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Patterns of care and survival of older patients with malignant pleural mesothelioma

Published:March 24, 2019DOI:https://doi.org/10.1016/j.jgo.2019.02.013

      Abstract

      Objective

      Malignant pleural mesothelioma (MPM) is a cancer that primarily affects older adults. However this patient population is frequently under-represented in clinical studies. Therefore, we studied the impact of advancing age on treatment utilisation and clinical outcomes in an extensive series of minimally selected MPM patients.

      Materials and Methods

      Patients with MPM receiving compensation from the New South Wales (NSW) Dust Diseases Authority (2002–2009) were assessed. They were categorised by age (<70 years, 70–80 years or > 80 years) and chi-square testing was used to assess the relationship between clinical and demographic variables, age, treatment and overall survival (OS).

      Results

      We identified 910 patients; 41% were aged <70 years, 40% were aged 70–80 years, and 19% were aged >80 years old. Median OS decreased with increasing age: 13.5 months in <70 years, 9.5 months in 70–80 years and 7.1 months in >80 years as did chemotherapy use (66%, 35% and 8% respectively). Radical surgical intervention, adjuvant, and palliative radiotherapy were less frequently used with advanced age. A Kaplan Meier analysis revealed that there was a significant survival advantage (p < .001) for patients <70 and 70–80 years receiving chemotherapy (16.8 vs 7.0 months; 13.9 vs 5.8 months respectively), but not for patients >80 years.

      Conclusion

      Advancing age group of NSW patients with MPM was associated with reduced treatment utilisation and a decline in OS. Prospective studies are warranted to verify if current treatment guidelines are relevant for the older adults with MPM.
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      References

