Exploring the characteristics of patients with mesothelioma who chose active symptom control over chemotherapy as first-line treatment: a prospective, observational, single centre study

Our plain-English summary of Exploring the characteristics of patients with mesothelioma who chose active symptom control over chemotherapy as first-line treatment: a prospective, observational, single centre study, by A.C. Bibby, D. De Fonseka, A.J. Morley, et al (BMC Palliative Care, 2017).

The study

• Authors: A.C. Bibby, D. De Fonseka, A.J. Morley, E. Keenan, A. Addeo, S. Smith, A.J. Edey, N.A. Maskell
• Journal: BMC Palliative Care
• Published: 2017;16(1):71
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Mesothelioma is an aggressive thoracic tumour with a poor prognosis. The only treatment that extends survival is chemotherapy. However, in the UK, up to 50% of patients who are suitable for chemotherapy choose not to receive it, opting for active symptom control instead. The aim of this prospective, single-centre observational study was to describe the characteristics of patients who chose active symptom control over chemotherapy and explore their reasons for doing so.

Methods: Two hundred consecutive patients with mesothelioma from one UK centre were included. Eligibility for chemotherapy and choice of first-line treatment were recorded prospectively. Patient characteristics and outcomes were compared using descriptive statistics, regression analysis and survival analysis. Reasons for choosing active symptom control over chemotherapy were extracted, retrospectively.

Results: People who chose active symptom control were older, more likely to be female and had worse performance statuses than patients who received front-line chemotherapy. Concern over side effects, the modest survival benefit and previous adverse experiences with chemotherapy were reported as reasons for the decision. Median survival was 13.9 months in the chemotherapy group compared with 6.7 months in the active symptom control group.

Conclusions: This is the first study to describe the characteristics of patients with mesothelioma who chose active symptom control over chemotherapy, in the front-line setting. Important differences were seen between this group and patients who received chemotherapy, although confounding is likely to have affected some outcomes. Future research could use qualitative methods to explore patients' reasons for choosing active symptom control, and to further elucidate the decision-making process.

In plain English

This study followed 200 consecutive patients with malignant pleural mesothelioma at one UK centre, enrolled between 2008 and 2016. It described those who were offered first-line chemotherapy but chose active symptom control (specialist follow-up and symptom treatment) instead. Of 139 patients offered chemotherapy, 93 (66.9%) accepted and 46 (33.1%) chose active symptom control. Compared with the chemotherapy group, those choosing symptom control were older (mean age 74.4 vs 68.4), more often female (23.9% vs 10.8%), and had poorer performance status, a measure of everyday physical function. Reasons were documented for only 15 of the 46. They included concern that the benefits did not justify side effects, and previous bad experiences with chemotherapy. Median survival was 14.5 months in the chemotherapy group and 10.8 months in the symptom-control group. The authors said confounding will have influenced this difference. The article's opening summary gives different survival figures (13.9 and 6.7 months). Asbestos exposure was not studied. The authors concluded that recognising these patients could improve communication between clinicians and patients.

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: Prospective, observational, single-centre study of consecutive patients; reasons for treatment choice were collected retrospectively from records
• Who was studied: 200 patients with malignant pleural mesothelioma (MPM) enrolled at one UK centre (Bristol) between 1 March 2008 and 8 June 2016. 150 were initially eligible for chemotherapy. 139 were offered first-line chemotherapy and analysed.
• Exposure: Not an asbestos exposure study. The comparison was the choice of first-line treatment: chemotherapy versus active symptom control (ASC).
• Main results:
  • Of 139 patients offered first-line chemotherapy, 93 (66.9%) accepted and 46 (33.1%) chose active symptom control.
  • The symptom-control group was older than the chemotherapy group (mean age 74.4 vs 68.4, p less than 0.001).
  • The symptom-control group had a higher proportion of women than the chemotherapy group (23.9% vs 10.8%, p = 0.041).
  • The symptom-control group had poorer performance status than the chemotherapy group: PS 0 17.4% vs 43.0%, PS 1 69.6% vs 51.6%, PS 2 13.0% vs 5.4% (p = 0.005).
  • The groups did not differ in side of disease, histology, stage, symptoms or blood tests.
  • In multivariable analysis, age (p less than 0.001) and performance status (p = 0.024) were independently associated with choosing active symptom control.
  • Reasons for choosing symptom control were documented in 15 of 46 cases (32.6%). The most common reason was concern that the benefits of chemotherapy did not justify the risk of side effects (5/15). Two of the 15 cited previous negative experiences with chemotherapy.
  • Median survival was 14.5 months in patients who received first-line chemotherapy and 10.8 months in patients who chose active symptom control (hazard ratio 0.62, 95% CI 0.42 to 0.92, p = 0.016).
  • In multivariable analysis among the 139 patients, not receiving chemotherapy was independently associated with poor survival (HR 1.83, 95% CI 1.13-2.95, p = 0.014).
• The authors' conclusion: The authors concluded that, in this single-centre UK study, people who chose active symptom control were older, more likely to be female and had worse performance status than those who accepted chemotherapy. They added that recognising these patients and understanding their motivations could improve communication between clinicians and patients.
• Limitations the authors state:
  • Reasons for choosing symptom control were collected retrospectively and were available for only about one third of patients. They may not be representative of the whole group.
  • Single UK centre; the results may not be generalizable.
  • Because the study was not randomised, confounding will have influenced the survival comparison.
  • Causal relationships cannot be assumed from this observational study.
  • Clinicians' preferences may have influenced patients' decisions during consultations.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Chemotherapy, Prognosis, Performance Status, Median Overall Survival, Confounding.

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