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Disparities in Compliance With National Guidelines for the Treatment of Malignant Pleural Mesothelioma. | LitMetric

AI Article Synopsis

  • Current guidelines for treating malignant pleural mesothelioma (MPM) suggest surgery, chemotherapy, or active surveillance for stages 1 to 3, but compliance with these recommendations is low, especially in nonacademic hospitals.
  • A study analyzed data from 3,419 patients to assess treatment compliance and its effect on overall survival, revealing that underutilization of surgery and varying results based on facility type significantly impact the outcomes.
  • Patients receiving surgery and chemotherapy had the best median survival rates (21.1 months), emphasizing the need for better adherence to guidelines to improve patient outcomes in MPM treatment.

Article Abstract

Background: Current guidelines support cancer-directed surgery, chemotherapy, or active surveillance for clinical stages 1 to 3 of epithelial malignant pleural mesothelioma (MPM). Definitive chemotherapy is recommended for sarcomatoid/biphasic histologies. Our objective is to assess compliance with recommendations, measuring their impact on overall survival.

Methods: The National Cancer Database participant user file (2004 to 2014) was queried for patients diagnosed with MPM clinical stages 1 to 3. Multivariable logistic regression model identified factors independently associated with guideline compliance. Kaplan-Meier analysis and Cox proportional hazards were used for overall survival comparison with histologic subgroup analysis.

Results: A total of 3419 patients with clinical stages 1 to 3 met criteria for analysis and comprised epithelial (68.5%), sarcomatoid (17.2%), and biphasic subtypes (14.3%). Cancer-directed surgery was significantly underutilized in epithelial MPM, with 29.3% having no treatment. On multivariable analysis, insurance status and facility type were the strongest predictors of guideline compliance. High-volume hospitals were the most compliant with guidelines (odds ratio 3.58, 95% confidence interval (CI), 2.34 to 5.49, P < .001). Median survival estimates for no treatment, chemotherapy alone, surgery plus chemotherapy, and trimodal therapy were 10.2, 15.4, 21.1, and 21.7 months, respectively (log rank P < .001). In epithelial MPM, a significant increase in overall survival was observed in surgery plus chemotherapy (hazard ratio 0.62, 95% CI, 0.53 to 0.73, P < .001) and trimodality (hazard ratio 0.61, 95% CI, 0.49 to 0.76, P < .001; reference: no treatment).

Conclusions: There is a suboptimal compliance with national guidelines for the treatment of MPM, particularly in low-volume nonacademic settings. Adherence to recommended surgery-based multimodal therapy is associated with an overall survival improvement.

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Source
http://dx.doi.org/10.1016/j.athoracsur.2019.03.052DOI Listing

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