Many Elderly Mesothelioma Patients Get No Treatment

The majority of elderly mesothelioma patients are observed rather than treated and this can have a negative impact on their survival.

That is the finding of a new study published in the Annals of Surgical Oncology.

The study included more than 4,500 mesothelioma patients. Less than a quarter of these patients received any treatment for their mesothelioma. As a result, most of these patients lived less than six months.

Treatment Options for Elderly Mesothelioma Patients

Exposure to asbestos causes pleural mesothelioma. It can take decades after exposure for mesothelioma symptoms to occur. The median age for a malignant pleural mesothelioma diagnosis is 72.

The older a patient is at diagnosis, the more likely they are to have other health problems. These “comorbidities” impact what mesothelioma treatment elderly mesothelioma patients can or should have.

Seniors with many other health problems might not be good candidates for surgery. Others might not be able to tolerate the stress of chemotherapy.

Observation is the Most Common “Treatment”

To conduct the new study, researchers searched the National Cancer Database for newly-diagnosed elderly mesothelioma patients who were 80 or older.

A combination of surgery and chemotherapy produces the best mesothelioma survival results for the right patients. But the study found that only two percent of the over-80 patients got this treatment.

For patients who cannot tolerate surgery (or have non-epithelioid mesothelioma) chemotherapy alone is the recommended route. Twenty-two percent of the elderly mesothelioma patients received chemotherapy.

The majority of elderly mesothelioma patients (63%) were simply “observed” by their physicians. The patients who received only observation had a median survival of 4.1 months.

In contrast, the median survival of the surgery + chemotherapy group was 12.2 months. Those who had only chemotherapy had a median survival of 9.5 months.

Elderly Mesothelioma Patients Present a Challenge

The numbers do not tell the full story. Elderly mesothelioma patients can be especially challenging to treat. Even though surgery and chemotherapy typically yield the best mesothelioma survival results, the combination is also the most risky. This is especially true for older patients.

Eleven percent of study subjects who did have surgery died within a month. Nearly 30 percent died within three months. The researchers say the key to the best outcomes for elderly mesothelioma patients is careful patient selection.

Study author Dr. Vivek Verma of Allegheny General Hospital in Pittsburgh concludes, “Although highly selected surgery/chemotherapy patients were associated with the longest OS [overall survival], given the high biases in database studies and high perioperative mortality rates, careful patient selection for combined modality approaches in this population is imperative.”

Source:

Verma, V, et al, “Management of Malignant Pleural Mesothelioma in the Elderly Population”, April 22, 2019, Annals of Surgical Oncology, Epub ahead of print, https://link.springer.com/article/10.1245%2Fs10434-019-07351-6