Health-related quality of life and inflammatory markers in malignant pleural mesothelioma
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Malignant pleural mesothelioma (MPM) is a highly aggressive and symptomatic disease. We examined the relationship between health-related quality of life (HRQoL) and inflammatory markers, and the prognostic role of HRQoL in MPM patients.
MPM patients from two parallel phase II studies (thalidomide alone or thalidomide with chemotherapy) were included. HRQoL was assessed at baseline using the modified Lung Cancer Symptom Scale (LCSS). Baseline inflammatory markers and cytokines were measured. Spearman correlation was used to examine the relationship between inflammatory markers and HRQoL measures. The prognostic value of the HRQoL domains was examined using Cox proportional hazard model.
Sixty-three patients were included: median age 61 years (range 44–79); 82 % male; 77 % Eastern Cooperative Oncology Group (ECOG) performance status 0–1; 44 % epithelial histology subtype. Baseline systemic symptoms of anorexia and fatigue, the summation symptoms of overall symptomatic distress, interference with normal activity and global QoL and the aggregate score of total LCSS score were all associated with elevated neutrophil-to-lymphocyte ratio, C-reactive protein and vascular endothelial growth factor levels at baseline (rho ≥ 0.25; p < 0.05). Baseline anorexia, fatigue, cough, dyspnoea, pain, overall symptomatic distress, interference with normal activity, global QoL and total LCSS score were all significantly related to survival (p < 0.05) after adjusting for established prognostic factors (age, gender, histological subtype and performance status) and treatment effect.
In conclusion, HRQoL seems to relate to a patient's systemic inflammatory status and is associated with survival in MPM patients.
KeywordsCancer Health-related quality of life Lung cancer symptom scale Malignant mesothelioma Sickness behaviour Systemic inflammation
This project was funded by the New South Wales Dust Diseases Compensation Board and the Estate of Mr. Clem Johnson, for financial support and Eli-Lilly for pharmaceutical support (supply of gemcitabine).
SCH Kao is supported by a National Health & Medical Research Council (NHMRC) postgraduate scholarship and a Research Scholar Award from the NSW Cancer Institute.
J Vardy is supported by the NSW Cancer Institute.
Conflict of interest statement
N Pavlakis is on an advisory board with E Lilly and has received a travel grant and speaking honoraria from E Lilly. N. van Zandwijk declares the following: advisory board for E Lilly, Merk Serono and Pfizer; speaker at Lilly Symposia.
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