A Survey of Quality of Life Following Surgery A Survey of Quality of Life Following Surgery for Malignant Pleural Mesothelioma: Reflects for Malignant Pleural Mesothelioma: Reflects

the patients’ commitment to Learning about the the patients’ commitment to Learning about the DiseaseDisease

D A RaffleD A Raffle, A Barua, A E Martin-Ucar, A Barua, A E Martin-Ucar

Thoracic Surgery UnitThoracic Surgery UnitNottingham University Hospital TrustNottingham University Hospital Trust

OverviewOverview

Definition Indications for studyPatients and MethodsResultsQuestionnairesDiscussion

Health related Quality of lifeHealth related Quality of life

In 1948,the World Health Organisation (WHO) defined health as:

“A state of complete physical, mental and social well-being, and not merely the absence of disease ”.

World Health Organisation (WHO) 1948

Why do we measure Quality of Why do we measure Quality of Life in healthcare?Life in healthcare?

The value of measuring quality of life has been increasingly recognised. It should identify and better describe the damaging effects of the disease or its treatment.

Responses to quality of life questionnaires help health professionals to understand better the burden that a particular treatment can place upon patients’ as well as providing data to help others in the future.

The consequences of treatment and treatment-related side effects may affect all of a patient's life, hence it is important to assess all aspects of a treatment's effects.

Staniszewska, S. (1998)

Indications for StudyIndications for Study

Published information on the effects on Published information on the effects on Quality of Life after surgical interventions for Quality of Life after surgical interventions for cancercancer

But little after surgery for Malignant Pleural But little after surgery for Malignant Pleural Mesothelioma. Mesothelioma.

Main role of intervention is palliation and Main role of intervention is palliation and debulking debulking

Impact of disease and treatment must be part Impact of disease and treatment must be part of discussion with patients and carersof discussion with patients and carers

Indications for StudyIndications for Study

Increasing incidence of the disease and Increasing incidence of the disease and patients searching for treatmentspatients searching for treatments

The appointment of a new Consultant The appointment of a new Consultant Thoracic Surgeon with an interest in surgery Thoracic Surgeon with an interest in surgery for Malignant Pleural Mesothelioma.for Malignant Pleural Mesothelioma.

To provide information on post-surgery To provide information on post-surgery symptoms/Health related QoL for patients in symptoms/Health related QoL for patients in the future .the future .

MethodsMethods

The generic EORTC QLQ-30 & the lung specific The generic EORTC QLQ-30 & the lung specific QLQ-13 questionnaires where given to all QLQ-13 questionnaires where given to all patient with a known diagnosis of malignant patient with a known diagnosis of malignant pleural mesothelioma who opted for different pleural mesothelioma who opted for different forms of surgery as part of their treatmentforms of surgery as part of their treatment

Patients were consented to receive the Patients were consented to receive the questionnaires, the first of which were filled in at questionnaires, the first of which were filled in at the pre op assessment visit.the pre op assessment visit.

The questionnaires were then posted to the The questionnaires were then posted to the patients at 6 weeks, 3,6,9 & 12 months (no patients at 6 weeks, 3,6,9 & 12 months (no reminders were sent).reminders were sent).

Data SourcesData Sources European Organisation for the Research and European Organisation for the Research and

Treatments of cancer’s generic Questionnaires:Treatments of cancer’s generic Questionnaires: EORTC QLQ-C30EORTC QLQ-C30 EORTC QLC-LC13EORTC QLC-LC13 EORTC Study Group on Quality of life.(1994)

Surgical and Department DatabasesSurgical and Department Databases

EORTC QLQ-C30EORTC QLQ-C30

Generic cancer questionnaire, includes:Generic cancer questionnaire, includes:1 global HRQoL scale1 global HRQoL scale5 functional scales5 functional scales

- role, social, emotional, physical, cognitive- role, social, emotional, physical, cognitive

3 general symptom scales3 general symptom scales

- fatigue, pain, nausea- fatigue, pain, nausea

6 single item measures6 single item measures

Statistical AnalysisStatistical Analysis3 stage process3 stage process

1.1. Convert response into a numerical scoreConvert response into a numerical score

2. Transpose score to a 0-100 scale2. Transpose score to a 0-100 scale

3. Compare the scales at 3, 6, 12 and 24 3. Compare the scales at 3, 6, 12 and 24 months (more recently 6 weeks)months (more recently 6 weeks)

(Fayers (Fayers et alet al, 2001), 2001)

PatientsPatients

Between August 2009 & November 2010 Between August 2009 & November 2010 questionnaires were given to:questionnaires were given to:

22 patients (19 male 3 female)22 patients (19 male 3 female) Median age 69Median age 69 65% Epithelioid65% Epithelioid

ProceduresProcedures

3

19

VATS Debulking

Total Pleurectomy

16

3

R1 R2

TOTAL PREOPERATIVE22

NO THORACIC SURGERY0

TOTAL PREOPERATIVE22

NO RESPONSE0

RESPONSE22

DIED WITHIN 3 Months2

DIED WITHIN 6 MONTHS2

100%

Comparing with other studiesComparing with other studies

77 79

100

30

40

50

60

70

80

90

100

OesophagealSurgery

Lung Surgery MesotheliomaSurgery

Functional ScalesFunctional Scales

0102030405060708090

100

Preoperative 3 Months 6 Months 9 months 12 months

ConclusionConclusion

The response rate reflects the commitment The response rate reflects the commitment of patients with malignant pleural of patients with malignant pleural mesothelioma to help learning about the mesothelioma to help learning about the disease and treatments. disease and treatments.

The response rate is higher than previous The response rate is higher than previous similar studies performed in patients similar studies performed in patients undergoing radical treatment for lung and undergoing radical treatment for lung and oesophageal malignancies.oesophageal malignancies.

Why?Why?

Mesothelioma patients more “militant”?Mesothelioma patients more “militant”?Patients perceive interest and commitment Patients perceive interest and commitment

Specialist Team?Specialist Team?Early experience?Early experience?Patients appreciate lack of information Patients appreciate lack of information

available to themavailable to them

ReferencesReferences

European Organisation for Research and Treatment of Cancer European Organisation for Research and Treatment of Cancer (EORTC) available @ (EORTC) available @ www.eortc.be/www.eortc.be/

Staniszewska, S. (1998)Staniszewska, S. (1998)Measuring quality of life in the evaluation of Measuring quality of life in the evaluation of health care Nursing Standard 12: 17, 36-39health care Nursing Standard 12: 17, 36-39

World Health Organisation (WHO) available@World Health Organisation (WHO) available@

www.who.int/library/collections/historical/en/index3.htmlwww.who.int/library/collections/historical/en/index3.html