Clinical characteristics and treatment outcomes in 132 patients with malignant mesothelioma

Symptom burden in mesothelioma patients admitted to home palliative care

CONTEXT

Mesothelioma is a very aggressive cancer that is brought on by asbestos exposure. Because there is a long latency period between exposure to asbestos and symptoms of disease, most patients with mesothelioma present with advanced disease and survive an average of 8-12 months. Thus, best supportive care should be considered critical to optimally manage these patients.

AIM

The aim of this study was to examine the epidemiological characteristics and symptom burden of mesothelioma patients when admitted to home palliative care.

METHODS

The charts of a consecutive sample of patients admitted to the home palliative care program with a diagnosis of mesothelioma in an endemic industrialized area were reviewed. The estimated survival time was about two months from admission. Epidemiological characteristics were collected. Karnofsky status, characteristics of pain and analgesic treatment at time of admission were recorded. ESAS (Edmonton Symptom Assessment System) and other clinical problems reported in the charts at admission time were also recorded.

RESULTS

Of the 674 charts reviewed, 56 patients (8.3%) had a diagnosis of mesothelioma. About three quarters of those had pain, with 18 and 2 patients with moderate and severe pain, respectively, despite receiving medium to high doses of opioids. The principal pain site was the chest. Pain was significantly associated with opioid consumption (p < .0005) and dyspnea (p = .049). Symptom burden was relevant, with a global ESAS of about 40. Pain, weakness, poor appetite, poor well-being, and dyspnea were the most frequent symptoms with the highest intensity; cough and pleural effusion were more frequently present as clinical problems.

CONCLUSION

This study shows that mesothelioma is a devastating cancer with a relevant symptom burden, and that patients were referred to palliative care late in the course of their disease, suggesting that earlier integration of palliative care should be considered to relieve suffering in all disease stages - not only at the end of life.

The value of inflammatory parameters in the prognosis of malignant mesothelioma

Objective

This study investigated the relationship between potential prognostic parameters that may be associated with increased inflammation and survival in patients with malignant mesothelioma (MM).

Methods

This retrospective study assessed potential prognostic parameters measured at the time of MM diagnosis. Data on asbestos exposure, histopathological subtype of MM and laboratory parameters were collected.

Results

In 155 patients with MM (90 male), mean survival time was 13.9 months. In univariate analysis, age ≥60 years and neutrophil-to-lymphocyte ratio (NLR) ≥3 were associated with significantly shortened median survival times. In multivariate analysis, nonepithelial subtype, red cell distribution width (RDW) ≥20% and NLR ≥3 were associated with significantly shortened median survival times. Mortality rate was increased 2.77-, 1.67- and 1.52-fold in patients with RDW ≥20%, NLR ≥3 and nonepithelial subtype, respectively. Nonepithelial subtype, white blood cell count ≥11 200 µl and platelet-to-lymphocyte ratio ≥300 at baseline were associated with a heightened NLR value.

Conclusions

The NLR and RDW were significant predictive factors for MM prognosis.