Treatment-associated quality of life in patients with malignant pleural mesothelioma

The symptomatic burden of malignant pleural mesothelioma (MPM) remains unsurmountable due to not only the insidious nature of its development and abrupt nature of progression, but also due to our relatively limited capabilities to treat it or even slow down its progress and the associated toll such a disease has on an individual's overall quality of life (QoL). The majority of cases are linked to occupational asbestos exposure and arise after a latency period of up to 40 years. Overall survival (OS) drastically varies across studies and treatments, with pooled analyses approximating 13 months post-diagnosis median survival and 10% 5-year survival. As a result of its very grim prognosis and significant deterioration in QoL, treatment strategies began to incorporate the effects of a particular treatment on a patient's QoL. Treatment is often multimodal and consists of surgery, chemotherapy, and radiotherapy (RT). Recent investigations have utilized standardized QoL measurement tools, such as the Lung Cancer Symptom Scale for mesothelioma (LCSS-Meso) and the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30), to make studies more comparable so treatments and their effects can be better understood and expanded on. Overall, surgery remains the mainstay of therapy with recent studies finding pleurectomy and decortication leads to improved QoL when compared to extrapleural pneumonectomy (EPP). Chemotherapy and immunotherapy are the most rapidly advancing segment of trimodality therapy due to technological advances which have improved development, synthesis, administration, and efficacy. RT's impact on QoL continues to be debated despite its significant palliative potential due to a high risk of radiation toxicity even after approach, dose, and timing modifications. Given the complexities in MPM treatment, understanding the standardized data generated by these questionnaires and investigating their generalizability in assessing patient QoL will be crucial in the advancement of MPM treatment.