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Does surgery for mesothelioma improve quality of life? Release omits risks, study limitations

Mesothelioma Surgery Improves Quality of Life, Study Finds

Our Review Summary

lung imageThis news release describes a small study on surgery for mesothelioma that was presented at a recent American Society of Clinical Oncology (ASCO) meeting. The study involved 114 mesothelioma patients who underwent a procedure called pleurectomy and decortication (PD). Following the surgery, patients generally reported experiencing improved quality of life.

Although the news release appropriately explains malignant pleural mesothelioma and PD in an easy-to-understand manner, it omits many important details regarding the study’s design and limitations. It describes the benefits of the surgery but does not mention any of its risks and harms. The release also includes sensational language.

We normally caution against covering studies that have not yet been peer-reviewed and published in a journal, since the findings tend to be preliminary. But if presentations are written about in a news release, we would expect a thorough weighing of the evidence, which was not the case here.

 

Why This Matters

Malignant mesothelioma is a rare cancer that represents less than 1 percent of all cancers. Prognosis is poor, since the median survival is about one year following diagnosis. Patients should be presented with treatments to improve their quality of life during their possible final year of life. Surgery is certainly an option, but is it really the best for this disease and for all patients? It is also important to present surgical treatments in a balanced, nuanced fashion, so that patients can be informed of the benefits and drawbacks before making such an important decision given the circumstances.

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Satisfactory

There is no mention of costs in the news release. Pleurectomy and decortication is a major two-part surgery requiring use of an operating room, post-operative recovery services and hospitalization as well as surgeon fees. Although the average age of the patients was 70 years, they ranged from 50 to 80 years. While Medicare coverage is available for those over age 65, it may not be for those under.  A ballpark range of the surgery cost would have been helpful for both reporters and consumers, which is why we give the news release a “Not Satisfactory” rating here.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The news release gives the impression that all patients experienced improved quality of life after surgery: “Patients who underwent an operation called pleurectomy and decortication (PD) generally reported their quality of life improved after surgery.” It also states, “Improved quality of life was observed in the first month after surgery and was maintained at late follow-up in all patients.” In the abstract, however, researchers explicitly state that not all patients experienced a benefit. For example, pain, fatigue and insomnia were worse at 1 month in all groups, while overall global health worsened at the first post-operative month, according to researchers. In one subset of patients, quality of life remained unchanged, while functional domain, physical functioning, role functioning and social functioning deteriorated at 1 month.

In the abstract, researchers conclude that quality of life was not significantly better among patients with epithelioid (a type of immune cell) histology, pre-operative performance status of 0 and tumor volume <600 mL. But the news release didn’t include these findings but instead cited only the positive cases, ignoring the fact that all patients experienced worsening symptoms at 1 month.”Quality of life was not adversely affected by surgery at any time in patients who, prior to surgery, had performance status of 1 or 2; a tumor volume greater than 600 mL or a type of tumor cell called non-epithelioid,” it states.

Due to all these factors, we give it a “Not Satisfactory” rating here.

Does the news release adequately explain/quantify the harms of the intervention?

Not Satisfactory

All interventions carry risks, and the news release does not mention any potential harms that may accompany major surgery. These include complications related to anesthesia — including blood clots and pneumonia, infection at the incision site, fluid build-up under the skin, bleeding, scarring and nerve damage.

As mentioned in the “benefits” section, the news release also does not point out the patient subgroups who did not experience a marked improvement in their quality of life.

For these reasons, we give it a “Not Satisfactory” rating here.

Does the news release seem to grasp the quality of the evidence?

Not Satisfactory

There is no discussion on the quality or limitations of the evidence in the news release. For instance, this was a small study of 114 patients, all of whom underwent surgery. Likely for ethical reasons, there was no control group with which to compare outcomes, but this is a limitation that should be pointed out in the release. In addition, the quality of life survey used in the study measured overall functioning, general symptoms and overall health, but we don’t know how the patients fared on all these criteria. How were these criteria (such as cognitive functioning) measured?

The news release notes:”Patients who underwent an operation called pleurectomy and decortication (PD) generally reported their quality of life improved after surgery.”  To its credit, the release does note the instrument used (EORTC QLQ-C30) but we are not told the magnitude of the improvement. Was the level of improvement clinically important or simply a statistical improvement?  

Given the importance of a balanced commentary we think that quantification is desirable over general statements.

Without any discussion of the study’s limitations and context, we give the news release a “Not Satisfactory” rating here.

Does the news release commit disease-mongering?

Satisfactory

There is no disease mongering in the news release.

Does the news release identify funding sources & disclose conflicts of interest?

Not Applicable

The news release does not mention any funding sources for the study but we’ll rate this “Not Applicable” since the surgeries described were performed in one surgeon’s practice. There are also no new drugs or devices in play and the procedures are not new or novel.

Does the news release compare the new approach with existing alternatives?

Not Satisfactory

The news release does not compare other treatments to pleurectomy and decortication. Although no cure is available, there are other types of surgeries to help treat mesothelioma. These include procedures to decrease fluid build-up (pleurodesis), to remove as much cancer as possible (debulking) and to remove a lung and surrounding tissue. Patients could also undergo chemotherapy or radiation therapy to kill cancer cells.

Since none of these options are discussed in the news release, we give it a “Not Satisfactory” rating here.

Does the news release establish the availability of the treatment/test/product/procedure?

Satisfactory

We rated this as satisfactory, but just barely. The release notes that surgery in the opening paragraph:”Although surgery can prolong the lives of patients with an aggressive type of cancer called malignant pleural mesothelioma, many patients avoid the operation for fear it will degrade their quality of life.”  This makes it clear that surgery is a routine option for treatment although not specifically pleurectomy and decortication. We appreciate that the release is intended for a sophisticated audience but think that the wording could have been a bit clearer.

Does the news release establish the true novelty of the approach?

Not Satisfactory

Pleurectomy and decortication (PD) have been around since the 1950s and are not considered novel treatments and have previously been shown to improve or maintain QOL. We’re not sure what’s exactly “new” about this research. What insight does this study bring to the existing body of literature?

Therefore, we give the news release a “Not Satisfactory” rating here.

Does the news release include unjustifiable, sensational language, including in the quotes of researchers?

Satisfactory

While not explicit, the news release veers toward absolute and ambiguous language at times. For example, it states that quality of life improved in all patients, which is not true, since some patients’ conditions remained unchanged. In others, quality of life was “not significantly better” or “adversely affected” by the surgery.

In addition, the sole quote from the researcher is limited in our opinion, since it only talks about the net benefits of the surgery without any mention of its potential risks. The researcher also concludes the procedure is “justified” in a majority of patients. But as we had mentioned previously in the benefits section, it’s hard to make such sweeping statements on a small study with no control group. These comments should be compared to an earlier study by the same researcher who concluded: ”Extended pleurectomy and decortication did not improve overall HRQoL and had a negative impact in pulmonary function in minimally symptomatic patients.”

Total Score: 3 of 9 Satisfactory

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