Use of cancer therapy at the end of life in patients with malignant pleural mesothelioma

Our plain-English summary of Use of cancer therapy at the end of life in patients with malignant pleural mesothelioma, by S.C. Kao, N. van Zandwijk, P. Corte, et al (Supportive Care in Cancer, 2013).

The study

• Authors: S.C. Kao, N. van Zandwijk, P. Corte, C. Clarke, S. Clarke, J. Vardy
• Journal: Supportive Care in Cancer
• Published: 2013;21(7):1879-84
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: Malignant pleural mesothelioma (MPM) is considered a treatment-resistant disease. We determined the proportion of patients who received treatment in the last month of life and potential factors associated with use of chemotherapy at the end of life.

Methods: Consenting MPM patients compensated by the Dust Diseases Board (DDB) were included. Patient, treatment and outcome details were obtained through the DDB, treating physicians and Medicare Australia. The association between potential factors (age, gender, geographical location, disease stage, histological subtype, palliative care referral, length of first line chemotherapy and lines of treatment) and chemotherapy use in the last month of life was determined.

Results: A total of 147 MPM patients were included in the analysis: 78 received chemotherapy, 50 had radiotherapy and 116 had surgery (77 received more than one treatment modality whilst 56 received one treatment modality). Twenty-one patients received treatment in their last month of life: nine received chemotherapy; six, radiotherapy and six had surgery. Those who were treated with second or subsequent lines of chemotherapy were more at risk of receiving chemotherapy until the end of life (six of 19 patients, i.e., 32 %) compared to those who were only treated with first-line therapy (three of 59 patients, i.e., 5 %; p < 0.01). Patients who received chemotherapy at the end of life had shorter survival compared to those who did not receive chemotherapy at the end of life (5.3 vs. 12.5 months, respectively; p = 0.01).

Conclusions: Chemotherapy utilisation in the last month of life is not uncommon in this series of MPM patients. Patients who failed previous chemotherapy were more likely to receive chemotherapy near the end of life. More careful consideration of when to cease chemotherapy needs to be made as patients who received chemotherapy at the end of life had poorer survival outcome.

In plain English

This retrospective review from New South Wales, Australia, looked at cancer treatment given in the last month of life to people with malignant pleural mesothelioma. It included 147 patients who were compensated by the NSW Dust Diseases Board between March 2007 and March 2009 and had died by 31 March 2011. Of the 133 who had any anti-cancer treatment or surgery, 21 (16 %) had chemotherapy, radiotherapy or surgery in their last month. Nine of the 78 patients given chemotherapy (12 %) were still receiving it then, and seven of those nine died of progressive mesothelioma. Patients given two or more lines of chemotherapy were more likely to receive it at the end of life (six of 19, 32 %) than those given only first-line treatment (three of 59, 5 %; p less than 0.01). Those given chemotherapy at the end of life had shorter survival from the start of chemotherapy (5.3 vs 12.5 months; p=0.01). The authors concluded that end-of-life chemotherapy was not uncommon and that doctors and patients should be aware of the risk of over-use of treatment. They named the small sample size and retrospective design 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: Retrospective review of patients from an earlier Pattern of Care Study, using Dust Diseases Board records, treating physicians and hospitals, Medicare Australia data and death certificates
• Who was studied: 147 patients with malignant pleural mesothelioma (MPM) who received compensation from the New South Wales Dust Diseases Board between March 2007 and March 2009 and had died by 31 March 2011. They were drawn from 159 patients in an earlier Pattern of Care Study. Median age was 73 years (range 45 to 91), and 92 % were male.
• Exposure: The exposure studied was cancer treatment (chemotherapy, radiotherapy and/or surgery) in the last month of life, not asbestos. The article gives no fiber types or details of asbestos exposure.
• Main results:
  • Of the 147 patients, 133 had anti-cancer treatment and/or surgery during their illness. Of these 133, 56 had one treatment type and 77 had at least two.
  • 21 patients (16 %) received chemotherapy, radiotherapy and/or surgery during the last month of life. No one received two or more treatment types in that month.
  • 116 of the 133 treated patients (87 %) had surgery, including surgical biopsies. Six had surgery in the last month of life: one extrapleural pneumonectomy and five thoracoscopic biopsies.
  • 50 patients (38 %) had radiotherapy. Six of these 50 (12 %) had it in the last month of life: five to relieve tumour-related symptoms and one to prevent tumour recurrence in the surgical tract.
  • 78 patients (59 %) received chemotherapy. None started a new line of chemotherapy in the last month of life, but nine of the 78 (12 %) were still receiving it. Of these nine, seven died of progressive MPM, one of treatment-related sepsis and one of pulmonary embolus.
  • Among chemotherapy patients, having had two or more lines of chemotherapy was the only factor examined that was related to chemotherapy in the last month of life. This applied to 6 of 19 patients (32 %) with two or more lines, compared with 3 of 59 (5 %) with first-line therapy only (p less than 0.01).
  • The other factors tested were not statistically significant. These were age, gender, geographical location, tumour stage, histological subtype, palliative care involvement and number of first-line cycles. For gender, 2 of 6 women (33 %) and 7 of 72 men (10 %) had chemotherapy within 4 weeks of death (p=0.08). The authors said the gender trend may be a chance finding given the small number of women.
  • Patients who received chemotherapy at the end of life had shorter survival from the start of chemotherapy than those who did not: 5.3 months compared with 12.5 months (p=0.01).
  • Of patients who did not receive chemotherapy in the last month of life, 18 of 69 (26 %) died in their usual place of residence, compared with 1 of 9 (11 %) of those who did. This difference was not statistically significant (p=0.32).
• The authors' conclusion: The authors concluded that some end-of-life treatments may be appropriate when they offer medical or legal benefit, such as radiation to manage symptoms or biopsies that allow financial compensation. They also found that chemotherapy at the end of life was not uncommon in MPM, and that patients who had failed previous chemotherapy were more likely to continue it. They said physicians and patients need to be aware of the risk of over-use of treatment.
• Limitations the authors state:
  • Small sample size
  • Hospital and intensive care unit admissions in the last month of life were not available for analysis
  • Retrospective design
  • Findings may not apply to other cancer populations

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, Chemotherapy, Treating Physician, Histological Subtype, Palliative Care, First-line Therapy.

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