Malignant pleural mesothelioma: treatment patterns and humanistic burden of disease in Europe

Our plain-English summary of Malignant pleural mesothelioma: treatment patterns and humanistic burden of disease in Europe, by A. Moore, B. Bennett, G. Taylor-Stokes, et al (BMC Cancer, 2022).

The study

• Authors: A. Moore, B. Bennett, G. Taylor-Stokes, L. McDonald, M.J. Daumont
• Journal: BMC Cancer
• Published: 2022;22(1):693
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Malignant pleural mesothelioma (MPM) is an aggressive and rare tumour with poor prognosis. Most patients are diagnosed with advanced disease and there is a paucity of data on the humanistic burden of MPM in terms of impact on health-related quality of life (HRQoL) and activity. This study examined real-world treatment patterns and humanistic disease burden of MPM in Europe.

Methods: Physicians abstracted demographic/clinical characteristics and treatment data from MPM-patient medical records; MPM patients self-completed a questionnaire including symptoms, 3-level-EQ-5D questionnaire and Visual Analogue Scale (VAS), Lung Cancer Symptom Scale for Mesothelioma (LCSS-Meso), and Work Productivity and Activity Impairment (WPAI) questionnaire.

Results: Physicians (n = 171) abstracted data of 1390 patients; 767/1390 patients self-completed questionnaires. Patients were elderly with advanced, unresectable MPM. Treatment patterns followed guidelines with most (81%) patients receiving platinum+antifolate chemotherapy at first line (1 L). Maintenance treatment use was high (51.1%) despite no recommended maintenance therapies. Symptom burden was high and health states and HRQoL were poor at 1; declining further with progression. Overall mean (SD): LCSS-Average Symptom Burden Index score was 48.8 (19.3; n = 758); EQ-5D Utility Index score was 0.510 (0.349; n = 763); EQ-5D VAS score was 54.2 (20.3;n = 766); LCSS-3-Item Global Index score was 143.2 (64.5; n = 762); LCSS-normal activities score was 51.9 (24.6;n = 765); WPAI-activity impairment was 56.0% (23.2%; n = 737).

Conclusion: The humanistic burden of MPM is high, despite treatments being prescribed as per available guidance. Treatments that delay progression and provide palliation of symptoms are most likely to improve/maintain HRQoL.

© 2022. The Author(s).

In plain English

In this non-interventional study, carried out in France, Germany, Italy, Spain and the UK in 2019, 171 physicians reviewed the medical charts of 1390 patients with unresectable malignant pleural mesothelioma. Of these patients, 767 completed questionnaires on symptoms, quality of life and daily activity. The study described treatments and patient-reported burden. A history of asbestos exposure was recorded for 64.5% of all patients. At first line, 81.1% of patients received platinum plus antifolate chemotherapy. Of 534 patients who had completed first line, 273 (51.1%) received maintenance treatment. More patients reported common symptoms themselves than their physicians had recorded. Among 763 patients with data, the mean quality-of-life utility score was 0.510. Among 737 patients, mean activity impairment was 56.0%. Quality of life was poorer in patients at later lines of therapy. The authors said differences between treatment groups likely reflected how long patients had been on treatment rather than how well treatments worked. The authors concluded that the burden of the disease was high despite guideline-based treatment. They noted that the study was a snapshot and carried a risk of selection bias.

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: Non-interventional real-world study with cross-sectional and retrospective components: physicians completed electronic case report forms from medical charts, and patients voluntarily completed a self-completion questionnaire
• Who was studied: Adults (18 or older) with physician-confirmed unresectable malignant pleural mesothelioma who were receiving or had completed first-line systemic anti-cancer therapy, excluding clinical trial participants. Patients were seen by oncologists and pulmonologists in France, Germany, Italy, Spain and the UK between January and June 2019.
• Exposure: The study examined treatments for mesothelioma (chemotherapy regimens, maintenance, later-line therapy, best supportive care) and patient-reported burden. It was not a study of asbestos exposure. History of asbestos exposure was recorded: 64.5% of all 1390 patients in the text, and 897 of 1192 patients with known status (75.3%) in Table 1.
• Main results:
  • 171 physicians abstracted data on 1390 patients. Of these patients, 767 completed the patient questionnaire (55.2% response rate).
  • At first line, 1127 patients (81.1%) received platinum plus antifolate doublet chemotherapy.
  • Of 534 patients who had completed first line, 273 (51.1%) received first-line maintenance treatment. Of these, 76.9% were receiving pemetrexed as a single chemotherapy.
  • The most common chart-recorded symptoms across all 1390 patients were dyspnea (39.1%), chest pain (36.8%), weakness/fatigue (35.5%), chronic cough (34.7%) and weight loss (27.9%).
  • More patients self-reported these common symptoms than their physicians had documented.
  • Mean (SD) LCSS average symptom burden index score was 48.8 (19.3) among 758 patients with data.
  • Mean (SD) EQ-5D utility index was 0.510 (0.349) among 763 patients with data.
  • Mean (SD) EQ-5D visual analogue scale score was 54.2 (20.3) among 766 patients.
  • Mean (SD) LCSS 3-item global index score was 143.2 (64.5) among 762 patients.
  • Mean (SD) activity impairment was 56.0% (23.2%) among 737 patients completing the WPAI questionnaire.
  • On the EQ-5D, 83% of patients reported at least moderate pain or discomfort.
  • Health-related quality of life was poorer in patients at later lines of therapy.
  • The authors wrote that the better quality of life seen in patients on single-drug maintenance chemotherapy likely reflected how long they had been on treatment rather than treatment efficacy.
• The authors' conclusion: The authors concluded that treatments were being prescribed as per available guidance, but that the humanistic burden of malignant pleural mesothelioma was high and patients experienced detriment to their health-related quality of life.
• Limitations the authors state:
  • As a cross-sectional design, the study provides only a snapshot of patient status.
  • The study relied on the accuracy of medical charts and on recall by patients.
  • Inclusion depended on physicians' and patients' willingness to participate, which carried a risk of selection bias.
  • Patients who completed the questionnaire differed in several statistically significant ways from those who did not.

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, Quality of Life, Lung Cancer, Mesothelioma, Unresectable, Antifolate, Chemotherapy.

Related studies

• Treatment patterns and humanistic burden of malignant pleural mesothelioma in Spain — S. Cedres, J. Calvete, et al. (2025)
• Asbestos: use, bans and disease burden in Europe — T. Kameda, K. Takahashi, et al. (2014)
• Caregivers of patients with malignant pleural mesothelioma: who provides care, what care do they provide and what burden do they experience? — A. Moore, B. Bennett, et al. (2023)
• Fiber burden and patterns of asbestos-related disease in chrysotile miners and millers — A. Churg, J.L. Wright, et al. (1993)
• Fiber burden and patterns of asbestos-related disease in workers with heavy mixed amosite and chrysotile exposure — A. Churg, S. Vedal (1994)
• Survival patterns in lung and pleural cancer in Europe 1999-2007: Results from the EUROCARE-5 study — S. Francisci, P. Minicozzi, et al. (2015)

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