Skip to main content

Advertisement

SpringerLink
Log in

Health-related quality of life and inflammatory markers in malignant pleural mesothelioma

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Malignant pleural mesothelioma (MPM) is a highly aggressive and symptomatic disease. We examined the relationship between health-related quality of life (HRQoL) and inflammatory markers, and the prognostic role of HRQoL in MPM patients.

Methods

MPM patients from two parallel phase II studies (thalidomide alone or thalidomide with chemotherapy) were included. HRQoL was assessed at baseline using the modified Lung Cancer Symptom Scale (LCSS). Baseline inflammatory markers and cytokines were measured. Spearman correlation was used to examine the relationship between inflammatory markers and HRQoL measures. The prognostic value of the HRQoL domains was examined using Cox proportional hazard model.

Results

Sixty-three patients were included: median age 61 years (range 44–79); 82 % male; 77 % Eastern Cooperative Oncology Group (ECOG) performance status 0–1; 44 % epithelial histology subtype. Baseline systemic symptoms of anorexia and fatigue, the summation symptoms of overall symptomatic distress, interference with normal activity and global QoL and the aggregate score of total LCSS score were all associated with elevated neutrophil-to-lymphocyte ratio, C-reactive protein and vascular endothelial growth factor levels at baseline (rho ≥ 0.25; p < 0.05). Baseline anorexia, fatigue, cough, dyspnoea, pain, overall symptomatic distress, interference with normal activity, global QoL and total LCSS score were all significantly related to survival (p < 0.05) after adjusting for established prognostic factors (age, gender, histological subtype and performance status) and treatment effect.

Conclusions

In conclusion, HRQoL seems to relate to a patient's systemic inflammatory status and is associated with survival in MPM patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Vogelzang NJ, Rusthoven JJ, Symanowski J, Denham C, Kaukel E, Ruffie P, Gatzemeier U, Boyer M, Emri S, Manegold C, Niyikiza C, Paoletti P (2003) Phase III study of pemetrexed in combination with cisplatin versus cisplatin alone in patients with malignant pleural mesothelioma. J Clin Oncol 21:2636–2644

    Article  PubMed  CAS  Google Scholar 

  2. Hollen PJ, Gralla RJ, Liepa AM, Symanowski J, Rusthoven J (2006) Measuring quality of life in patients with pleural mesothelioma using a modified version of the Lung Cancer Symptom Scale (LCSS): psychometric properties of the LCSS-Meso. Support Care Cancer 14:11–21

    Article  PubMed  Google Scholar 

  3. Nowak AK, Stockler MR, Byrne MJ (2004) Assessing quality of life during chemotherapy for pleural mesothelioma: feasibility, validity, and results of using the european organization for research and treatment of cancer core quality of life questionnaire and lung cancer module. J Clin Oncol 22:3172–3180

    Article  PubMed  Google Scholar 

  4. Gotay CC, Kawamoto CT, Bottomley A, Efficace F (2008) The prognostic significance of patient-reported outcomes in cancer clinical trials. J Clin Oncol 26:1355–1363

    Article  PubMed  Google Scholar 

  5. Quinten C, Coens C, Mauer M, Comte S, Sprangers MAG, Cleeland C, Osoba D, Bjordal K, Bottomley A, Clinical Groups EORTC (2009) Baseline quality of life as a prognostic indicator of survival: a meta-analysis of individual patient data from EORTC clinical trials. Lancet Oncol 10:865–871

    Article  PubMed  Google Scholar 

  6. Bottomley A, Coens C, Efficace F, Gaafar R, Manegold C, Burgers S, Vincent M, Legrand C, van Meerbeeck JP, EORTC-NCIC (2007) Symptoms and patient-reported well-being: do they predict survival in malignant pleural mesothelioma? A prognostic factor analysis of EORTC-NCIC 08983: randomized phase III study of cisplatin with or without raltitrexed in patients with malignant pleural mesothelioma. J Clin Oncol 25:5770–5776

    Article  PubMed  CAS  Google Scholar 

  7. Kelley K, Bluthe R, Dantzer R, Zhou JH, Shen WH, Johnson RW, Broussard SR (2003) Cytokine-induced sickness behavior. Brain Behav Immun 17:S112–S118

