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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.

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Change in mean EQ-5D values in patients receiving chemotherapy with a falling vs rising mesothelin at 6 weeks.  
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fig3: Change in mean EQ-5D values in patients receiving chemotherapy with a falling vs rising mesothelin at 6 weeks.  

Mentions: The following analyses use only the chemotherapy arm (n=58). Table 3 shows the effect of demographic, tumour and biochemical factors on HRQoL. This analysis focussed on results from the EQ-5D. An independent samples T-test showed no significant differences between the groups at baseline. An ANCOVA method was used to assess the change in HRQoL from baseline to 16 weeks. Those with non-epithelioid histology had a decline in HRQoL and the variance from baseline between the groups was significant, although the same pattern was seen in the comparator group (see Figure 1). Serum mesothelin was measured at baseline and visit 2, a rising or falling mesothelin was not subject to any thresholds. Patients with a falling mesothelin at visit 2 compared with baseline had an improvement in HRQoL compared with those with a rising mesothelin (see Figure 3). Disease response on serial CT imaging (using RECIST criteria) at 8 weeks was also positively correlated with HRQoL (see Figure 4).


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)

Change in mean EQ-5D values in patients receiving chemotherapy with a falling vs rising mesothelin at 6 weeks.  
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig3: Change in mean EQ-5D values in patients receiving chemotherapy with a falling vs rising mesothelin at 6 weeks.  
Mentions: The following analyses use only the chemotherapy arm (n=58). Table 3 shows the effect of demographic, tumour and biochemical factors on HRQoL. This analysis focussed on results from the EQ-5D. An independent samples T-test showed no significant differences between the groups at baseline. An ANCOVA method was used to assess the change in HRQoL from baseline to 16 weeks. Those with non-epithelioid histology had a decline in HRQoL and the variance from baseline between the groups was significant, although the same pattern was seen in the comparator group (see Figure 1). Serum mesothelin was measured at baseline and visit 2, a rising or falling mesothelin was not subject to any thresholds. Patients with a falling mesothelin at visit 2 compared with baseline had an improvement in HRQoL compared with those with a rising mesothelin (see Figure 3). Disease response on serial CT imaging (using RECIST criteria) at 8 weeks was also positively correlated with HRQoL (see Figure 4).

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