Limits...
The effect of chemotherapy on health-related quality of life in mesothelioma: results from the SWAMP trial.

Arnold DT, Hooper CE, Morley A, White P, Lyburn ID, Searle J, Darby M, Hall T, Hall D, Rahman NM, De Winton E, Clive A, Masani V, Dangoor A, Guglani S, Jankowska P, Lowndes SA, Harvey JE, Braybrooke JP, Maskell NA - Br. J. Cancer (2015)

Bottom Line: This study focussed on the HRQoL outcomes of these patients using the EQ-5D, EORTC QLQ-C30 and LC13.Compliance with HRQoL questionnaires was 98% at baseline.Additionally, those with a falling mesothelin or improvement on modified-RECIST CT at early follow-up had a better HRQoL at 16 weeks.

View Article: PubMed Central - PubMed

Affiliation: Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol BS10 5NB, UK.

ABSTRACT

Background: The effect of chemotherapy on health-related quality of life (HRQoL) in malignant pleural mesothelioma (MPM) is poorly understood. Patient-individualised prognostication and prediction of treatment response from chemotherapy is useful but little evidence exists to guide practice.

Method: Consecutive patients with MPM who were fit for first-line chemotherapy with pemetrexed and cisplatin\carboplatin were recruited and followed up for a minimum of 12 months. This study focussed on the HRQoL outcomes of these patients using the EQ-5D, EORTC QLQ-C30 and LC13.

Results: Seventy-three patients were recruited of which 58 received chemotherapy and 15 opted for best supportive care (BSC). Compliance with HRQoL questionnaires was 98% at baseline. The chemotherapy group maintained HRQoL compared with the BSC group whose overall HRQoL fell (P=0.006) with worsening dyspnoea and pain. The impact of chemotherapy was irrespective of histological subtype although those with non-epithelioid disease had worse HRQoL at later time points (P=0.012). Additionally, those with a falling mesothelin or improvement on modified-RECIST CT at early follow-up had a better HRQoL at 16 weeks.

Conclusions: HRQoL was maintained following chemotherapy compared with a self-selected BSC group. Once chemotherapy is initiated, a falling mesothelin or improved RECIST CT findings infer a quality-of-life advantage.

Show MeSH

Related in: MedlinePlus

HRQoL dimensions with significant (P<0.01) changes from baseline between the chemotherapy and comparator groups. (A) QLQ-C30 Functional Scales. (B) QLQ-C30 Symptom Scales. (C) LC13 Symptom Scales.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4385962&req=5

fig2: HRQoL dimensions with significant (P<0.01) changes from baseline between the chemotherapy and comparator groups. (A) QLQ-C30 Functional Scales. (B) QLQ-C30 Symptom Scales. (C) LC13 Symptom Scales.

Mentions: There were significant differences between the chemotherapy and comparator groups over time, despite comparable HRQoL at baseline. Most notably in overall health measured by the EQ-5D where the chemotherapy group maintained overall health throughout whereas the comparator group worsened considerably, so that by time point 3 the difference between them using the ANCOVA approach was significant (P=0.006). Figure 1 demonstrates the change in mean EQ-5D from baseline to 16 weeks between the chemotherapy and comparator arms divided by histological subtype. For the EORTC instruments, the Wilcoxon signed ranked test was used to investigate change in functional and symptom scales from baseline. Any dimensions that changed significantly (P<0.01) are represented graphically in Figure 2. General worsening of global health, physical function and fatigue were seen across the cohort. At visit 2, the chemotherapy group experienced worsening social function as well as worsening symptoms of nausea and vomiting and sore mouth. At visit 3, these functional and symptoms scores had resolved but alopecia had worsened significantly. The comparator group did not suffer from the same gastrointestinal symptoms or alopecia but, at visit 3, had significantly worse dyspnoea and arm pain compared with baseline.


The effect of chemotherapy on health-related quality of life in mesothelioma: results from the SWAMP trial.

Arnold DT, Hooper CE, Morley A, White P, Lyburn ID, Searle J, Darby M, Hall T, Hall D, Rahman NM, De Winton E, Clive A, Masani V, Dangoor A, Guglani S, Jankowska P, Lowndes SA, Harvey JE, Braybrooke JP, Maskell NA - Br. J. Cancer (2015)

HRQoL dimensions with significant (P<0.01) changes from baseline between the chemotherapy and comparator groups. (A) QLQ-C30 Functional Scales. (B) QLQ-C30 Symptom Scales. (C) LC13 Symptom Scales.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4385962&req=5

fig2: HRQoL dimensions with significant (P<0.01) changes from baseline between the chemotherapy and comparator groups. (A) QLQ-C30 Functional Scales. (B) QLQ-C30 Symptom Scales. (C) LC13 Symptom Scales.
Mentions: There were significant differences between the chemotherapy and comparator groups over time, despite comparable HRQoL at baseline. Most notably in overall health measured by the EQ-5D where the chemotherapy group maintained overall health throughout whereas the comparator group worsened considerably, so that by time point 3 the difference between them using the ANCOVA approach was significant (P=0.006). Figure 1 demonstrates the change in mean EQ-5D from baseline to 16 weeks between the chemotherapy and comparator arms divided by histological subtype. For the EORTC instruments, the Wilcoxon signed ranked test was used to investigate change in functional and symptom scales from baseline. Any dimensions that changed significantly (P<0.01) are represented graphically in Figure 2. General worsening of global health, physical function and fatigue were seen across the cohort. At visit 2, the chemotherapy group experienced worsening social function as well as worsening symptoms of nausea and vomiting and sore mouth. At visit 3, these functional and symptoms scores had resolved but alopecia had worsened significantly. The comparator group did not suffer from the same gastrointestinal symptoms or alopecia but, at visit 3, had significantly worse dyspnoea and arm pain compared with baseline.

Bottom Line: This study focussed on the HRQoL outcomes of these patients using the EQ-5D, EORTC QLQ-C30 and LC13.Compliance with HRQoL questionnaires was 98% at baseline.Additionally, those with a falling mesothelin or improvement on modified-RECIST CT at early follow-up had a better HRQoL at 16 weeks.

View Article: PubMed Central - PubMed

Affiliation: Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol BS10 5NB, UK.

ABSTRACT

Background: The effect of chemotherapy on health-related quality of life (HRQoL) in malignant pleural mesothelioma (MPM) is poorly understood. Patient-individualised prognostication and prediction of treatment response from chemotherapy is useful but little evidence exists to guide practice.

Method: Consecutive patients with MPM who were fit for first-line chemotherapy with pemetrexed and cisplatin\carboplatin were recruited and followed up for a minimum of 12 months. This study focussed on the HRQoL outcomes of these patients using the EQ-5D, EORTC QLQ-C30 and LC13.

Results: Seventy-three patients were recruited of which 58 received chemotherapy and 15 opted for best supportive care (BSC). Compliance with HRQoL questionnaires was 98% at baseline. The chemotherapy group maintained HRQoL compared with the BSC group whose overall HRQoL fell (P=0.006) with worsening dyspnoea and pain. The impact of chemotherapy was irrespective of histological subtype although those with non-epithelioid disease had worse HRQoL at later time points (P=0.012). Additionally, those with a falling mesothelin or improvement on modified-RECIST CT at early follow-up had a better HRQoL at 16 weeks.

Conclusions: HRQoL was maintained following chemotherapy compared with a self-selected BSC group. Once chemotherapy is initiated, a falling mesothelin or improved RECIST CT findings infer a quality-of-life advantage.

Show MeSH
Related in: MedlinePlus