P3.03-061 Burden of Disease and Management of Mesothelioma in France: A National Cohort Analysis: Topic: Mesothelioma Clinical

Abstract

Malignant pleural mesothelioma (MPM) is an uncommon cancer with poor survival. The aim of this study was to determine the burden of MPM disease in France and analyze associations between socio-economic deprivation, population density, management and outcomes of MPM. We used a national hospital data base (PMSI-MCO) to extracted MPM incidents patients of years 2011 and 2012 (ICD-10 codes C45.0 and C54.9 as principal/related or significantly associated diagnosis (PD,RD, SAD) in 2011 and 2012, without MPM codes or C34/C38.4 codes as PD/RD/SAD since 2006). Patients were followed for two years after the initial diagnosis. Cox models were used to analysis one and two-years survival according to sex, age, comorbidities, management, a population density index (PDI) and a social deprivation index (SDI) based on census data aggregated at the municipalities level. 1890 patients were included on the analysis (men: 76%, age: 73.6 ± 10 years, significant comorbidities: 84%). Patients lived in urban zones in 57% cases and in highly deprived areas in 53%. Only 1% had a curative surgical procedure; 65% received at least one dose of chemotherapy (72% at least one administration of chemotherapy with pemetrexed, 28% at least one administration with pemetrexed - bevacizumab); 42% and 20% of the patient received chemotherapy on the last three and the last months of their life, respectively); Survival rate at one- and two-year were 64% and 48% respectively. In multi-variate analysis men, older, patients with chronic renale failure, patients with chronic respiratory failure and patients who didn't receive pemetrexed at any time of their management had worse prognostic. Adjusting analysis on age, gender, comorbidities (hypertension, diabetes, COPD), leaving in rural/semi-rural area was associated with a better survival at one and two-year, HR: 0.82 (0.72-0.96) and HR: 0.83 (0.73-0.94); social deprivation index was not a significant variable for survival. The mean cost management per patient was 27 624 ± (15894 ) euros (31.4% of this cost was the cost of pemetrexed and bevacizumab). MPM remained an uncommon disease, with less of 1000 new cases a year in France, with a very poor prognostic and a significant burden for National Health system.