Relationship Between Physical Function and Health Utility in Patients Undergoing Surgical Treatment for Malignant Pleural Mesothelioma

Our plain-English summary of Relationship Between Physical Function and Health Utility in Patients Undergoing Surgical Treatment for Malignant Pleural Mesothelioma, by T. Tanaka, S. Morishita, M. Hashimoto, et al (Integrative Cancer Therapies, 2021).

The study

• Authors: T. Tanaka, S. Morishita, M. Hashimoto, T. Nakamichi, Y. Uchiyama, S. Hasegawa, K. Domen
• Journal: Integrative Cancer Therapies
• Published: 2021;20:15347354211043508
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Purpose: Health utility, which is a measure of patient-reported outcome (PRO), has recently been used in health-related quality of life for patients with various cancers. However, the relationship between health utility and the physical function and of patients undergoing pleurectomy/decortication (P/D) as surgical treatment for malignant pleural mesothelioma (MPM) has not been reported in the perioperative and convalescent phases. This study aimed to evaluate the perioperative and postoperative health utility of patients undergoing P/D for MPM at one year postoperatively and to examine the relationship with physical function.

Methods: We included patients underwent P/D. Grip strength, knee extension strength, 6-minute walk distance (6MWD), forced vital capacity (FVC), and forced expiratory volume in one second (FEV1) were measured to assess physical function, and the Short-Form Six-Dimension (SF-6D) was completed to assess health utility. These assessments were performed preoperatively, postoperatively, and one year postoperatively. Statistical analysis was performed using one-way analysis of variance for comparison of pre and postoperative and one year mean values.

Results: There were 24 subjects (23 males, 65.5±8.3 year). SF-6D, 6MWD, FVC, and FEV1 values one year operatively improved significantly compared with postoperative. Additionally, SF-6D was correlated with 6MWD.

Conclusion: Health utility were also correlated with exercise capacity.

In plain English

This prospective observational study followed 24 patients in Japan (23 men) with malignant pleural mesothelioma who had lung-sparing surgery called pleurectomy/decortication between September 2014 and April 2019. Asbestos exposure was not examined. The authors measured grip and knee strength, 6-minute walk distance, lung function and a health utility score (SF-6D, where 0 equals death and 1 equals perfect health). Measurements were taken before surgery, about 3 weeks after, and 1 year after. Average SF-6D was 0.61 before surgery, 0.52 after, and 0.61 at 1 year. The drop and the recovery were statistically significant. Walk distance fell after surgery and was not significantly different from its pre-surgery level at 1 year. Lung function fell after surgery and was still significantly below pre-surgery values at 1 year. Changes in muscle strength were not statistically significant. The change in walk distance from before surgery to 1 year correlated with the change in SF-6D (coefficient 0.437). The authors concluded that health utility and physical function improved from post-surgery values by 1 year. They noted that, when calculating these correlations, they could not correct for repeated measurements in the same 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 study
• Who was studied: 24 patients with malignant pleural mesothelioma (23 men; age 65.5, range 42 to 79, per Table 1) who underwent pleurectomy/decortication at Hyogo College of Medicine Hospital, Nishinomiya, Japan, between September 2014 and April 2019. Disease stage at surgery: stage I in 18, stage II in 3, stage III in 3.
• Exposure: Not an asbestos exposure study. The exposure studied was pleurectomy/decortication surgery, preceded in all patients by 3 cycles of chemotherapy. Physiotherapy began the day after surgery, with no rehabilitation after discharge. Assessments were made before surgery, about 3 weeks after surgery, and 1 year after surgery.
• Main results:
  • Health utility (SF-6D), mean (SD), for the 24 patients: 0.61 (0.12) before surgery, 0.52 (0.10) after surgery, and 0.61 (0.11) at 1 year. P was less than .001 for before vs after and for after vs 1 year, and P = .896 for before vs 1 year.
  • Six-minute walk distance averaged 466.2 m before surgery, 366.5 m after surgery, and 471.0 m at 1 year. The post-surgery value was significantly lower than both other time points. There was no significant difference between 1 year and before surgery (P = .949).
  • Lung function fell after surgery. FVC averaged 3.36 L before surgery, 1.87 L after, and 2.43 L at 1 year. FEV1 averaged 2.56 L, 1.57 L and 1.90 L at the same points. Table 2 shows 1-year values still significantly below pre-surgery values (P less than .001).
  • Grip strength and knee extension strength were lower after surgery and partly recovered at 1 year, but these differences were not statistically significant. Post-surgery body weight was significantly lower than before surgery (P = .002).
  • The change in 6-minute walk distance from before surgery to 1 year correlated with the change in SF-6D over the same period (Pearson coefficient 0.437, P less than .05). No other correlation between physical function and SF-6D was marked as significant.
• The authors' conclusion: The authors concluded that patients with malignant pleural mesothelioma who underwent pleurectomy/decortication showed improved health utility and physical function in the convalescent phase compared with their postoperative values. They also concluded that exercise tolerance and health utility were related.
• Limitations the authors state:
  • The study was not interventional, so causal effects of rehabilitation interventions could not be estimated.
  • Patients with recurrent malignant mesothelioma were not included, which may have caused selection bias.
  • The factors behind poor lung function before and after surgery were not investigated; a multivariate analysis is needed in future work.
  • The effect of chemotherapy on quality of life was not considered or compared with the effect of surgery.
  • When calculating correlations between physical function and health utility, the authors could not correct for correlations between repeated measurements in the same patient.

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, Quality of Life, Pleurectomy/Decortication (P/D), FEV1.

Related studies

• Physical function and health-related quality of life in patients undergoing surgical treatment for malignant pleural mesothelioma — T. Tanaka, S. Morishita, et al. (2017)
• Physical function and health-related quality of life in the convalescent phase in surgically treated patients with malignant pleural mesothelioma — T. Tanaka, S. Morishita, et al. (2019)
• Hyperthermic intraoperative pleural cisplatin chemotherapy extends interval to recurrence and survival among low-risk patients with malignant pleural mesothelioma undergoing surgical macroscopic complete resection — D.J. Sugarbaker, R.R. Gill, et al. (2013)
• A systematic review and meta-analysis of surgical treatments for malignant pleural mesothelioma — C. Cao, D. Tian, et al. (2014)
• The role of surgical cytoreduction in the treatment of malignant pleural mesothelioma: meeting summary of the International Mesothelioma Interest Group Congress, September 11-14, 2012, Boston, Mass — V. Rusch, E.H. Baldini, et al. (2013)
• Utility of Chemoresponse Assay in Patients Undergoing Cytoreductive Surgery Plus Hyperthermic Intraperitoneal Chemotherapy — S. Bhagwandin, S. Naffouje, et al. (2015)

Browse return to medical research.