Quality of Life Still Good with HIPEC Surgery for Peritoneal Mesothelioma
• by Tim Povtak
• Research&Clinical Trials
• May 22 , 2019
Surgical oncologist Dr . Edward Levine was not surprised by the encouraging results of the recent study measuring quality-of-life issues following aggressive treatment for patients with peritoneal mesothelioma .
He has been seeing it regularly for several years .
“ It just confirmed my clinical gestalt of how patients
did , ” Levine told The Mesothelioma Center at Asbestos . com . “ But it was nice to now quantify it with standardized , accepted quality-of-life measures . ”
The potential benefits outweighed the risks .
Levine , chief of the surgical oncology program at Wake Forest Baptist Comprehensive Cancer Center , is a nationally recognized specialist in peritoneal surface malignancies .
He is the senior author of the study that questioned 46 mesothelioma patients who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy , also known as HIPEC .
Annals of Surgical Oncology published the study in May 2019 .
Patients completed surveys preoperatively to establish a baseline , then again at three , six , 12 and 24 months after completion of the surgery and HIPEC combination .
“ Patients who go through the treatment tend to have good quality of life after recovering from the acute effects of surgery , ” Levine said . “ If we can get patients to these procedures , many of them will be long-term survivors . ”
Procedure Produces Long-Term Survivors
Much of the work was presented at the Society of Surgical Oncology meeting in Chicago last spring .
Median survival was 3 . 4 years . One- , three-and five-year survival rates were 77.4 % , 55.2 % and 36.5 % , respectively .
An earlier study at Wake Forest reported a five-year survival rate of 45 % , but it included only patients who achieved a complete cytoreduction .
Several patients in this latest study had incomplete cytoreduction with only palliative intent .
The quality-of-life measurements—mental and physical—were considerably higher for those with the complete resection .
Researchers used multiple verified quality-of-life surveys . The median age of the patients was 52.8 years at time of treatment , and 52%were male .
Mental and Physical Quality of Life
Patients were questioned on topics such as :
• Physical functioning
• Bodily pain
• General Health
• Vitality
• Social functioning
• Mental health
• Depression
Researchers concluded that after treatment , quality of life typically went down before it went up .
When compared to pretreatment measurements , physical function decreased at three months , reached baseline by six months and steadily improved until 24 months .
The emotional well-being scores also were decreased at three months , but significantly increased through the next 21 months .
Authors wrote that the initial decrease in quality of life after surgery likely was because of pain and limitations associated with the large incision and physiologic impact of complications .
They also noted 30% of patients had no significant complications after surgery .
A decrease in quality-of-life measures after 24 months was attributed to disease recurrence .
Procedure Has Become Standard of Care
The combination of cytoreduction and HIPEC can be a debilitating procedure , lasting from 8-12 hours .
The surgeon first removes all visible tumor growth , which often has metastasized throughout the abdominal cavity .
A heated chemotherapy solution is then circulated for up to 90 minutes before it is removed .
The high-dose chemotherapy solution is designed to reach the microscopic tumor cells that evaded the surgeon .
The Peritoneal Surface Oncology Group International began listing the treatment combination as standard of care for peritoneal mesothelioma more than a decade ago .
“ This is probably the procedure of choice for patients who are candidates for it , ” Levine said . “ But it is a major operative undertaking with significant risks . ”
Procedure Not for Every Patient
With many patients , the disease is too advanced when first diagnosed that it prevents them from being candidates for this aggressive treatment combination .
For those who qualify , though , aggressive treatment most often proves to be worth the risk .
“ This study shows that the improvement in quality of life can be very significant compared with the preoperative status , ” Levine said . “ By six months , virtually all of the patients had recovered to preoperative baseline or better quality-of-life measures . ”
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