Advertisement

Effect of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy on Quality of Life in Patients with Peritoneal Mesothelioma

  • Yasmin M. Ali
  • Joseph Sweeney
  • Perry Shen
  • Konstantinos I. Votanopoulos
  • Richard McQuellon
  • Katie Duckworth
  • Kathleen C. Perry
  • Greg Russell
  • Edward A. LevineEmail author
Peritoneal Surface Malignancy

Abstract

Introduction

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) is an accepted treatment for peritoneal mesothelioma. In this study, we evaluated QOL after HIPEC for peritoneal mesothelioma.

Methods

This was a prospective study performed after HIPEC for peritoneal mesothelioma between 2002 and 2015. Patients completed QOL surveys, including the Short Form-36 (SF-36), Functional Assessment of Cancer Therapy + Colon (FACT-C), Brief Pain Inventory (BPI), and Center for Epidemiologic Studies Depression Scale (CES-D) preoperatively and at 3, 6, 12, and 24 months postoperatively.

Results

Overall, 46 patients underwent HIPEC for peritoneal mesothelioma and completed QOL surveys. Mean age was 52.8 ± 13.8 years and 52% were male. Good preoperative functional status was 70%. Median survival was 3.4 years, and 1, 3, and 5-year survivals were 77.4, 55.2, and 36.5%, respectively. CES-D score decreased at 3 months postoperatively, but increased at 24 months (p = 0.014); SF-36 physical functioning scale decreased at 3 months but returned to baseline at 12 months (p = 0.0045); and the general health scale decreased at 3 months, then improved by 6 months (p = 0.0034). Emotional well-being (p = 0.0051), role limitations due to emotional problems (p = 0.0006), social functioning (p = 0.0022), BPI (p = 0.025), least pain (p = 0.045), and worst pain (p < 0.0001) improved. FACT-C physical well-being decreased at 3 months but returned to baseline at 6 months (p = 0.020), and total FACT-C score improved at 6 months (p = 0.052).

Conclusion

QOL returned to baseline or improved from baseline between 3 months and 1 year following surgery. Despite the risks associated with this operation, patients may tolerate HIPEC well and have good overall QOL postoperatively.

Notes

Funding

Supported in part by the Orin Smith Family fund.

