Exploring the characteristics of patients with mesothelioma who chose active symptom control over chemotherapy as first-line treatment: A prospective, observational, single centre study

Anna Bibby*, Duneesha De Fonseka, Anna J Morley, Emma Keenan, Alfredo Addeo, Sarah Smith, Anthony Edey, Nick Maskell

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

1 Citation (Scopus)
220 Downloads (Pure)

Abstract

Background: Mesothelioma is an aggressive thoracic tumour with a poor prognosis. The only treatment that extends survival is chemotherapy. However, in the UK, up to 50% of patients who are suitable for chemotherapy choose not to receive it, opting for active symptom control instead.

Aim: The aim of this study was to describe the characteristics of patients who chose active symptom control over chemotherapy and explore their reasons for doing so.

Design: A prospective, single-centre observational study.

Methods: 200 consecutive patients with mesothelioma from one UK centre were included. Eligibility for chemotherapy and choice of first-line treatment were recorded prospectively. Patient characteristics and outcomes were compared using descriptive statistics, regression analysis and survival analysis. Reasons for choosing active symptom control over chemotherapy were extracted, retrospectively.

Results: People who chose active symptom control were older, more likely to be female and had worse performance statuses than patients who received front-line chemotherapy. Concern over side effects, the modest survival benefit and previous adverse experiences with chemotherapy were reported as reasons for the decision.

Median survival was 13.9 months in the chemotherapy group compared with 6.7 months in the active symptom control group.

Conclusions: This is the first study to describe the characteristics of patients with mesothelioma who chose active symptom control over chemotherapy, in the front-line setting. Important differences were seen between this group and patients who received chemotherapy, although confounding is likely to have affected some outcomes.

Future research could use qualitative methods to explore patients’ reasons for choosing active symptom control, and to further elucidate the decision-making process
Original languageEnglish
Article number71
JournalBMC Palliative Care
Volume16
Issue number1
DOIs
Publication statusPublished - 8 Dec 2017

Structured keywords

  • Brain and Behaviour
  • Nutrition and Behaviour

Keywords

  • Active symptom control
  • Best supportive care
  • Chemotherapy
  • Mesothelioma
  • Treatment decisions

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