PURPOSE: Malignant pleural mesothelioma (MPM) is considered a treatment-resistant disease. We determined the proportion of patients who received treatment in the last month of life and potential factors associated with use of chemotherapy at the end of life. METHODS: Consenting MPM patients compensated by the Dust Diseases Board (DDB) were included. Patient, treatment and outcome details were obtained through the DDB, treating physicians and Medicare Australia. The association between potential factors (age, gender, geographical location, disease stage, histological subtype, palliative care referral, length of first line chemotherapy and lines of treatment) and chemotherapy use in the last month of life was determined. RESULTS: A total of 147 MPM patients were included in the analysis: 78 received chemotherapy, 50 had radiotherapy and 116 had surgery (77 received more than one treatment modality whilst 56 received one treatment modality). Twenty-one patients received treatment in their last month of life: nine received chemotherapy; six, radiotherapy and six had surgery. Those who were treated with second or subsequent lines of chemotherapy were more at risk of receiving chemotherapy until the end of life (six of 19 patients, i.e., 32 %) compared to those who were only treated with first-line therapy (three of 59 patients, i.e., 5 %; p < 0.01). Patients who received chemotherapy at the end of life had shorter survival compared to those who did not receive chemotherapy at the end of life (5.3 vs. 12.5 months, respectively; p = 0.01). CONCLUSIONS: Chemotherapy utilisation in the last month of life is not uncommon in this series of MPM patients. Patients who failed previous chemotherapy were more likely to receive chemotherapy near the end of life. More careful consideration of when to cease chemotherapy needs to be made as patients who received chemotherapy at the end of life had poorer survival outcome.
PURPOSE:Malignant pleural mesothelioma (MPM) is considered a treatment-resistant disease. We determined the proportion of patients who received treatment in the last month of life and potential factors associated with use of chemotherapy at the end of life. METHODS: Consenting MPM patients compensated by the Dust Diseases Board (DDB) were included. Patient, treatment and outcome details were obtained through the DDB, treating physicians and Medicare Australia. The association between potential factors (age, gender, geographical location, disease stage, histological subtype, palliative care referral, length of first line chemotherapy and lines of treatment) and chemotherapy use in the last month of life was determined. RESULTS: A total of 147 MPM patients were included in the analysis: 78 received chemotherapy, 50 had radiotherapy and 116 had surgery (77 received more than one treatment modality whilst 56 received one treatment modality). Twenty-one patients received treatment in their last month of life: nine received chemotherapy; six, radiotherapy and six had surgery. Those who were treated with second or subsequent lines of chemotherapy were more at risk of receiving chemotherapy until the end of life (six of 19 patients, i.e., 32 %) compared to those who were only treated with first-line therapy (three of 59 patients, i.e., 5 %; p < 0.01). Patients who received chemotherapy at the end of life had shorter survival compared to those who did not receive chemotherapy at the end of life (5.3 vs. 12.5 months, respectively; p = 0.01). CONCLUSIONS: Chemotherapy utilisation in the last month of life is not uncommon in this series of MPM patients. Patients who failed previous chemotherapy were more likely to receive chemotherapy near the end of life. More careful consideration of when to cease chemotherapy needs to be made as patients who received chemotherapy at the end of life had poorer survival outcome.
Authors: Jan P van Meerbeeck; Rabab Gaafar; Christian Manegold; Rob J Van Klaveren; Eric A Van Marck; Mark Vincent; Catherine Legrand; Andrew Bottomley; Channa Debruyne; Giuseppe Giaccone Journal: J Clin Oncol Date: 2005-10-01 Impact factor: 44.544
Authors: Ezekiel J Emanuel; Yinong Young-Xu; Norman G Levinsky; Gail Gazelle; Olga Saynina; Arlene S Ash Journal: Ann Intern Med Date: 2003-04-15 Impact factor: 25.391
Authors: Raja M Flores; Harvey I Pass; Venkatraman E Seshan; Joseph Dycoco; Maureen Zakowski; Michele Carbone; Manjit S Bains; Valerie W Rusch Journal: J Thorac Cardiovasc Surg Date: 2008-02-14 Impact factor: 5.209
Authors: Martin F Muers; Richard J Stephens; Patricia Fisher; Liz Darlison; Christopher M B Higgs; Erica Lowry; Andrew G Nicholson; Mary O'Brien; Michael Peake; Robin Rudd; Michael Snee; Jeremy Steele; David J Girling; Matthew Nankivell; Cheryl Pugh; Mahesh K B Parmar Journal: Lancet Date: 2008-05-17 Impact factor: 79.321