References

  1. 1.
    Valente K, et al. A histomorphologic grading system that predicts overall survival in diffuse malignant peritoneal mesothelioma with epithelioid subtype. Am J Surg Pathol. 2016;40(9):1243–8.CrossRefGoogle Scholar
  2. 2.
    Alexander HR, Li CY, Kennedy TJ. Current management and future opportunities for peritoneal metastases: peritoneal mesothelioma. Ann Surg Oncol. 2018;25(8):2159–64.CrossRefGoogle Scholar
  3. 3.
    Sugarbaker PH, et al. Management of malignant peritoneal mesothelioma using cytoreductive surgery and perioperative chemotherapy. J Oncol Pract. 2016;12(10):928–35.CrossRefGoogle Scholar
  4. 4.
    Deraco M, et al. Consensus statement on peritoneal mesothelioma. J Surg Oncol. 2008; 98(4):268–72.CrossRefGoogle Scholar
  5. 5.
    Kusamura S, et al. Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion: analysis of morbidity and mortality in 209 peritoneal surface malignancies treated with closed abdomen technique. Cancer. 2006;106(5):1144–53.CrossRefGoogle Scholar
  6. 6.
    Smeenk RM, Verwaal VJ, Zoetmulder FA. Toxicity and mortality of cytoreduction and intraoperative hyperthermic intraperitoneal chemotherapy in pseudomyxoma peritonei: a report of 103 procedures. Eur J Surg Oncol. 2006;32(2):186–90.CrossRefGoogle Scholar
  7. 7.
    Dodson RM, et al. Quality-of-life evaluation after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2016;23 Suppl 5:72–783.Google Scholar
  8. 8.
    Cella DF, Bonomi AE., Measuring quality of life: 1995 update. Oncology. 1995;9:47–60.Google Scholar
  9. 9.
    McQuellon R, Duckworth KE. Health-related quality of life and cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy. Curr Probl Cancer. 2009;33(3):203–218.CrossRefGoogle Scholar
  10. 10.
    Votanopoulos KI, Sugarbaker P, Deraco M, Morris D, Glehen O, Elias D, et al.; RENAPE Working Group. Is Cytoreductive surgery with heated intraperitoneal chemotherapy justified for biphasic variants of peritoneal mesothelioma? Outcomes from Peritoneal Surface Oncology Group International Registry. Ann Surg Oncol. 2018;25(3):667–73.Google Scholar
  11. 11.
    Cella DF, et al. The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11(3):570–9.CrossRefGoogle Scholar
  12. 12.
    Earlam S, et al. Relation between tumor size, quality of life, and survival in patients with colorectal liver metastases. J Clin Oncol. 1996;14(1):171–5.CrossRefGoogle Scholar
  13. 13.
    Saxton A, Velanovich V. Preoperative frailty and quality of life as predictors of postoperative complications. Ann Surg. 2011;253(6):1223–9.CrossRefGoogle Scholar
  14. 14.
    Hill AR, et al. Survival and quality of life following cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis of colonic origin. Ann Surg Oncol. 2011;18(13):3673–9.CrossRefGoogle Scholar
  15. 15.
    Radloff LS. The use of the center for epidemiologic studies depression scale in adolescents and young adults. J Youth Adolesc. 1991;20(2):149–66.CrossRefGoogle Scholar
  16. 16.
    Daut RL, Cleeland CS, Flanery RC. Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases. Pain. 1983;17(2):197–210.CrossRefGoogle Scholar
  17. 17.
    Oken MM, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5(6):649–55.CrossRefGoogle Scholar
  18. 18.
    Levine EA, et al. Intraperitoneal chemotherapy for peritoneal surface malignancy: experience with 1,000 patients. J Am Coll Surg. 2014;218(4):573–85.CrossRefGoogle Scholar
  19. 19.
    Levine EA, et al. Cytoreductive surgery and intraperitoneal hyperthermic chemotherapy for peritoneal surface malignancy: experience with 501 procedures. J Am Coll Surg. 2007; 204(5):943–53; discussion 953–5.CrossRefGoogle Scholar
  20. 20.
    Dodson R, Kuncewitch M, Votanopoulos KI, Shen P, Levine EA. Techniques for Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol. 2018;25(8):2152–2158.CrossRefGoogle Scholar
  21. 21.
    Blackham A, Levine EA. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for malignant peritoneal mesothelioma. Eur J Clin Med Oncol. 2012;4:25–32.Google Scholar
  22. 22.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefGoogle Scholar
  23. 23.
    Ihemelandu CU, McQuellon R, Shen P, Stewart JH, Votanopolos KI, Levine EA. Predicting Postoperative Morbidity following Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy (CS + HIPEC) with preoperative FACT-C (Functional Assessment of Cancer Therapy) and Patient Rated Performance Status. Ann Surg Oncol. 2013;20;3519–3526.CrossRefGoogle Scholar
  24. 24.
    Park B, Alexander H, Libutti S, Wu P, Royalty D, Kranda K, et al. Treatment of primary peritoneal mesothelioma by continuous hyperthermic peritoneal perfusion. Ann Surg Oncol 1999;6:582–590.CrossRefGoogle Scholar
  25. 25.
    Busija L, Pausenberger E, Haines TP, Haymes S, Buchbinder R, Osborne RH. Adult measures of general health and health‐related quality of life: Medical Outcomes Study Short Form 36‐Item (SF‐36) and Short Form 12‐Item (SF‐12) Health Surveys, Nottingham Health Profile (NHP), Sickness Impact Profile (SIP), Medical Outcomes Study Short Form 6D (SF‐6D), Health Utilities Index Mark 3 (HUI3), Quality of Well‐Being Scale (QWB), and Assessment of Quality of Life (AQOL). Arthritis Care & Research, 2011; 63: S383–S412.CrossRefGoogle Scholar
  26. 26.
    Markman M, Bundy BN, Alberts DS, Fowler JM, Clark-Pearson DL, Carson LF, et al. Phase III trial of standard-dose intravenous cisplatin plus paclitaxel versus moderately high-dose carboplatin followed by intravenous paclitaxel and intraperitoneal cisplatin in small-volume stage III ovarian carcinoma: an intergroup study of the Gynecologic Oncology Group, Southwestern Oncology Group, and Eastern Cooperative. J Clin Oncol. 2001;19(4):1001–7.CrossRefGoogle Scholar
  27. 27.
    Valle SJ, Alzahrani NA, Liauw W, Sugarbaker PH, Bhatt A, Morris DL. Hyperthermic intraperitoneal cehmaotherapy (HIPEC) methodology, drugs, and bidirectional chemotherapy. Indian J Surg Oncol. 2016;7(2):152–9.CrossRefGoogle Scholar
  28. 28.
    Verwaal VJ. Long-term results of cytoreduction and HIPEC followed by systemic chemotherapy. Cancer J. 2009;15(3):212–5.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Yasmin M. Ali
    • 1
  • Joseph Sweeney
    • 1
  • Perry Shen
    • 1
  • Konstantinos I. Votanopoulos
    • 1
  • Richard McQuellon
    • 1
  • Katie Duckworth
    • 1
  • Kathleen C. Perry
    • 1
  • Greg Russell
    • 1
  • Edward A. Levine
    • 1
    Email author
  1. 1.Surgical Oncology Service, Department of General SurgeryWake Forest UniversityWinston-SalemUSA

Personalised recommendations