Abstract
BackgroundMesothelioma is an aggressive thoracic tumour with a poor prognosis. The only treatment that extends survival is chemotherapy. However, in the UK, up to 50% of patients who are suitable for chemotherapy choose not to receive it, opting for active symptom control instead.The aim of this prospective, single-centre observational study was to describe the characteristics of patients who chose active symptom control over chemotherapy and explore their reasons for doing so.MethodsTwo hundred consecutive patients with mesothelioma from one UK centre were included. Eligibility for chemotherapy and choice of first-line treatment were recorded prospectively. Patient characteristics and outcomes were compared using descriptive statistics, regression analysis and survival analysis. Reasons for choosing active symptom control over chemotherapy were extracted, retrospectively.ResultsPeople who chose active symptom control were older, more likely to be female and had worse performance statuses than patients who received front-line chemotherapy. Concern over side effects, the modest survival benefit and previous adverse experiences with chemotherapy were reported as reasons for the decision.Median survival was 13.9 months in the chemotherapy group compared with 6.7 months in the active symptom control group.ConclusionsThis is the first study to describe the characteristics of patients with mesothelioma who chose active symptom control over chemotherapy, in the front-line setting. Important differences were seen between this group and patients who received chemotherapy, although confounding is likely to have affected some outcomes.Future research could use qualitative methods to explore patients’ reasons for choosing active symptom control, and to further elucidate the decision-making process.
Highlights
Mesothelioma is an aggressive thoracic tumour with a poor prognosis
Combination chemotherapy with cisplatin and pemetrexed was the first regimen to demonstrate improved survival in mesothelioma – a phase III randomised controlled trial reported a median survival benefit of 2.8 months with dual therapy compared to cisplatin alone, [5] and a subsequent expanded access program report showed survival enhancements of 4 months [6]
The aim of this study was to explore the characteristics of patients who chose to receive active symptom control (ASC) rather than first-line chemotherapy, and to determine what factors were associated with this decision
Summary
Mesothelioma is an aggressive thoracic tumour with a poor prognosis. The only treatment that extends survival is chemotherapy. In the UK, up to 50% of patients who are suitable for chemotherapy choose not to receive it, opting for active symptom control instead. Combination chemotherapy with cisplatin and pemetrexed was the first regimen to demonstrate improved survival in mesothelioma – a phase III randomised controlled trial reported a median survival benefit of 2.8 months with dual therapy compared to cisplatin alone, [5] and a subsequent expanded access program report showed survival enhancements of 4 months [6]. More recently the phase III MAPS trial showed that the addition of bevacizumab to this regimen extended survival by another 2.7 months, this agent may not be suitable for everyone, and is not universally available [7]. Aside from clinical trials, the current alternative to chemotherapy as first-line treatment for MPM is active symptom control (ASC). Whilst the true effect of pemetrexed/cisplatin chemotherapy versus no treatment is currently unknown, it is likely to exceed the 6 months survival benefit conferred by adding pemetrexed and bevacizumab to cisplatin [5, 7]
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