    Article  PubMed  CAS  Google Scholar 

  8. Dantzer R (2004) Cytokine-induced sickness behaviour: a neuroimmune response to activation of innate immunity. Eur J Pharmacol 500:399–411

    Article  PubMed  CAS  Google Scholar 

  9. Myers J (2008) Proinflammatory cytokines and sickness behavior: implications for depression and cancer-related symptoms. Oncol Nurs Forum 35:916–920

    Article  PubMed  Google Scholar 

  10. Seruga B, Zhang H, Bernstein LJ, Tannock IF (2008) Cytokines and their relationship to the symptoms and outcome of cancer. Nat Rev Cancer 8:887–899

    Article  PubMed  CAS  Google Scholar 

  11. Robinson BW, Musk AW, Lake RA (2005) Malignant mesothelioma. Lancet 366:397–408

    Article  PubMed  CAS  Google Scholar 

  12. Kao SC, Pavlakis N, Harvie R, Vardy JL, Boyer MJ, van Zandwijk N, Clarke SJ (2010) High blood neutrophil-to-lymphocyte ratio is an indicator of poor prognosis in malignant mesothelioma patients undergoing systemic therapy. Clin Cancer Res 16:5805–5813

    Article  PubMed  CAS  Google Scholar 

  13. Kao SC, Klebe S, Henderson DW, Reid G, Chatfield M, Armstrong NJ, Yan TD, Vardy J, Clarke S, van Zandwijk N, McCaughan B (2011) Low calretinin expression and high Neutrophil-to-Lymphocyte Ratio are poor prognostic factors in malignant mesothelioma patients undergoing extrapleural pneumonectomy. J Thorac Oncol 6:1923–1929

    Article  PubMed  Google Scholar 

  14. Zahorec R (2001) Ratio of neutrophil to lymphocyte counts—rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 102:5–14

    PubMed  CAS  Google Scholar 

  15. Duffy BK, Gurm HS, Rajagopal V, Gupta R, Ellis SG, Bhatt DL (2006) Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention. Am J Cardio 97:993–996

    Article  Google Scholar 

  16. Walsh SR, Cook EJ, Goulder F, Justin TA, Keeling NJ (2005) Neutrophil–lymphocyte ratio as a prognsotic factor in colorectal cancer. J Surg Oncol 91:181–184

    Article  PubMed  CAS  Google Scholar 

  17. Gomez D, Morris-Stiff G, Toogood GJ, Lodge JP, Prasad KR (2008) Impact of systemic inflammation on outcome following resection for intrahepatic cholangiocarcinoma. J Surg Oncol 97:513–518

    Article  PubMed  Google Scholar 

  18. Sarraf KM, Belcher E, Raevsky E, Nicholson AG, Goldstraw P, Lim E (2009) Neutrophil/lymphocyte ratio and its association with survival after complete resection in non-small cell lung cancer. J Thorac Cardiovasc Surg 137:425–428

    Article  PubMed  Google Scholar 

  19. Chua W, Charles KA, Baracos VE, Clarke SJ (2011) Neutrophil–lymphocyte ratio predicts chemotherapy outcomes in patients with advanced colorectal cancer. Brit J Cancer 104:1288–1295

    Article  PubMed  CAS  Google Scholar 

  20. Kao SC, Harvie R, Paturi F, Taylor R, Davey R, Abraham R, Clarke S, Marx G, Cullen M, Kerestes Z, Pavlakis N (2012) The predictive role of serum VEGF in an advanced malignant mesothelioma patient cohort treated with thalidomide alone or combined with cisplatin/gemcitabine. Lung Cancer 75:248–254

    Article  PubMed  Google Scholar 

  21. Hollen P, Gralla R, Kris M (1995) An overview of the Lung Cancer Symptom Scale. In: Gralla R, Moinpour C (eds) Assessing quality of life in patients with lung cancer: a guide for clinicians. NCM Publishers, New York, pp 57–59

    Google Scholar 

  22. Schroeder MA (1990) Diagnosing and dealing with multicollinearity. West J Nurs Res 12:175–187

    Article  PubMed  Google Scholar 

  23. van Meerbeeck JP, Gaafar R, Manegold C, van Klaveren RJ, van Marck EA, Vincent M, Legrand C, Bottomley A, Debruyne C, Giaccone G, European Organisation for Research and Treatment of Cancer Lung Cancer Group; National Cancer Institute of Canada (2005) Randomized phase III study of cisplatin with or without raltitrexed in patients with malignant pleural mesothelioma: an intergroup study of the European Organisation for Research and Treatment of Cancer Lung Cancer Group and the National Cancer Institute of Canada. J Clin Oncol 23:6881–6889

