New research confirms that surgery followed by HIPEC improves mesothelioma quality of life for people with peritoneal disease.
Every mesothelioma surgery carries risks and can cause serious side effects. These problems often have a negative impact on mesothelioma quality of life in the short term.
But researchers at Wake Forest University say cytoreductive surgery followed by intraperitoneal chemotherapy (HIPEC) boosts life quality for most mesothelioma patients over time.
Evolving Management of Peritoneal Mesothelioma
Malignant mesothelioma is a fast-growing cancer with a very low cure rate. Peritoneal mesothelioma accounts for about a fifth of all mesothelioma cases.
With peritoneal mesothelioma, tumors start on the membrane that surrounds the abdominal organs and can spread to other parts of the body. Fatigue, pain, and gastrointestinal problems may reduce mesothelioma quality of life.
But new surgical techniques have changed the outlook for many peritoneal mesothelioma patients. During cytoreductive surgery (CRS), doctors remove as much of the cancer as possible. CRS followed by a rinse of heated chemotherapy drugs (HIPEC) directly in the abdomen is now the gold standard treatment for peritoneal mesothelioma.
Measuring Mesothelioma Quality of Life
The Wake Forest researchers followed the cases of 46 peritoneal mesothelioma patients between 2002 and 2015. More than half of the patients were men and their mean age was just over 52. About 70 percent of the patients were functioning well before their surgery.
Patients completed a series of surveys related to mesothelioma quality of life before and after surgery. They answered questions about their mental and physical health, social functioning, and pain levels.
Patients filled out the surveys before their CRS/HIPEC procedures and again at 3, 6, 12 and 24 months afterward.
Mesothelioma Quality of Life Goes Down Before it Goes Up
The biggest take-away from the study is that mesothelioma quality of life after CRS/HIPEC surgery usually goes down before it goes up.
Patients reported worse depression three months after their surgery. But the same patients felt happier two years later than they did going in.
The same was true with physical functioning. At three months, it was worse than it had been before surgery but it was back to normal by 12 months. General health was better at 6 months than it had been prior to surgery. Emotional well-being was also better after surgery.
Surgery also had a positive impact on the length of patients’ lives. Participants had a median survival of 3.4 years and 36% of them were still alive at five years.
In a summary of their study in the Annals of Surgical Oncology, the researchers conclude that the chances of improved mesothelioma quality of life make surgery worth the risk for most patients.
“Despite the risks associated with this operation, patients may tolerate HIPEC well and have good overall QOL postoperatively,” they write.
Ali, YM, et al, “Effect of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy on Quality of Life in Patients with Peritoneal Mesothelioma”, May 8, 2019, Annals of Surgical Oncology, Epub ahead of print, https://www.ncbi.nlm.nih.gov/pubmed/31069554