Author of

• 12736

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  P3.14 - Poster Session 3 - Mesothelioma (ID 197)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Mesothelioma
  • Presentations: 2
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12749

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    P3.14-013 - Longitudinal Observation of Health Related Quality of Life following Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma (ID 3159)

    09:30 - 09:30  |  Author(s): H.M. Dhillon
    • Abstract

    Background
    The aim of this study was to describe the longitudinal picture of Health Related Quality of Life (HQOL) in people with Malignant Pleural Mesothelioma (MPM) post Extrapleural Pneumonectomy (EPP).

    Methods
    Participants receiving EPP from 2011- 2013 were assessed pre-operatively, pre and post adjuvant radiotherapy (Rt), and at 8, 12 and 24 months following surgery. Here we report Global HQOL and HQOL Domain Scores of the EORTC QLQ-C30, and Fatigue Scores from FACT-F. Least squares means were obtained from a mixed models analysis with time as a fixed effect, the pre-op assessment as a covariate and a random subject effect.

    Results
    Twelve men with a mean age of 65 years (range 48-78) completed pre-op and at least one post op assessment. Table 1 and Figure 1 report the mean HQOL domain scores, global HQOL and fatigue at baseline as well as the least squares mean and 95% confidence intervals at each follow up assessment. Table 1. Health related quality of life over time Figure 1 Figure 2 Figure 1: Health related quality of life over time These results suggest that people who elect to have EPP have baseline levels of HQOL comparable to the general population. As expected, HQOL declines after surgery and during adjuvant radiotherapy. Emotional functioning changes least, while physical and social functioning closely mirror each other. Role functioning is the domain most affected and remains low out to 24 months. Global HQOL is relatively stable over time, with an apparent increase at 24 months. Fatigue is worst at the conclusion of radiotherapy and gradually improves.

    Conclusion
    People electing to have EPP report a sudden decline in HQOL, with the nadir around the end of adjuvant radiotherapy. This gradually improves over time, returning to slightly below baseline in many domains.

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    P3.14-014 - Chemotherapy for mesothelioma: patient, caregiver and health professionals' perceptions of treatment and what influences access. (ID 3291)

    09:30 - 09:30  |  Author(s): H.M. Dhillon
    • Abstract

    Background
    Current evidence-based guidelines for management of malignant pleural mesothelioma (MPM) suggest the optimal rate of chemotherapy utilisation should be around 65%. Reported rates of chemotherapy utilisation in Australia are about 54%. This reflects an under-utilisation rate of around 11%; i.e.,11% of those suitable for chemotherapy do not receive it. Here we explore patient, caregiver and health professional perceptions of chemotherapy treatment for MPM, as well as potential barriers and facilitators to accessing treatment.

    Methods
    Semi-structured interviews were conducted with people with MPM, caregivers and health professionals, in person or via telephone, to explore their perception of chemotherapy treatment for people with MPM. The analysis was informed by a framework approach.

    Results
    Overall 68 interviews were conducted: 16 people with MPM, 14 caregivers, 13 medical oncologists, 4 radiation oncologists, 7 respiratory physicians, 3 cardiothoracic surgeons and 11 lung cancer nurses. Health professionals reported varied responses to our estimate of the chemotherapy under-utilisation rate in people with MPM: some suggested it was likely much lower and others higher. Patients and caregivers demonstrated mixed views about the value of chemotherapy. Many reported choosing chemotherapy because they felt the need to “do something”; others stated that starting and/or continuing chemotherapy was their family’s preference, not their own; some believed that their medical oncologist made the decision about treatment. Those electing not to have chemotherapy were satisfied with their decision. Barriers to accessing chemotherapy included: patients’ nihilistic views regarding chemotherapy (no benefit, makes you unwell, other people have done poorly), distance from treatment centre; health professional perceptions such as nihilistic views regarding chemotherapy (no benefit, high toxicity), patient frailty, concerns about overtreatment, cases not presented at multi-disciplinary team meetings (MDTM), low volume MPM centres, lack of availability of carboplatin through Pharmaceutical Benefits Scheme. Facilitators to accessing chemotherapy included: MDTM discussion, treatment in specialist centres, policy to refer all MPM patients to a Medical Oncologist, and use of clinical practice guidelines. Other suggestions to improve access to chemotherapy for MPM included: increased access to specialist lung cancer nurses and allied health professionals, General Practitioner education regarding asbestos exposure history and investigating recurrent pleural effusions. People with MPM and caregivers highlighted the importance of information from health professionals and from others who have experienced these treatments.

    Conclusion
    Reasons for lower than expected rates of chemotherapy utilisation in people with MPM are multifaceted and complex to address. These qualitative results will inform the development of quantitative surveys of people with MPM, caregivers and health professionals to further investigate barriers and facilitators to chemotherapy treatment to guide the development of potential interventions.