=0.05), and dyspnea (p=0.048). At 8 to 9 months' follow-up, PS 0 patients showed significant improvement in symptoms of fatigue (p=0.026) from baseline and PS 1 maintained the improvements in symptoms of fatigue (p=0.049) and dyspnea (p=0.048).

Conclusions: Radical PD does not negatively impact minimally symptomatic patients at intermediate follow-up. Patients who have symptoms at baseline can have significant improvement in their QoL after surgical treatment.

Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

In plain English

This study at the University of Chicago enrolled 28 consecutive patients with malignant pleural mesothelioma who had radical pleurectomy decortication between 2010 and 2011. The article does not discuss asbestos exposure. Patients completed a standard quality-of-life questionnaire (EORTC QLQ-C30) before surgery and 1, 5 to 6, and 8 to 9 months afterwards. Sixteen were fully active before surgery (performance status 0), and 12 had symptoms but could walk (performance status 1). Before surgery, the status 1 group had significantly worse global quality of life, fatigue, pain, breathlessness and appetite loss. At one month, the status 0 group had significantly worse pain and insomnia. At 5 to 6 months, the status 0 group showed no significant change, while the status 1 group had significantly better global quality of life and less fatigue. By 8 to 9 months six patients had died. Among those still followed, fatigue had improved significantly in both groups. The status 1 group also improved significantly in global quality of life, breathlessness and appetite loss. The authors concluded that the operation did not harm minimally symptomatic patients at intermediate follow-up.

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 study of consecutive patients at a single institution, measuring patient-reported quality of life before and after surgery, with patients compared by baseline performance status
• Who was studied: 28 consecutive patients with malignant pleural mesothelioma (21 male, 7 female; median age 66, range 54 to 89) treated at the University of Chicago, January 1, 2010 to December 31, 2011. 16 were World Health Organization performance status 0 and 12 were performance status 1.
• Exposure: Not an asbestos exposure study. The intervention studied was radical pleurectomy decortication: removal of the parietal and visceral pleura and resection of the hemidiaphragm with prosthetic reconstruction, plus partial pericardiectomy in 21 patients. All operations were done by the same surgeon. 20 of 28 patients also received adjuvant chemotherapy (pemetrexed with carboplatin or cisplatin). Asbestos exposure is not reported.
• Main results:
  • Grouping before surgery: 16 patients (57.1%) were performance status 0 and 12 (42.9%) were performance status 1.
  • Before surgery, performance status 1 patients had significantly worse functional scores for global health quality of life, physical function and role function. They also had significantly worse fatigue, pain, dyspnea and appetite loss than performance status 0 patients.
  • At 1 month after surgery, both groups had a decline in global health quality of life, physical, role, cognitive and social function scores that was not statistically significant. Performance status 0 patients had significantly worse pain and insomnia scores than at baseline.
  • At 5 to 6 months, performance status 0 patients had no significant change in global quality of life or function scores. Performance status 1 patients had a significant improvement in global quality of life (19.4 points; p value 0.038) and in fatigue (minus 21.3 points; p value 0.050).
  • By 8 to 9 months after surgery, 6 patients (21%) had died, 1 had withdrawn, and 3 had not yet completed follow-up.
  • At 8 to 9 months, performance status 0 patients (n = 11) showed significant improvement in fatigue from baseline (minus 21.2 points; p value 0.026). They had no significant change in global quality of life or function scores.
  • At 8 to 9 months, performance status 1 patients (n = 7) had significant improvement in global quality of life (24.2 points). They also had significant improvements in fatigue (minus 23.8; p value 0.048), dyspnea (minus 13.1; p value 0.048) and appetite loss (minus 28.6; p value 0.050).
  • Questionnaires were not continued for 1 performance status 0 patient (6.3%) and 5 performance status 1 patients (41.7%) who had significant disease progression between 5 to 6 and 8 to 9 months.
  • A subgroup analysis found no significant change in quality-of-life or dyspnea scores at any interval between patients with and without persistent effusion after surgery. The data were not shown.
• The authors' conclusion: The authors concluded that pleurectomy decortication did not negatively affect minimally symptomatic patients at intermediate follow-up. They also concluded that patients with significant symptoms at baseline can have significant improvement in their quality of life from surgical resection.
• Limitations the authors state:
  • Relatively few patients had the higher (worse) performance status at baseline. The authors say this could represent selection bias, because such patients may not seek, or may be excluded from, radical surgery.
  • The definition of baseline performance status can be subjective.
  • It is unclear whether the improvements came from the surgery or from adjuvant therapy.

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, Performance Status, Dyspnea.

Related studies

• 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)
• A Clinical Trial of TumorGlow to Identify Residual Disease During Pleurectomy and Decortication — J.D. Predina, A.D. Newton, et al. (2019)
• Extrapleural pneumonectomy or pleurectomy/decortication for malignant pleural mesothelioma — S. Hasegawa (2014)
• Non-incisional pleurectomy-decortication for malignant pleural mesothelioma — F. Tanaka, N. Imanishi, et al. (2018)
• Extended pleurectomy decortication for thymoma with pleural dissemination — N. Imanishi, Y. Nabe, et al. (2019)

Browse more research in The Annals of Thoracic Surgery, or return to medical research.