How Baseline Symptom Burden Is Related to Survival in Patients With Advanced Malignant Pleural Mesothelioma

The baseline physical symptom burden may be prognostic of survival among patients with advanced malignant pleural mesothelioma, according to a recent study.

Abhenil Mittal, MD, DM, MBBS, of the Northeast Cancer Center of the Northern Ontario School of Medicine, and colleagues conducted the study and published their findings in JTO Clinical and Research Reports.

It was important to conduct the study because there is a “paucity of real-world associations” among EQ-5D–generated health utility scores, patient symptoms as measured by the Edmonton Symptom Assessment Scale (ESAS) and Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (pro-CTCAE), and survival outcomes among patients with advanced malignant pleural mesothelioma.

Dr. Mittal and colleagues retrospectively evaluated clinical and demographic variables and treatment information for 262 patients who were diagnosed with advanced malignant pleural mesothelioma at the Princess Margaret Cancer Centre between January 2004 and February 2021. The median patient age was 69 years, with 77% being male and 52% reporting that they ever smoked. Most patients (67%) had the epithelioid subtype, and 62% received first-line systemic therapy for advanced disease.

They measured quality-of-life outcomes by using health utility scores, ESAS results, and pro-CTCAE findings, as well as stable versus progressive disease and line-of-treatment states.

At diagnosis, the mean baseline health utility score was 0.68 (95% CI, 0.62-0.74), with the “majority of symptoms consisting of pain, dyspnea, and fatigue,” the researchers reported. However, the pooled physical and psychologic ESAS scores “changed significantly” based on the status of the disease. For example, the mean ESAS scores were worst at baseline, but improved with stable or responding disease (physical, P<0.001; psychologic, P<0.001), and then worsened with progressive disease (physical, P<0.001; psychologic, P<0.001). The researchers reported “similar trends” in health utility scores and the pro-CTCAE symptom severity/frequency.

The study showed that patients who had a high baseline ESAS physical symptom burden had reduced overall survival (median, 8.9 months) compared with those who had a low baseline ESAS physical symptom burden (median, 12.6 months; P=0.022). The researchers also reported “weak-to-moderate correlations” between most ESAS domains and health utility, as well as between pro-CTCAE domains and health utility, with the “strongest domain correlations” including well-being, shortness of breath, tiredness, and depression domains.

Based on these findings, the study authors concluded that the baseline quality-of-life burden is high in patients with advanced malignant pleural mesothelioma and is “well captured by both EQ-5D and ESAS.”

“Individual ESAS and pro-CTCAE domains showed low/moderate correlations with HUS [health utility scores], reflecting inability of one symptom to predict the entire disease state, thus paving the way for future mapping studies,” Dr. Mittal and colleagues explained. “Baseline physical symptom burden (ESAS) was prognostic of survival.”

Reference

Mittal A, Everest L, Patel D, et al. Health utility and symptom scores in patients with advanced malignant pleural mesothelioma treated in a real-world setting. JTO Clin Res Rep. Published online February 12, 2025:100802. doi:https://doi.org/10.1016/j.jtocrr.2025.100802