Although surgery can prolong the lives of patients with malignant pleural mesothelioma (MPM), many patients avoid the surgery, fearing it will degrade their quality of life. However, research led by Dr. Wickii Vigneswaran, a Loyola Medicine thoracic surgeon, has found that patients with MPM who underwent pleurectomy and decortication (PD), generally reported an improvement in their quality of life following surgery.
The findings, titled “Quality of Life in Patients Undergoing Pleurectomy and Decortication for Malignant Pleural Mesothelioma,” were recently presented at the 2016 American Society of Clinical Oncology (ASCO) annual meeting.
MPM is a rare cancer often diagnosed in people who have been exposed to high levels of asbestos. The malignancy affects the pleura, a thin membrane of lubricating cells that lines the lungs and chest wall.
Pleurectomy/decortication surgery is a treatment option for some patients with MPM. It is a major two-part surgery that first removes the lining surrounding one lung (pleurectomy), then meticulously removes any tumor masses that are growing inside the chest cavity (decortication). The advantage of PD surgery – often called lung-sparing surgery — is that a patient can keep their lungs. Although PD cannot cure MPM, it can lessen cancer pain and help to improve breathing.
Vigneswaran and colleagues administered a cancer quality-of-life questionnaire (EORTC QLQ-C30) at one month, four-five months, seven-eight months, and 10-11 months in 114 patients with MPM who underwent PD surgery. Before surgery, 31 percent of the patients had a performance status score of 0 (fully functional); 65 percent had a performance status result of 1 (able to do office or light housework); and 4 percent had a performance score of 2 (ambulatory, unable to work but capable of self-care).
The questionnaire assessed patients’ general symptoms (fatigue, nausea/vomiting, and pain); overall functioning (physical, cognitive, emotional); overall health status; and symptoms such as financial difficulties, shortness of breath, constipation, diarrhea, and insomnia.
One month after the PD surgery, researchers observed an improvement in patients’ quality of life, which was maintained at the later follow-up in all patients. Also, surgery did not negatively affect patients’ quality of life at any time in those who, before surgery, had the presence of a tumor cell known as non-epithelioid, who had a performance status of 1 or 2 or a tumor volume superior to 600 ml.
“The net benefit of pleurectomy and decortication justifies the procedure in the majority of patients with malignant pleural mesothelioma,” Vigneswaran, a division director of thoracic surgery and a professor in the department of thoracic and cardiovascular surgery of Loyola University Chicago Stritch School of Medicine, said in a recent news release.