Physical Function Predicts Mesothelioma Surgery Outcomes

A patient’s level of physical function prior to mesothelioma surgery is a strong predictor of how well they will do after surgery.

That is the conclusion of a new University of Maryland study. Researchers analyzed the cases of 54 pleural mesothelioma patients before and after lung-sparing P/D surgery. 

The goal was to see what factors had the biggest impact on their post-surgical outcomes. Patients underwent lung function and physical function tests both before and after their operations. 

It turns out that a mesothelioma patient’s ability to be physically active is even more important than their lung function in predicting their recovery.

Lung-Sparing Pleural Mesothelioma Surgery

Pleural mesothelioma is a cancer of the multi-layer membrane (pleura) that surrounds the lungs. As tumors grow, they can constrict and invade the lungs. 

There are two main surgical approaches to pleural mesothelioma. One removes one of the lungs. The other, called pleurectomy with decortication (P/D), leaves the lungs intact. 

Mesothelioma is caused by exposure to asbestos. It can take decades to develop. Most people who receive a mesothelioma diagnosis are over 65. A person’s level of physical function at this age can vary widely. 

The Eastern Cooperative Oncology Group Performance Status (ECOG) test measures physical function in cancer patients. The higher a person scores on this test, the better they are able to perform everyday tasks. Not surprisingly, older patients tend to have lower ECOG scores.

Some lung function tests measure how much air the lungs can hold. Others measure the amount of air a person can exhale and how long it takes. A diffusing capacity test measures how easily oxygen enters the bloodstream.

The Link Between Physical Function and Mesothelioma Outcomes

The new study included 54 pleural mesothelioma patients who had operations between 2015 and 2020. The patients all had extended P/D/ surgery. Surgeons removed their diseased pleural lining and other tissues that could host new mesothelioma tumors. 

After surgery, many pleural mesothelioma patients end up on a ventilator. Some require a chest tube to drain fluid. Others may need to stay in the hospital for many days or weeks.

The goal of the new study was to see if pre-surgical physical function or lung function affected any of these things. 

Outcomes Linked to ECOG Scores

According to the researchers, a person’s ECOG score before surgery was the best predictor of postoperative physical function. 

“Preoperative ECOG was a significant predictor of postoperative patient outcomes while preoperative lung function lacked predictive ability,” writes lead author Simon Ho. A person’s age also played a role. Older patients tended to have more physical difficulties after surgery than younger ones. 

The study brings up two important questions: Could improving a patient’s physical function prior to mesothelioma surgery improve their outcomes? And do more patients need rehabilitation after mesothelioma surgery to improve physical function?

The research team says their study shows the importance of rehabilitation as soon as possible for the best mesothelioma surgery outcomes.

“Patients with MPM should receive rehabilitation early after diagnosis and throughout the continuum of care,” the study concludes. “The results of our study highlight…the need for early rehabilitation and further research to determine optimal rehabilitation interventions.”

Source: 

Ho, S, et al, “Examining the impact of physical function performance in predicting patient outcomes after lung-sparing surgery for malignant pleural mesothelioma”, August 29, 2021, Disability and Rehabilitation, Online ahead of print, https://www.tandfonline.com/doi/abs/10.1080/09638288.2021.1970256?journalCode=idre20