Pleural mesothelioma patients who undergo pleurectomy/decortication (P/D) surgery may need customized rehabilitation strategies to help restore their quality of life. That is the finding of a Japanese study conducted by rehabilitation experts at the Hyogo College of Medicine.
In a study of malignant pleural mesothelioma patients, the team found that, after P/D, many measures of physical strength and vitality decreased, along with their health-related quality of life.
The authors say healthcare professionals who work with mesothelioma patients should be aware of these findings and the potential need for special rehabilitation approaches after P/D surgery.
P/D Surgery for Pleural Mesothelioma
The study’s 22 subjects all completed P/D mesothelioma surgery between December 2013 and March 2015. P/D is considered the less radical of the two major types of pleural mesothelioma surgery because it does not involve the removal of a lung.
But P/D is still an extensive surgery that can take a toll on the body. During P/D, surgeons remove the patient’s diseased pleural membrane (where mesothelioma tumors start), all or part of the diaphragm, the pericardial membrane around the heart, and other tissues that could potentially host new mesothelioma tumors.
In some centers, the procedure is followed by HIPEC, a rinse of heated chemotherapy drugs aimed at destroying any residual mesothelioma cells before the incision is closed. In the current study, no mention was made of HIPEC.
Assessing Physical Function
To measure what kind of an impact P/D had on the physical function and life quality of people with malignant pleural mesothelioma, the researchers took them through several different tests and a survey.
Post surgical physical evaluations included a handgrip strength test and a knee extensor strength test as well as 6-minute walking distance test. To test their ability to breathe, researchers measured the force and volume of patients’ exhaled breath.
Finally, each mesothelioma patient was asked to complete a 36-item health survey called the SF-36 to assess their health-related quality of life.
Health/Life Quality Suffer After Surgery
Unfortunately, the news was not good for the mesothelioma patients, most of whom felt worse after surgery than before it.
Handgrip strength, 6-mile walk distance, and lung functioning all “decreased significantly compared to baseline”, according to the report in Supportive Care in Cancer. “Additionally, scores of three of the eight SF-36 domains were significantly lower following P/D: physical functioning, body pain, and vitality,” write the authors.
They also found a significant correlation between how much air a post-surgical mesothelioma patient could exhale and how well they functioned, both physically and socially.
Although the strength of the muscles involved in knee extension did not decrease significantly, their capacity to exercise them did, leading the authors to conclude that mesothelioma patients may need special consideration to bounce back after surgery.
“Physicians, nurses, and rehabilitation staff should note these findings, which may provide insight into the development of customized rehabilitation strategies for patients with malignant pleural mesothelioma who completed P/D,” the report concludes.
Tanaka, T, et al, “Physical function and health-related quality of life in patients undergoing surgical treatment for malignant pleural mesothelioma”, March 14, 2017, Supportive Care in Cancer, Epub ahead of print