Quality of life and personality traits in patients with malignant pleural mesothelioma and their first-degree caregivers

Our plain-English summary of Quality of life and personality traits in patients with malignant pleural mesothelioma and their first-degree caregivers, by A. Granieri, S. Tamburello, A. Tamburello, et al (Neuropsychiatric Disease and Treatment, 2013).

The study

• Authors: A. Granieri, S. Tamburello, A. Tamburello, S. Casale, C. Cont, F. Guglielmucci, M. Innamorati
• Journal: Neuropsychiatric Disease and Treatment
• Published: 2013;9:1193-202
• Cited by: 27 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Asbestos exposure causes significant pleural diseases, including malignant pleural mesothelioma (MPM). Taking into account the impact of MPM on emotional functioning and wellbeing, this study aimed to evaluate the quality of life and personality traits in patients with MPM and their first-degree caregivers through the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and the Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF). The sample was composed of 27 MPM patients, 55 first-degree relatives enrolled in Casale Monferrato and Monfalcone (Italy), and 40 healthy controls (HC). Patients and relatives reported poorer physical health than the HC. Patients had a higher overall sense of physical debilitation and poorer health than relatives and the HC, more numerous complaints of memory problems and difficulties in concentrating, and a greater belief that goals cannot be reached or problems solved, while often claiming that they were more indecisive and inefficacious than the HC. First-degree relatives reported lower opinions of others, a greater belief that goals cannot be reached or problems solved, support for the notion that they are indecisive and inefficacious, and were more likely to suffer from fear that significantly inhibited normal activities than were HC. In multinomial regression analyses, partial models indicated that sex, physical comorbidities, and the True Response Inconsistency (TRIN-r), Malaise (MLS), and Behavior-Restricting Fears (BRF) dimensions of the MMPI-2-RF had significant effects on group differences. In conclusion, health care providers should assess the ongoing adjustment and emotional wellbeing of people with MPM and their relatives, and provide support to reduce emotional distress.

In plain English

This cross-sectional study in Casale Monferrato and Monfalcone, Italy, compared quality of life and personality-test scores in 27 people with malignant pleural mesothelioma, 55 first-degree relatives who cared for them, and 40 healthy controls recruited among people not exposed to asbestos. All the patients had occupational exposure to asbestos. Participants filled in two self-report questionnaires, the WHOQOL-BREF and the MMPI-2-RF. Patients and relatives reported poorer physical health than controls. Patients scored higher than controls on scales for physical malaise, memory and concentration complaints, and helplessness. Relatives scored higher than controls on cynicism, helplessness and fears that restrict normal activities. Differences in psychological and environmental quality of life were not statistically significant after correction for multiple testing. In a final statistical model, patients were more likely than controls to have other physical illnesses (odds ratio 27.43; 95% confidence interval 3.17 to 237.50) and to have higher malaise scores. The authors noted the small number of patients and their reliance on self-report questionnaires. The authors concluded that health care providers should assess the ongoing adjustment and emotional wellbeing of patients and their relatives.

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: Cross-sectional questionnaire study comparing patients, their caregiving relatives, and healthy controls
• Who was studied: Of 153 people enrolled, 19 patients died before the assessment was complete and 12 people were excluded. The final sample was 27 patients with malignant pleural mesothelioma (8 women, 19 men; mean age 61.41), 55 first-degree relatives who provided direct care (43 women, 12 men; mean age 56.51), and 40 healthy controls (22 women, 18 men; mean age 44.63). Patients lived in Casale Monferrato and Monfalcone, Italy, and were diagnosed between January and June 2010. Controls came from similar towns and were not exposed to asbestos.
• Exposure: All patients had occupational exposure to asbestos. Fiber types, jobs and doses were not reported. The study measured quality of life (WHOQOL-BREF) and personality traits (MMPI-2-RF), not exposure.
• Main results:
  • Patients and relatives both reported poorer physical health on the WHOQOL than the healthy controls.
  • Patients and relatives had lower raw scores than controls on psychological and environmental health, but these differences were not statistically significant after correction for multiple testing.
  • Patients had a higher overall sense of physical debilitation and poor health (Malaise scale) than both relatives and controls.
  • Patients complained of memory and concentration problems more often than controls. They were also more likely than controls to believe that goals cannot be reached or problems solved, and to describe themselves as indecisive and inefficacious.
  • Compared with controls, first-degree relatives reported lower opinions of others (Cynicism scale), more helplessness/hopelessness and inefficacy, and more fears that significantly inhibit normal activities.
  • Patients and relatives scored higher than controls on several MMPI-2-RF validity scales, which the authors read as more inconsistent 'true' answering and more frequent reporting of uncommon and somatic complaints.
  • The healthy controls were younger than the other groups, more likely to be women, more likely to live alone, and less likely to have low school attainment.
  • In the final regression model, patients compared with controls were more likely to have physical comorbidities: odds ratio 27.43 (95% CI 3.17 to 237.50).
  • In the final model, patients compared with controls had higher True Response Inconsistency scores (OR 1.99; 95% CI 1.22 to 3.22) and higher Malaise scores (OR 1.88; 95% CI 1.15 to 3.08).
  • In the final model, patients compared with controls were less likely to be women (OR 0.12; 95% CI 0.02 to 0.78) and less likely to live alone (OR 0.08; 95% CI 0.01 to 0.51).
  • In the final model, first-degree relatives compared with controls were less likely to live alone (OR 0.20; 95% CI 0.05 to 0.80) and more likely to have had lower amounts of schooling (OR 5.16; Table 6 gives 95% CI 1.12 to 23.82).
  • The final model explained 66% of the variability in the data. Behavior-restricting fears and WHOQOL physical health did not have a significant effect in that model.
• The authors' conclusion: The authors concluded that patients with malignant pleural mesothelioma have poorer physical health and report malaise, cognitive symptoms, inefficacy, helplessness and hopelessness. They found that caregivers report inefficacy and helplessness and lack trust in people. In the authors' view, health care providers should assess the ongoing adjustment and emotional wellbeing of patients and their relatives. They added that no controlled studies yet show whether psychological interventions reduce this distress.
• Limitations the authors state:
  • The number of patients was low because of short survival times.
  • Low statistical power may have kept some comparisons from reaching significance, and small group sizes may have widened confidence intervals.
  • The authors did not use well-accepted measures to screen for depression and anxiety symptoms.
  • Only self-report measures were used, which may be affected by social desirability bias.
  • Patients and caregivers scored higher than controls on validity scales.
  • Controls differed from patients and relatives on several sociodemographic variables, even after controlling for other variables.

Topics

Medical terms in this study, explained in our Lexicon: Quality of Life, Pleural Mesothelioma, Asbestos Exposure, Casale Monferrato.

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