Treatment patterns and survival analysis in 9014 patients with malignant pleural mesothelioma from Belgium, the Netherlands and England

Our plain-English summary of Treatment patterns and survival analysis in 9014 patients with malignant pleural mesothelioma from Belgium, the Netherlands and England, by R.A. Damhuis, A. Khakwani, H. De Schutter, et al (Lung Cancer, 2015).

The study

• Authors: R.A. Damhuis, A. Khakwani, H. De Schutter, A.L. Rich, J.A. Burgers, J.P. van Meerbeeck
• Journal: Lung Cancer
• Published: 2015;89(2):212-7
• Cited by: 46 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Pleural mesothelioma has a dismal prognosis and is refractory to local treatment. Combination chemotherapy can increase median survival by several months and was gradually introduced in the period 2003-2006. Elderly patients may be unfit for chemotherapy but little is known about age-related treatment practice. To determine treatment patterns and current survival outcome, three large population-based registries were queried in a uniform manner.

Methods: Data from the Belgian Cancer Registry, the Netherlands Cancer Registry and the UK National Lung Cancer Audit were analyzed for patients diagnosed with pleural mesothelioma since 2007. Treatment patterns and survival rates were compared between countries and age-groups.

Results: The study included 900, 2306 and 5808 patients from Belgium, the Netherlands and England, respectively. Fifty-nine percent of patients were 70 years or older and 84% were men. Chemotherapy use decreased with advancing age and was used more often in Belgium (60%) than in the Netherlands (41%) and England (37%). For patients aged 70-79 years, chemotherapy use was 55%, 36% and 34% in the respective countries. Median survival was 10.7 months in Belgium versus 9.2 months for the Netherlands and 9.5 months for England. Survival rates decreased with advancing age. On average, median survival was 5.6 months longer for patients treated with chemotherapy, irrespective of age.

Conclusions: Combined analysis of data from three countries with high mesothelioma rates demonstrates that chemotherapy has become standard treatment for younger patients. Elderly patients currently account for more than half of all cases and less toxic treatment options will be required to improve their prospects.

Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

In plain English

Using the Belgian and Netherlands cancer registries and the UK National Lung Cancer Audit, the authors described treatment and survival for 9014 patients with pathologically confirmed malignant pleural mesothelioma. There were 900 from Belgium (2007 to 2010), 2306 from the Netherlands and 5808 from England (2007 to 2011). Most were men (84%), and 59% were 70 or older. Chemotherapy was recorded for 60% of patients in Belgium, 41% in the Netherlands and 37% in England, falling with age. For patients 80 or older the figures were 18%, 7% and 8%. Overall median survival was 10.7 months in Belgium, 9.2 in the Netherlands and 9.5 in England, and fell with age. Median survival averaged 5.6 months longer for patients given chemotherapy, but the authors wrote that this difference is probably overrated because of selection bias. They noted that treatment definitions differed between countries and that data on other illnesses and general fitness were missing. The authors concluded that chemotherapy has become standard treatment for younger patients and that elderly patients need less toxic options. The study did not examine asbestos exposure.

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: Descriptive, population-based observational analysis of three national data sources: the Belgian Cancer Registry, the Netherlands Cancer Registry and the UK National Lung Cancer Audit. Each was analysed separately under a uniform protocol, without formal statistical testing. The authors also call it a narrative review of current practice.
• Who was studied: 9014 patients with malignant pleural mesothelioma confirmed by cytology or histology: 900 from the Belgian Cancer Registry (diagnosed 2007 through 2010), 2306 from the Netherlands Cancer Registry and 5808 from the UK National Lung Cancer Audit, restricted to England (both 2007 through 2011). 84% were men and 59% were 70 years or older.
• Exposure: Not asbestos exposure. The study looked at the treatment received (chemotherapy, radiotherapy, surgery), compared by country and age group. In Belgium, 90% of chemotherapy was a pemetrexed-containing regimen. Asbestos exposure was not assessed.
• Main results:
  • Chemotherapy use, all ages: Belgium 60%, the Netherlands 41%, England 37%.
  • Chemotherapy use decreased with age. Among patients aged 70–79 it was 55% (Belgium), 36% (the Netherlands) and 34% (England).
  • Among patients aged 80 and older, chemotherapy use was 18% (Belgium), 7% (the Netherlands) and 8% (England).
  • Overall median survival was 10.7 months in Belgium, 9.2 months in the Netherlands and 9.5 months in England.
  • Across the three countries, median survival fell with age: 13 to 16 months at ages 18–59, 12–13 months at 60–69, 8–10 months at 70–79, and 5–6 months at 80 and over.
  • Patients not treated with chemotherapy had median survival of about 8–10 months at ages 18–59, falling to 5–6 months at 80 and over.
  • Patients treated with chemotherapy had median survival of 15 to 17 months at ages 18–59 and 7–12 months at 80 and over.
  • Median survival was on average 5.6 months longer for patients treated with chemotherapy. The authors judged this difference probably overrated.
  • Surgery (16%) and surgery combined with chemotherapy (11%) were used more often in Belgium. Table 1 gives surgery as 3% in the Netherlands and 8% in England, and surgery with chemotherapy as 2% in each.
• The authors' conclusion: The authors concluded that chemotherapy has become standard treatment for younger patients. They noted that elderly patients now account for more than half of all cases and that less toxic treatment options will be required to improve their prospects.
• Limitations the authors state:
  • Case ascertainment was incomplete because tumours not confirmed by cytology or histology were excluded. If these patients had poor performance status, median survival would be overrated.
  • Treatment categories, and the time periods over which treatment was recorded, were defined differently in each country.
  • There was no information on relevant confounders such as comorbidity, performance status and histological subtype.
  • The analyses were done by three separate researchers without a central database.
  • The survival comparison between patients with and without chemotherapy is prone to selection bias, so the real benefit will be smaller.
  • Differences in survival between countries may reflect differences in diagnostic or registry practice, not only in chemotherapy use.

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, Prognosis, Chemotherapy, Median Survival, Cancer Registry, Lung Cancer, Mesothelioma.

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