Treatment patterns and humanistic burden of malignant pleural mesothelioma in Spain

Our plain-English summary of Treatment patterns and humanistic burden of malignant pleural mesothelioma in Spain, by S. Cedres, J. Calvete, G. Taylor-Stokes, et al (Clinical & Translational Oncology, 2025).

The study

• Authors: S. Cedres, J. Calvete, G. Taylor-Stokes, N.Á. Ayerza, D.V. Larena, M. Daumont
• Journal: Clinical & Translational Oncology
• Published: 2025;27(1):213-222
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Purpose: Malignant pleural mesothelioma (MPM) is an aggressive cancer with long latency and poor prognosis. The real-world treatment patterns and humanistic burden of MPM in an international cohort of patients were recently published. Spanish data are currently lacking and are reported here.

Methods/patients: Data were collected from three sources: physician-abstracted demographic, clinical and treatment characteristics of patients with MPM; patient-completed questionnaires on treatment satisfaction, symptoms, caregiver use, and impact of the disease; and caregiver-completed questionnaire reporting their activity and its impact on their daily life.

Results: The 241 patients in Spain were primarily elderly (median age: 67 years), male, retired/unemployed/on long-term sick leave, and diagnosed at stage IV with unresectable disease. Exposure to asbestos was detected (54%, 101/188). First-line treatment (1L) consisted primarily of doublet chemotherapy (86%, 207/241). Of 102 patients who completed 1L at data abstraction, 67 were receiving maintenance therapy, most commonly singlet chemotherapy with pemetrexed. Best supportive care was given to 29 patients, primarily after 1L (86.2%, 25/29). Symptom burden was high and health-related quality of life was poor and declined with progression: mean (SD) EQ-5D score and EQ-5D visual analogue scale score were 0.615 (0.285) and 60.8 (17.1) in 1L and 0.497 (0.370) and 56.1 (19.5) in second line. Overall, 67% of patients (162/241) required daily assistance from their caregiver, who reported an impact on their psychological well-being.

Conclusions: Patients with MPM in Spain were overall treated according to treatment guidelines at the time. Nevertheless, a considerable burden of disease was reported by patients and caregivers.

© 2024. The Author(s).

In plain English

This study described treatment and everyday burden among 241 patients with malignant pleural mesothelioma in Spain, part of a larger European survey. Between January and June 2019, 30 oncologists completed forms from medical records, and patients and caregivers filled in optional questionnaires. Most patients had stage IV (69%, 167/241) and unresectable (88%, 213/241) disease. Of the 188 patients with this information recorded, 101 (54%) had a history of asbestos exposure, compared with 79% in the other countries. The article does not identify which asbestos fiber types patients encountered. Most first-line treatment was doublet chemotherapy (86%, 207/241). Mean quality-of-life (EQ-5D) scores were 0.615 for patients on first-line treatment and 0.497 for those on second-line treatment, a difference the authors described as clinically meaningful. Physicians reported that 67% (162/241) of patients needed daily help from a caregiver. Among caregivers, 55% (61/111) needed treatment for conditions linked to caregiving. The authors concluded that care broadly followed the guidelines of the time but that patients and caregivers reported a considerable burden. They cited the cross-sectional design, reliance on reported data, and a six-month timeframe as limitations.

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, descriptive real-world survey study (Spanish subset of an international study), using physician-completed case report forms and voluntary patient and caregiver questionnaires
• Who was studied: 241 adult patients in Spain with unresectable malignant pleural mesothelioma who were undergoing or had completed first-line systemic therapy. Data came from 30 oncologists between January and June 2019. 209 patients completed questionnaires, and 111 patients had caregiver questionnaires.
• Exposure: History of asbestos exposure was recorded for 101 of 188 patients with available data (54%). The article does not name asbestos fiber types. Erionite exposure was recorded for 3 of 128 (2%). The study's main focus was treatment patterns and disease burden, not exposure.
• Main results:
  • Most of the 241 patients were diagnosed at stage IV (69%, 167/241). Most had unresectable disease (88%, 213/241).
  • Considering only available data, 54% of patients in Spain had been exposed to asbestos, compared with 79% of patients abroad (Germany, France, Italy, UK).
  • First-line treatment for the 241 patients was mainly doublet chemotherapy (86%, 207/241). The most common combination was cisplatin plus pemetrexed (56%, 134/241).
  • Of the 102 patients who completed first-line treatment, 67 (66%) had received or were receiving maintenance therapy. Maintenance was mainly pemetrexed (60/67).
  • Mean (SD) EQ-5D-3L scores were 0.615 (0.285) for patients on first-line treatment (n = 118) and 0.497 (0.370) for those on second-line treatment (n = 56). The authors reported this difference as clinically meaningful.
  • LCSS scores (a mesothelioma symptom and quality-of-life scale) showed worse quality of life in second-line than in first-line treatment. The difference was not clinically meaningful.
  • According to physicians, 67% of patients (162/241) required daily assistance from a caregiver.
  • Of the 111 caregivers, 55% (61/111) required treatment for conditions developed or exacerbated by caregiving. Caregivers' mean (SD) Zarit Burden Interview score was 34.8 (15.5).
• The authors' conclusion: The authors concluded that patients with malignant pleural mesothelioma in Spain were overall treated according to the guidelines of the time. They also concluded that patients and caregivers reported a considerable burden of disease.
• Limitations the authors state:
  • The study used a cross-sectional design. It relied on patient- or caregiver-reported data and on complete physician-collected information.
  • The study was conducted over a relatively short timeframe (6 months).
  • Information on erionite exposure was missing for almost half of the sample.

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, Latency, Prognosis, Unresectable, Chemotherapy, Pemetrexed (Alimta), Quality of Life.

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