Use of cancer therapy at the end of life in patients with malignant pleural mesothelioma
- First Online:
- 258 Downloads
Malignant pleural mesothelioma (MPM) is considered a treatment-resistant disease. We determined the proportion of patients who received treatment in the last month of life and potential factors associated with use of chemotherapy at the end of life.
Consenting MPM patients compensated by the Dust Diseases Board (DDB) were included. Patient, treatment and outcome details were obtained through the DDB, treating physicians and Medicare Australia. The association between potential factors (age, gender, geographical location, disease stage, histological subtype, palliative care referral, length of first line chemotherapy and lines of treatment) and chemotherapy use in the last month of life was determined.
A total of 147 MPM patients were included in the analysis: 78 received chemotherapy, 50 had radiotherapy and 116 had surgery (77 received more than one treatment modality whilst 56 received one treatment modality). Twenty-one patients received treatment in their last month of life: nine received chemotherapy; six, radiotherapy and six had surgery. Those who were treated with second or subsequent lines of chemotherapy were more at risk of receiving chemotherapy until the end of life (six of 19 patients, i.e., 32 %) compared to those who were only treated with first-line therapy (three of 59 patients, i.e., 5 %; p < 0.01). Patients who received chemotherapy at the end of life had shorter survival compared to those who did not receive chemotherapy at the end of life (5.3 vs. 12.5 months, respectively; p = 0.01).
Chemotherapy utilisation in the last month of life is not uncommon in this series of MPM patients. Patients who failed previous chemotherapy were more likely to receive chemotherapy near the end of life. More careful consideration of when to cease chemotherapy needs to be made as patients who received chemotherapy at the end of life had poorer survival outcome.
KeywordsChemotherapy End of life Malignant pleural mesothelioma Radiotherapy Surgery Treatment utilisation
- 1.Vogelzang NJ, Rusthoven JJ, Symanowski J, Denham C, Kaukel E, Ruffie P, Gatzemeier U, Boyer M, Emri S, Manegold C, Niyikiza C, Paoletti P (2003) Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol 21:2636–2644PubMedCrossRefGoogle Scholar
- 2.van Meerbeeck JP, Gaafar R, Manegold C, van Klaveren RJ, van Marck EA, Vincent M, Legrand C, Bottomley A, Debruyne C, Glaccone G, European Organisation for Research and Treatment of Cancer Lung Cancer Group, National Cancer Institute of Canada (2005) Randomized phase III study of cisplatin with or without raltitrexed in patients with malignant pleural mesothelioma: an Intergroup Study of the European Organisation for Research and Treatment of Cancer Lung Cancer Group and the National Cancer Institute of Canada. J Clin Oncol 23:6881–6889PubMedCrossRefGoogle Scholar
- 3.McIllmurray M (2010) The medical treatment of cancer in palliative care. In: Hanks G, Cherny N, Christakis N, Fallon M, Kaasa S, Portenov R (eds) Oxford textbook of palliative Medicine, 4th edn. Oxford University Press, New York, pp 513–525Google Scholar
- 4.Muers MF, Stephens RJ, Fisher P, Darlison L, Higgs CM, Lowry E, Nicholson AG, O'Brien M, Peake M, Rudd R, Snee M, Steele J, Girling DJ, Nankivell M, Pugh C, Parmar MK, MS01 Trial Management Group (2008) Active symptom control with or without chemotherapy in the treatment of patients with malignant pleural mesothelioma (MS01): a multicentre randomised trial. Lancet 371:1685–1694PubMedCrossRefGoogle Scholar
- 5.Australia SW (2011) Mesothelioma in Australia: incidence 1982 to 2007, Mortality 1997 to 2007. Commonwealth of Australia, CanberraGoogle Scholar
- 6.Kao S, Clarke S, Vardy J, Corte P, Clarke C, van Zandwijk N (2012) Patterns of care for malignant pleural mesothelioma patients compensated by the Dust Diseases Board in New South Wales of Australia. Intern Med J. doi:10.1111/j.1445-5994.2012.02925.x
- 9.Nappa U, Lindqvist O, Rasmussen B, Axelsson B (2011) Palliative chemotherapy during the last month of life. Ann Oncol. doi:10.1093/annonc/mdq778
- 15.Kao S, Vardy J, Chatfield M, Corte P, Pavlakis N, Clarke C, van Zandwijk N, Clarke S (2012) Validation of prognostic factors in malignant pleural mesothelioma: a retrospective analysis of data from patients seeking compensation from the New South Wales Dust Diseases Board. Clin Lung Cancer. doi:10.1016/j.cllc.2012.03.011
- 16.Australian Bureau of Statistics (2003) ASGC Remoteness Classification: purpose and use (Census Paper No. 03/01). Commonwealth of Australia, CanberraGoogle Scholar
- 20.Zauderer MG, Sima CS, Ginsberg MS, Krug LM (2012) Lack of response to vinorelbine in patients with previously treated malignant pleural mesothleioma (MPM): rational for placebo-controlled trials in the 2nd line setting. 11th International Conference of the International Mesothelioma Interest Group, Boston, Abstr IB.7Google Scholar
- 22.Flores RM, Pass HI, Seshan VE, Dycoco J, Zakowski M, Carbone M, Bains MS, Rusch VW (2008) Extrapleural pneumonectomy versus pleurectomy/decortication in the surgical management of malignant pleural mesothelioma: results in 663 patients. J Thorac Cardiovasc Surg 135:620–625PubMedCrossRefGoogle Scholar