Health utility and symptom scores in patients with advanced malignant pleural mesothelioma treated in a real-world setting

Mittal A, Everest L, Patel D, Zhan LJ, Brown MC, Zaeimi F, Schmid S, Khan K, Dietrich K, Balaratnam K, Pardo de Santayana MG, Eng L, Sacher AG, Shepherd FA, Leighl NB, Cho J, De Perrot M, Liu G, Bradbury P. Health utility and symptom scores in patients with advanced malignant pleural mesothelioma treated in a real-world setting. JTO Clinical and Research Reports. Published online February 12, 2025:100802. doi:10.1016/j.jtocrr.2025.100802

Background: There is a paucity of real-world associations between EQ-5D-generated health utility scores (HUS), symptoms as measured by ESAS and pro-CTCAE, and survival in advanced Malignant Pleural Mesothelioma (aMPM) patients.

Methods: Clinico-demographic variables and treatment information were captured retrospectively in patients diagnosed with aMPM between Jan-2004 and Feb-2021 at Princess-Margaret-Cancer-Centre. Quality-of-life (QoL) outcomes were measured using HUS, ESAS and proCTCAE scales, by stable versus progressive disease and line-of-treatment states. Survival by mean ESAS scores were analyzed using the Kaplan-Meier method.

Results: Of 262 patients: median age was 69 years (IQR:62-74); 77% were male; ever-smokers=52%; epithelioid-subtype=67%; 62% received first-line systemic therapy for advanced disease. Mean baseline HUS at diagnosis was 0.68 [95%CI:0.62-0.74] with majority of symptoms consisting of pain, dyspnea and fatigue. Pooled ESAS physical and psychological scores changed significantly with disease state: Mean scores were worst at baseline, improved with stable/responding disease (physical, p<0.001; psychological, p<0.001) and worsened at progressive disease (physical, p<0.001; psychological, p<0.001). Similar trends were seen in HUS and pro-CTCAE symptom severity/frequency. Patients with high baseline ESAS physical symptom burden had inferior overall survival: median 8.9 (high) vs 12.6 months (low; p=0.022). Weak-to-moderate correlations were observed between most ESAS domains and HU and between pro-CTCAE domains and HU. Strongest domain correlations were with well-being, shortness of breath, tiredness and depression domains.

Conclusions: Baseline QoL burden is high in aMPM patients and is well captured by both EQ-5D and ESAS Individual ESAS and pro-CTCAE domains showed low/moderate correlations with HUS, reflecting inability of one symptom to predict the entire disease state, thus paving the way for future mapping studies. Baseline physical symptom burden (ESAS) was prognostic of survival.