Treatment patterns among patients with malignant pleural mesothelioma: An Italian, population-based nationwide study.
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Trama Annalisa, Proto Claudia, Signorelli Diego, Garassino Marina C, Lo Russo Giuseppe, Ganzinelli Monica, Prelaj Arsela, Mensi Carolina, Gangemi Manuela, Gennaro Valerio, Chellini Elisabetta, Caldarella Adele, Angelillo Italo F, Ascoli Valeria, Pascucci Cristiana, Tagliabue Giovanna, Cusimano Rosanna, Bella Francesca, Falcini Fabio, Merler Enzo, Masanotti Giuseppe, Ziino Antonio, Michiara Maria, Gola Gemma, Storchi Cinzia, Mangone Lucia, Vitale Maria F, Cirilli Claudia, Tumino Rosario, Scuderi Tiziana, Fanetti Anna C, Piffer Silvano, Tiseo Marcello, Gatta Gemma, Botta Laura, LUME study WG
Аннотация
METHODS: We performed an observational study on a random sample of 2026 MPM patients diagnosed in 2003-2008. We included 26 population-based registries covering 70% of the Italian population. To identify factors associated with treatment patterns, across the different regions, we fitted a multinomial logistic regression model adjusted by age, sex, stage, histology and hospital with thoracic surgical department.
RESULTS: MPM patients mostly received chemotherapy alone (41%) or no cancer-directed therapy (36%) especially the older patients. The first course of treatment for MPM patients differed across regions. Patients from Piedmont, Liguria and Campania were more likely to receive no cancer-directed therapy; those living in Tuscany and Sicily were more likely to get surgery; patients from Marche and Lazio were more likely to receive chemotherapy. These differences were not explained by age, sex, stage, histology and availability of a thoracic surgery department.
CONCLUSIONS: There is limited expertise available and lack of a network able to maximize the expertise available may contribute to explaining the results of our study. Our findings support the need to ensure the appropriate care of all MPM patients in reorganizing the health care services.
KEY POINTS: Significant findings of the study: MPM patients mostly received chemotherapy alone or no cancer-directed therapy especially the older patients. The first course of treatment for MPM patients differed across Italian regions.
WHAT THIS STUDY ADDS: Differences in MPM clinical management are not explained by the age, stage, histology nor by the availability of a thoracic surgery department. Limited expertise for MPM contribute to explaining the unequal access to appropriate care for MPM patients in Italy.