        • Australian Institute of Health and Welfare
        Cancer in Australia: an overview 2014.
        in: Cancer Series No 90 Cat no CAN 88. AIHW, Canberra2015
        • Quinten C.
        • Coens C.
        • Ghislain I.
        • Zikos E.
        • Sprangers M.A.
        • Ringash J.
        • et al.
        The effects of age on health-related quality of life in cancer populations: a pooled analysis of randomized controlled trials using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 involving 6024 cancer patients.
        Eur J Cancer. 2015; 51: 2808-2819
        • Owonikoko T.K.
        • Ragin C.C.
        • Belani C.P.
        • Oton A.B.
        • Gooding W.E.
        • Taioli E.
        • et al.
        Lung Cancer in elderly patients: an analysis of the surveillance, epidemiology, and end results database.
        J Clin Oncol. 2007; 25: 5570-5577
        • Satoh H.
        • Kurishima K.
        • Nakamura R.
        • Ishikawa H.
        • Kagohashi K.
        • Ohara G.
        • et al.
        Lung cancer in patients aged 80 years and over.
        Lung Cancer. 2009; 65: 112-118
        • Talarico L.
        • Chen G.
        • Pazdur R.
        Enrollment of elderly patients in clinical trials for cancer drug registration: a 7-year experience by the US Food and Drug Administration.
        J Clin Oncol. 2004; 22: 4626-4631
        • Sanoff H.K.
        • Carpenter W.R.
        • Stürmer T.
        • Goldberg R.M.
        • Martin C.F.
        • Fine J.P.
        • et al.
        Effect of adjuvant chemotherapy on survival of patients with stage III Colon Cancer diagnosed after age 75 years.
        J Clin Oncol. 2012; 30: 2624-2634
        • McKibbin T.
        • Frei C.R.
        • Greene R.E.
        • Kwan P.
        • Simon J.
        • Koeller J.M.
        Disparities in the use of chemotherapy and monoclonal antibody therapy for elderly advanced colorectal Cancer patients in the community oncology setting.
        Oncologist. 2008; 13: 876-885
        • Vogelzang N.J.
        • Rusthoven J.J.
        • Symanowski J.
        • Denham C.
        • Kaukel E.
        • Ruffie P.
        • et al.
        Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma.
        J Clin Oncol. 2003; 21: 2636-2644
        • Zalcman G.
        • Mazieres J.
        • Margery J.
        • Greillier L.
        • Audigier-Valette C.
        • Moro-Sibilot D.
        • et al.
        Bevacizumab for newly diagnosed pleural mesothelioma in the mesothelioma Avastin cisplatin Pemetrexed study (MAPS): a randomised, controlled, open-label, phase 3 trial.
        Lancet. 2016; 387: 1405-1414
        • Damhuis R.A.
        • Schroten C.
        • Burgers J.A.
        Population-based survival for malignant mesothelioma after introduction of novel chemotherapy.
        Eur Respir J. 2012; 40: 185-189
        • Ceresoli G.L.
        • Grosso F.
        • Zucali P.A.
        • Mencoboni M.
        • Pasello G.
        • Ripa C.
        • et al.
        Prognostic factors in elderly patients with malignant pleural mesothelioma: results of a multicenter survey.
        Br J Cancer. 2014; 111: 220-226
        • Ceresoli G.L.
        • Castagneto B.
        • Zucali P.A.
        • Favaretto A.
        • Mencoboni M.
        • Grossi F.
        • et al.
        Pemetrexed plus carboplatin in elderly patients with malignant pleural mesothelioma: combined analysis of two phase II trials.
        Br J Cancer. 2008; 99: 51-56
        • Yang C.J.
        • Yan B.W.
        • Meyerhoff R.R.
        • Saud S.M.
        • Gulack B.C.
        • Speicher P.J.
        • et al.
        Impact of age on long-term outcomes of surgery for malignant pleural mesothelioma.
        Clin Lung Cancer. 2016 Sep; 17: 419-426
        • Damhuis R.A.
        • Khakwani A.
        • De Schutter H.
        • Rich A.L.
        • Burgers J.A.
        • van Meerbeeck J.P.
        Treatment patterns and survival analysis in 9014 patients with malignant pleural mesothelioma from Belgium, the Netherlands and England.
        Lung Cancer. 2015; 89: 212-217
        • Linton A.
        • Pavlakis N.
        • O'Connell R.
        • Soeberg M.
        • Kao S.
        • Clarke S.
        • et al.
        Factors associated with survival in a large series of patients with malignant pleural mesothelioma in New South Wales.
        Br J Cancer. 2014; 111: 1860-1869
        • Baas P.
        • Fennell D.
        • Kerr K.M.
        • Van Schil P.E.
        • Haas R.L.
        • Peters S.
        • et al.
        Malignant pleural mesothelioma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up.
        Ann Oncol. 2015; 26: v31-v39
        • van Zandwijk N.
        • Clarke C.
        • Henderson D.
        • Musk A.W.
        • Fong K.
        • Nowak A.
        • et al.
        Guidelines for the diagnosis and treatment of malignant pleural mesothelioma.
        J Thorac Dis. 2013; 5: E254-E307
        • Farzin M.
        • Toon C.W.
        • Clarkson A.
        • Sioson L.
        • Watson N.
        • Andrici J.
        • et al.
        Loss of expression of BAP1 predicts longer survival in mesothelioma.
        Pathology. 2015; 47: 302-307
        • Korc-Grodzicki B.
        • Holmes H.M.
        • Shahrokni A.
        Geriatric assessment for oncologists.
        Cancer Biol Med. 2015; 12: 261-274
        • Hamaker M.E.
        • Schiphorst A.H.
        • ten Bokkel Huinink D.
        • Schaar C.
        • van Munster B.C.
        The effect of a geriatric evaluation on treatment decisions for older cancer patients--a systematic review.
        Acta Oncol. 2014; 53: 289-296
        • Hamaker M.E.
        • Te Molder M.
        • Thielen N.
        • van Munster B.C.
        • Schiphorst A.H.
        • van Huis L.H.
        The effect of a geriatric evaluation on treatment decisions and outcome for older cancer patients - a systematic review.
        J Geriatr Oncol. 2018 Sep; 9: 430-440
        • Wildiers H.
        • Heeren P.
        • Puts M.
        • Topinkova E.
        • Janssen-Heijnen M.L.
        • Extermann M.
        • et al.
        International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer.
        J Clin Oncol. 2014; 32: 2595-2603
        • Versteeg K.S.
        • Konings I.R.
        • Lagaay A.M.
        • van de Loosdrecht A.A.
        • Verheul H.M.
        Prediction of treatment-related toxicity and outcome with geriatric assessment in elderly patients with solid malignancies treated with chemotherapy: a systematic review.
        Ann Oncol. 2014; 25: 1914-1918
        • Mohile S.G.
        • Dale W.
        • Somerfield M.R.
        • Schonberg M.A.
        • Boyd C.M.
        • Burhenn P.S.
        • et al.
        Practical assessment and Management of Vulnerabilities in older patients receiving chemotherapy: ASCO guideline for geriatric oncology.
        J Clin Oncol. 2018; 36: 2326-2347
        • Hurria A.
        • Togawa K.
        • Mohile S.G.
        • Owusu C.
        • Klepin H.D.
        • Gross C.P.
        • et al.
        Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study.
        J Clin Oncol. 2011; 29: 3457-3465
        • Extermann M.
        • Boler I.
        • Reich R.R.
        • Lyman G.H.
        • Brown R.H.
        • DeFelice J.
        • et al.
        Predicting the risk of chemotherapy toxicity in older patients: the chemotherapy risk assessment scale for high-age patients (CRASH) score.
        Cancer. 2012; 118: 3377-3386
        • Gironés R.
        • Torregrosa D.
        • Gómez-Codina J.
        • Maestu I.
        • Tenias J.M.
        • Rosell R.
        Lung cancer chemotherapy decisions in older patients: the role of patient preference and interactions with physicians.
        Clin Transl Oncol. 2012; 14: 183-189
        • Moth E.
        • McLachlan S.A.
        • Veillard A.S.
        • Muljadi N.
        • Hudson M.
        • Stockler M.R.
        • et al.
        Patients' preferred and perceived roles in making decisions about adjuvant chemotherapy for non-small-cell lung cancer.
        Lung Cancer. 2016; 95: 8-14