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
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 language | English |
|---|---|
| Article number | 71 |
| Journal | BMC Palliative Care |
| Volume | 16 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 8 Dec 2017 |
Research Groups and Themes
- Brain and Behaviour
- Nutrition and Behaviour
- Academic Respiratory Unit
Keywords
- Active symptom control
- Best supportive care
- Chemotherapy
- Mesothelioma
- Treatment decisions