Surgery May Improve Mesothelioma Survival of Older Patients

You might have heard that mesothelioma surgery isn’t a good idea if you’re over 70. An article in the journal Clinical Lung Cancer suggests something different.

Researchers from Duke University in Durham, North Carolina, and from Stanford University near San Francisco, California, wrote that they are now of the opinion that surgery can be beneficial for septuagenarian mesothelioma patients — and for those who are even older.

It’s long been thought that you need to be younger than 70 for mesothelioma surgery. This is because surgery can be hard on a patient. There is concern that very old mesothelioma patients may be too fragile for it.

This isn’t a baseless concern. It’s generally accepted that advanced age makes you less capable of bouncing back speedily and fully from surgery.

Even tougher is bouncing back from surgery as a very elderly person who’s been battling mesothelioma.

Minimal Data on Age and Mesothelioma Surgery

Another element underlying the apprehensiveness about performing mesothelioma surgery on people over 70 years of age is the concern that it won’t buy as much time for them as it might for younger patients.

The Duke and Stanford team were aware of these and other concerns, but had their doubts about the validity of them.

Those doubts were stoked by the fact that there isn’t much in the way of scientific literature supporting or opposing mesothelioma surgery for very old patients.

“Although malignant pleural mesothelioma is generally a disease associated with more advanced age, the association of age, treatment, and outcomes has not been well-characterized,” they wrote.

The researchers said they decided to address this knowledge gap by evaluating the impact of age on outcomes in malignant pleural mesothelioma patients.

They went about this by reviewing and analyzing data related to the treatment selection process for elderly mesothelioma patients who were potentially treatable by surgery.

Accordingly, the researchers retrieved the medical records of 879 mesothelioma patients stored in the Surveillance, Epidemiology, and End Results database between 2004 and 2010.

These 879 patients had malignant pleural mesothelioma characterized as Stage I, Stage II or Stage III. In other words, all were potentially suitable candidates for surgery because their mesothelioma had not yet progressed far enough to preclude such treatment.

Some of the 879 patients were 70 or older, some were younger. The researchers evaluated all of them with the help of multivariable Cox proportional hazard models and propensity score-matched analysis.

Mesothelioma Surgery Improved Their Survival

It turned out that 284 of these patients — 34 percent — had undergone mesothelioma surgery. The records showed that these patients tended to experience improved overall survival.

“Cancer-directed surgery was used much less commonly in patients 70 years and older compared with patients younger than 70 years,” they wrote. “But patients 70 years and older had improved one-year and three-year overall survival compared with non-operative management.”

The researchers said it was plain that some mesothelioma patients 70 years and older benefitted from surgery. This benefit was seen “even after propensity score-matched analysis was used to control for selection bias,” they wrote.

Bottom line: if you’re 70 or older and you have mesothelioma, ask your doctor to consider whether surgery is right for you.

The title of the researchers’ article is “Impact of Age on Long-Term Outcomes of Surgery for Malignant Pleural Mesothelioma.”