    Article  PubMed  Google Scholar 

  24. Schubert C, Hong S, Natarajan L, Mills PJ, Dimsdale JE (2007) The association between fatigue and inflammatory marker levels in cancer patients: a quantitative review. Brain Behav Immun 21:413–427

    Article  PubMed  CAS  Google Scholar 

  25. Wang X, Shi Q, Williams L, Mao L, Cleeland CS, Komaki RR, Mobley GM, Liao Z (2010) Inflammatory cytokines are associated with the development of symptom burden in patients with NSCLC undergoing concurrent chemoradiation therapy. Brain Behav Immun 24:968–974

    Article  PubMed  CAS  Google Scholar 

  26. Pusztai L, Mendoza T, Reuben J, Willey JS, Lara J, Syed A, Fritsche HA, Bruera E, Booser D, Valero V, Arun B, Ibrahim N, Rivera E, Royce M, Cleeland CS, Hortobagyi GN (2004) Changes in plasma levels of inflammatory cytokines in response to paclitaxel chemotherapy. Cytokine 25:94–102

    Article  PubMed  CAS  Google Scholar 

  27. Jones LW, Eves ND, Mackey JR, Peddle CJ, Haykowsky M, Joy AA, Tankel K, Courneya KS, Reiman T (2008) Systemic inflammation, cardiorespiratory fitness, and quality of life in patients with advanced non-small cell lung cancer. J Thorac Oncol 3:194–195

    Article  PubMed  Google Scholar 

  28. Brown DJF, McMillan DC, Milroy R (2005) The correlation between fatigue, physical function, the systemic inflammatory response, and psychological distress in patients with advanced lung cancer. Cancer 103:377–382

    Article  PubMed  Google Scholar 

  29. Scott HR, McMillan DC, Brown DJF, Forrest LM, McArdle CS, Milroy R (2003) A prospective study of the impact of weight loss and the systemic inflammatory response on quality of life in paitnets with inoperable non-small cell lung cancer. Lung Cancer 40:295–299

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This project was funded by the New South Wales Dust Diseases Compensation Board and the Estate of Mr. Clem Johnson, for financial support and Eli-Lilly for pharmaceutical support (supply of gemcitabine).

SCH Kao is supported by a National Health & Medical Research Council (NHMRC) postgraduate scholarship and a Research Scholar Award from the NSW Cancer Institute.

J Vardy is supported by the NSW Cancer Institute.

Conflict of interest statement

N Pavlakis is on an advisory board with E Lilly and has received a travel grant and speaking honoraria from E Lilly. N. van Zandwijk declares the following: advisory board for E Lilly, Merk Serono and Pfizer; speaker at Lilly Symposia.

Author information

Authors and Affiliations

  1. Department of Medical Oncology, Sydney Cancer Centre, Sydney, Australia

    Steven C. Kao & Janette Vardy

  2. Asbestos Diseases Research Institute, Sydney, Australia

    Steven C. Kao & Nico van Zandwijk

  3. Faculty of Medicine, University of Sydney, Sydney, Australia

    Steven C. Kao, Janette Vardy, Nico van Zandwijk, Stephen Clarke & Nick Pavlakis

  4. Department of Medical Oncology, Royal North Shore Hospital, St Leonards NSW 2065, Sydney, Australia

    Rozelle Harvie, Stephen Clarke & Nick Pavlakis

  5. NHMRC Clinical Trials Centre, Sydney, Australia

    Mark Chatfield

Authors
  1. Steven C. Kao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Janette Vardy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rozelle Harvie
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mark Chatfield
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nico van Zandwijk
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stephen Clarke
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nick Pavlakis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nick Pavlakis.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kao, S.C., Vardy, J., Harvie, R. et al. Health-related quality of life and inflammatory markers in malignant pleural mesothelioma. Support Care Cancer 21, 697–705 (2013). https://doi.org/10.1007/s00520-012-1569-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-012-1569-6

Keywords

Search

Navigation