Rehabilitation for Functioning and Quality of Life in Patients with Malignant Pleural Mesothelioma: A Scoping Review

Our plain-English summary of Rehabilitation for Functioning and Quality of Life in Patients with Malignant Pleural Mesothelioma: A Scoping Review, by L. Lippi, A. de Sire, V. Aprile, et al (Current Oncology, 2024).

The study

• Authors: L. Lippi, A. de Sire, V. Aprile, D. Calafiore, A. Folli, F. Refati, A. Balduit, A. Mangogna, M. Ivanova, K. Venetis, N. Fusco, M. Invernizzi
• Journal: Current Oncology
• Published: 2024;31(8):4318-4337
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) represents a significant clinical challenge due to limited therapeutic options and poor prognosis. Beyond mere survivorship, setting up an effective framework to improve functioning and quality of life is an urgent need in the comprehensive management of MPM patients. Therefore, this study aims to review the current understanding of MPM sequelae and the effectiveness of rehabilitative interventions in the holistic approach to MPM. A narrative review was conducted to summarize MPM sequelae and their impact on functioning, disability, and quality of life, focusing on rehabilitation interventions in MPM management and highlighting gaps in knowledge and areas for further investigation. Our findings showed that MPM patients experience debilitating symptoms, including fatigue, dyspnea, pain, and reduced exercise tolerance, decreasing quality of life. Supportive and rehabilitative interventions, including pulmonary rehabilitation, physical exercise improvement, psychological support, pain management, and nutritional supplementation, seem promising approaches in relieving symptoms and improving quality of life but require further research. These programs emphasize the pivotal synergy among patient-tailored plans, multidisciplinary team involvement, and disease-specific focus. Despite advancements in therapeutic management, MPM remains a challenging disease with limited effective interventions that should be adapted to disease progressions. Rehabilitative strategies are essential to mitigate symptoms and improve the quality of life in MPM patients. Further research is needed to establish evidence-based guidelines for rehabilitative interventions tailored to the unique needs of MPM patients.

In plain English

This article was a review of published research, not a new study of patients. The authors called it a scoping review (it is also called a narrative review) of rehabilitation for people with malignant pleural mesothelioma. Two reviewers searched four databases (PubMed/Medline, Scopus, Web of Science and PEDro) between 1 September 2022 and 29 February 2024. Of 669 records found, plus 4 from other sources, 7 studies were included in the synthesis. The review did not study asbestos exposure. Studies it discussed reported frequent symptoms. In one study of patients receiving chemotherapy, 94% reported fatigue. In another, 38% of 61 patients were malnourished. The authors noted that most breathing and exercise programs had been tested in mixed groups of lung cancer and mesothelioma patients, often with small samples. One home-based exercise study reported improved six-minute walk results in its mesothelioma subgroup. The authors concluded that patient-tailored rehabilitation within a multidisciplinary strategy is needed and that further good-quality studies are warranted. They noted that differing study designs and the lack of a formal quality assessment limit the review.

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: Scoping review of published literature (also described in the article as a narrative review)
• Who was studied: Published English-language peer-reviewed studies on rehabilitation and quality of life in malignant pleural mesothelioma patients. Sources were PubMed/Medline, Scopus, Web of Science and PEDro, searched between 1 September 2022 and 29 February 2024. There were 669 database records and 4 from other sources, 599 after duplicates were removed, 53 full texts assessed, and 7 studies included.
• Exposure: No asbestos exposure was studied. The review covered supportive and rehabilitative interventions: respiratory rehabilitation, physical exercise, psychological support, pain management and nutrition.
• Main results:
  • In a cited study of 61 MPM patients (Jeffery et al.), 38% were malnourished and 54% were pre-sarcopenic. Malnourished patients had significantly lower quality-of-life scores than well-nourished patients.
  • In a cited study of MPM patients receiving chemotherapy, the most common symptoms were fatigue (94%), dyspnea (89%), appetite loss (87%) and pain (85%).
  • Studies of respiratory rehabilitation used mixed samples of lung cancer and MPM patients rather than MPM patients alone.
  • In a cited home-based exercise study (Olivier et al.), the six-minute walk test improved significantly in the MPM subgroup (p less than 0.01).
  • The authors judged that small samples and the absence of comparison groups limited the exercise studies they reviewed.
  • A cited source reported that about 19% of MPM patients might experience anxiety and 12.9% might have symptoms of depression.
• The authors' conclusion: The authors concluded that patient-tailored rehabilitation grounded in a comprehensive multidisciplinary strategy is needed for MPM patients, and that further good-quality studies are warranted.
• Limitations the authors state:
  • The included studies varied in design, patient demographics and outcome measures, which may affect comparability.
  • As a scoping review, it did not formally assess study quality or perform a meta-analysis.
  • There is a lack of evidence specific to MPM patients, which may influence the conclusions.

Topics

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

Medical terms in this study, explained in our Lexicon: Quality of Life, Pleural Mesothelioma, Prognosis, Dyspnea, Pulmonary Rehabilitation, Multidisciplinary Team, Disease Progression.

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• Quality of life in patients after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: is it worth the risk? — N. Tsilimparis, C. Bockelmann, et al. (2013)
• Health-related quality of life and inflammatory markers in malignant pleural mesothelioma — S.C. Kao, J. Vardy, et al. (2013)
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