Research into the discovery of independently-useful prognostic factors for patients with mesothelioma makes up a growing number of trials and studies. Because this disease has proven so difficult to treat, the discovery of additional factors or improvements upon current factors may give doctors one more tool in the fight for their patients’ lives. A number of models have been proposed for this purpose, but few have taken into consideration patient-reported symptoms as independent prognostic factors. A recent article in the December 20, 2007 edition of the Journal of Clinical Oncology reports on such a study. The article describes the use of specific patient-reported symptoms in the development of prognostic factors for patients with pleural mesothelioma.

Introduction to the Study

The fundamental question the study inquired into was the relationship between overall survival and individual prognostic factors, using a recently-proposed medical prognostic model and one developed by the analysis of patient-reported symptoms. For the former, the authors utilized the European Organization for Research and Treatment of Cancer (EORTC) prognostic index (PI), which is an index developed from an analysis of “histologic subtype, interval since diagnosis, platelet count, hemoglobin and disease stage.” Along with the EORTC PI, they collected data from patients regarding symptoms using two standards for self-reported symptoms of health-related quality of life (HRQOL), EORTC QLQ-30 and the QLQ-LC13. The former standard, QLQ-30, measured functional living abilities, symptom groups and individual symptoms. The latter, QLQ-LC13, was setup to measure individual reactions of lung cancer patients to symptoms, treatment effects and pain medication. Information from both standards included patient descriptions of functional scales, including physical, role, emotional, cognitive and social abilities, as well as reports of a number of individual elements, such as pain, loss of appetite, nausea, cough, dyspnea, as well other factors.

The authors enrolled 250 patients with pleural mesothelioma into their randomized study. 126 patients received ralitrexed and cisplatin, while 124 received cisplatin alone. To be eligible for the study, patients must have presented with non-resectable, histologically-proven pleural mesothelioma, demonstrated a WHO performance score between 0 and 2 and showed healthy function of liver and kidneys. Median survival for both groups was 10.1 months, with no statistically significant differences between cohorts.

Of the 250 patients enrolled, 229 met the baseline standard for HRQOL descriptions, so those 229 were the sample populatoin used in the analysis of patient-reported symptoms.

Conclusion

At first glance, many of the HRQOL descriptions appeared significant, but when looked into further, few could be independently correlated as a prognostic factor. Using a number of statistical techniques, the authors finally concluded that the elements most effective as prognostic factors for patients with mesothelioma were the EORTC PI and patient-reported symptoms of pain and appetite loss. Physical functioning was also implicated as a prognostic factor, but was more significant when correlated with pain and appetite loss, so they were seen as the significant, independent factors.

These findings do represent an important contribution to the diagnosis and treatment of mesothelioma, as they point towards the beginnings of a prognostic model for this difficult disease.

Labels: mesothelioma