Malignant pleural mesothelioma: treatment patterns and humanistic burden of disease in Europe

Abstract

Background: Malignant pleural mesothelioma (MPM) is an aggressive and rare tumour with poor prognosis. Most patients are diagnosed with advanced disease and there is a paucity of data on the humanistic burden of MPM in terms of impact on health-related quality of life (HRQoL) and activity. This study examined real-world treatment patterns and humanistic disease burden of MPM in Europe.

Methods: Physicians abstracted demographic/clinical characteristics and treatment data from MPM-patient medical records; MPM patients self-completed a questionnaire including symptoms, 3-level-EQ-5D questionnaire and Visual Analogue Scale (VAS), Lung Cancer Symptom Scale for Mesothelioma (LCSS-Meso), and Work Productivity and Activity Impairment (WPAI) questionnaire.

Results: Physicians (n = 171) abstracted data of 1390 patients; 767/1390 patients self-completed questionnaires. Patients were elderly with advanced, unresectable MPM. Treatment patterns followed guidelines with most (81%) patients receiving platinum+antifolate chemotherapy at first line (1 L). Maintenance treatment use was high (51.1%) despite no recommended maintenance therapies. Symptom burden was high and health states and HRQoL were poor at 1; declining further with progression. Overall mean (SD): LCSS-Average Symptom Burden Index score was 48.8 (19.3; n = 758); EQ-5D Utility Index score was 0.510 (0.349; n = 763); EQ-5D VAS score was 54.2 (20.3;n = 766); LCSS-3-Item Global Index score was 143.2 (64.5; n = 762); LCSS-normal activities score was 51.9 (24.6;n = 765); WPAI-activity impairment was 56.0% (23.2%; n = 737).

Conclusion: The humanistic burden of MPM is high, despite treatments being prescribed as per available guidance. Treatments that delay progression and provide palliation of symptoms are most likely to improve/maintain HRQoL.

Keywords: Disease management; Health-related quality of life; Malignant pleural mesothelioma; Real-world; Treatment.

Fig. 1

1 L combinations (A) and use of 1 L-M (B) for MPM patients, stratified by country. MPM, malignant pleural mesothelioma; 1 L, first-line therapy. Error bars represent 95% confidence intervals. ^†Proportion of patients that had completed 1 L and went on to received 1 L-M

Fig. 2

Symptoms currently experienced by MPM patients: CRF symptom data for all patients, CRF symptom data for those patients that completed the PSC, and patient self-reported symptoms recorded on the PSC. Note: Most frequently reported symptoms recorded for all patients. Error bars represent 95% confidence intervals. CFR, case report form; MPM, malignant pleural mesothelioma; PSC, patient self-completion questionnaire

Fig. 3

Mean LCSS ASBI (A), Mean LCSS-3-IGI (B), and mean Overall Impact on Normal Activities (C) of MPM patients, stratified by current treatment and by current line of therapy at time of data abstraction. Note: Patients from EU countries including France, Germany, Italy, Spain, and the UK. Error bars represent 95% confidence intervals. The MID for the LCSS ASBI is 10 points and the MID for the LCSS-3-IGI is 30 points. ASBI, average symptom burden index; BSC, best supportive care; doublet, doublet chemotherapy; LCSS, Lung Cancer Symptom Scale-Mesothelioma; LOT, line of therapy; MPM, malignant pleural mesothelioma; others, other therapies; SACT, systemic anti-cancer therapy; triplet, triplet chemotherapy; 1 L, first-line therapy; 1 L-M, first-line maintenance therapy; 2 L + SACT, SACT at second or later lines; 2 L+ BSC, BSC at second or later lines; 3-IGI, three-item global index

Fig. 4

Mean EQ-5D UI (A) and mean EQ-5D VAS scores (B) of MPM patients, stratified by current treatment and by current line of therapy at time of data abstraction. Note: Patients from EU countries including France, Germany, Italy, Spain, and the UK. Error bars represent 95% confidence intervals. The MID for the EQ-5D UI score is 0.08 points, and the MID for the EQ-5D VAS score is 7 points. BSC, best supportive care; doublet, doublet chemotherapy; EQ-5D, European quality of life–5 dimensions; UI, utility index; LOT, line of therapy; MID, minimally important difference; MPM, malignant pleural mesothelioma; others, other therapies; SACT, systemic anti-cancer therapy; triplet, triplet chemotherapy; VAS, visual analogue scale; 1 L, first-line therapy; 1 L-M, first-line maintenance therapy; 2 L + SACT, SACT at second or later lines; 2 L+ BSC, BSC at second or later lines