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Simon Ho



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    ES11 - Practice Changing Initiatives (ID 169)

    • Event: WCLC 2020
    • Type: Educational Session
    • Track: Nursing and Allied Health Professionals
    • Presentations: 1
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      ES11.04 - Assessment of Physical Function in Patients Undergoing Lung-sparing Surgery for Malignant Pleural Mesothelioma (ID 3990)

      09:15 - 10:45  |  Presenting Author(s): Simon Ho

      • Abstract
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      Abstract

      Malignant pleural mesothelioma (MPM) is a rare and incurable cancer that involves the pleural surfaces of the lungs.1 The tumor grows circumferentially within the pleural space and restricts the function of the lungs. Common symptoms include chest pain, dyspnea, and poor functional capacity.1 While the current standard of care is platinum-pemetrexed-based systemic treatment, MPM is typically treated with a multimodality approach including chemotherapy, immunotherapy, radiation, and surgery.2 Surgical intervention is an aggressive treatment option with improved quality of life being the goal but is associated with prolonged hospital stays and increased risks of mortality and morbidity.3,4

      Physical function has been widely studied in lung cancer and has been associated with outcomes such as hospital length of stay and rates of complications;5 however, limited studies exist for patients with MPM. Nonetheless, physical function has been reported to be impaired in patients with MPM and is further reduced after lung-sparing surgery.6,7 We performed a retrospective analysis of 54 patients with MPM undergoing lung-sparing surgery and found that preoperative physical function, as measured by the Eastern Cooperative Oncology Group Performance Status Scale (ECOG), was predictive of postoperative outcomes such as ventilator days (p=0.01) and hospital length of stay (p=0.02). Pulmonary function was not predictive of postoperative outcomes. We also found that all patients had impaired physical function after surgery at the time of discharge from hospital and that age was the best predictor of physical function at the first postoperative visit (OR 1.09; p=0.01). Our findings highlight the importance of assessing physical function in patients undergoing lung-sparing surgery for MPM in order to address functional deficits early and to optimize postoperative outcomes. Assessment of physical function can be done via self-reported methods as well as performance-based measures. Nonetheless, comprehensive functional assessment of patients with MPM has not been established as a standard of care for these patients. Thus, a change in practice is needed so that functional assessment and rehabilitation take place early and throughout the continuum of care.

      1. Bibby AC, Tsim S, Kanellakis N, et al. Malignant pleural mesothelioma: an update on investigation, diagnosis and treatment. Eur Respir Rev. 2016;25(142):472-486. doi:10.1183/16000617.0063-2016

      2. Mutti L, Peikert T, Robinson BWS, et al. Scientific Advances and New Frontiers in Mesothelioma Therapeutics. J Thorac Oncol Off Publ Int Assoc Study Lung Cancer. 2018;13(9):1269-1283. doi:10.1016/j.jtho.2018.06.011

      3. Friedberg JS, Culligan MJ, Tsao AS, et al. A Proposed System Toward Standardizing Surgical-Based Treatments for Malignant Pleural Mesothelioma, From the Joint National Cancer Institute–International Association for the Study of Lung Cancer–Mesothelioma Applied Research Foundation Taskforce. J Thorac Oncol. 2019;14(8):1343-1353. doi:10.1016/j.jtho.2019.04.029

      4. Verma V, Ahern CA, Berlind CG, et al. National Cancer Database Report on Pneumonectomy Versus Lung-Sparing Surgery for Malignant Pleural Mesothelioma. J Thorac Oncol Off Publ Int Assoc Study Lung Cancer. 2017;12(11):1704-1714. doi:10.1016/j.jtho.2017.08.012

      5. Batchelor TJP, Rasburn NJ, Abdelnour-Berchtold E, et al. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardiothorac Surg. 2019;55(1):91-115. doi:10.1093/ejcts/ezy301

      6. Tanaka T, Morishita S, Hashimoto M, et al. Physical function and health-related quality of life in patients undergoing surgical treatment for malignant pleural mesothelioma. Support Care Cancer. 2017;25(8):2569-2575. doi:10.1007/s00520-017-3666-z

      7. Tanaka T, Morishita S, Hashimoto M, et al. Physical function and health-related quality of life in the convalescent phase in surgically treated patients with malignant pleural mesothelioma. Support Care Cancer. 2019;27(11):4107-4113. doi:10.1007/s00520-019-04704-5

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