title: The effect of chemotherapy on health-related quality of life in mesothelioma: results from the SWAMP trial.
abstract: BACKGROUND
  The effect of chemotherapy on health-related quality of life (HRQoL) in malignant pleural mesothelioma (MPM) is poorly understood. Patient-individualised prognostication and prediction of treatment response from chemotherapy is useful but little evidence exists to guide practice.
  
  
  METHODS
  Consecutive patients with MPM who were fit for first-line chemotherapy with pemetrexed and cisplatin\carboplatin were recruited and followed up for a minimum of 12 months. This study focussed on the HRQoL outcomes of these patients using the EQ-5D, EORTC QLQ-C30 and LC13.
  
  
  RESULTS
  Seventy-three patients were recruited of which 58 received chemotherapy and 15 opted for best supportive care (BSC). Compliance with HRQoL questionnaires was 98% at baseline. The chemotherapy group maintained HRQoL compared with the BSC group whose overall HRQoL fell (P=0.006) with worsening dyspnoea and pain. The impact of chemotherapy was irrespective of histological subtype although those with non-epithelioid disease had worse HRQoL at later time points (P=0.012). Additionally, those with a falling mesothelin or improvement on modified-RECIST CT at early follow-up had a better HRQoL at 16 weeks.
  
  
  CONCLUSIONS
  HRQoL was maintained following chemotherapy compared with a self-selected BSC group. Once chemotherapy is initiated, a falling mesothelin or improved RECIST CT findings infer a quality-of-life advantage.
authors.affiliation: Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol BS10 5NB, UK.
authors.forename: D T
authors.initials: DT
authors.lastname: Arnold
authors.affiliation: 1] Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol BS10 5NB, UK [2] North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK.
authors.forename: C E
authors.initials: CE
authors.lastname: Hooper
authors.affiliation: North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK.
authors.forename: A
authors.initials: A
authors.lastname: Morley
authors.affiliation: Applied Statistics Group, University of West of England (UWE), Bristol BS16 1QY, UK.
authors.forename: P
authors.initials: P
authors.lastname: White
authors.affiliation: Cobalt Health, Thirlestaine Road, Cheltenham GL53 7AS, UK.
authors.forename: I D
authors.initials: ID
authors.lastname: Lyburn
authors.affiliation: Cobalt Health, Thirlestaine Road, Cheltenham GL53 7AS, UK.
authors.forename: J
authors.initials: J
authors.lastname: Searle
authors.affiliation: Department of Radiology, Southmead Hopsital, North Bristol NHS Trust, Bristol BS10 5NB, UK.
authors.forename: M
authors.initials: M
authors.lastname: Darby
authors.affiliation: Department of Radiology, Royal United Hospital Bath, Bath BA1 3NG, UK.
authors.forename: T
authors.initials: T
authors.lastname: Hall
authors.affiliation: Cobalt Health, Thirlestaine Road, Cheltenham GL53 7AS, UK.
authors.forename: D
authors.initials: D
authors.lastname: Hall
authors.affiliation: Oxford Respiratory Clinical Trial Unit (Funded by the NIHR Biomedical Research Centre), Churchill Hospital, Oxford OX3 7LJ, UK.
authors.forename: N M
authors.initials: NM
authors.lastname: Rahman
authors.affiliation: Department of Oncology, Royal United Hospital Bath, Bath BA1 3NG, UK.
authors.forename: E
authors.initials: E
authors.lastname: De Winton
authors.affiliation: Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol BS10 5NB, UK.
authors.forename: A
authors.initials: A
authors.lastname: Clive
authors.affiliation: Department of Respiratory Medicine, Royal United Hospital Bath, Bath BA1 3NG, UK.
authors.forename: V
authors.initials: V
authors.lastname: Masani
authors.affiliation: Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8ED, UK.
authors.forename: A
authors.initials: A
authors.lastname: Dangoor
authors.affiliation: Department of Oncology, Cheltenham General Hospital, Cheltenham GL53 7AN, UK.
authors.forename: S
authors.initials: S
authors.lastname: Guglani
authors.affiliation: Department of Oncology, Musgrove Park Hospital, Taunton, Severn TA1 5DA, UK.
authors.forename: P
authors.initials: P
authors.lastname: Jankowska
authors.affiliation: Department of Oncology, Great Western Hospital, Swindon SN3 6BB, UK.
authors.forename: S A
authors.initials: SA
authors.lastname: Lowndes
authors.affiliation: North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK.
authors.forename: J E
authors.initials: JE
authors.lastname: Harvey
authors.affiliation: Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8ED, UK.
authors.forename: J P
authors.initials: JP
authors.lastname: Braybrooke
authors.affiliation: 1] Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol BS10 5NB, UK [2] North Bristol Lung Centre, Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK.
authors.forename: N A
authors.initials: NA
authors.lastname: Maskell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000032:analysis; D016190:Carboplatin / Q000008:administration & dosage; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D005971:Glutamates / Q000008:administration & dosage; D006147:Guanine / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008654:Mesothelioma / Q000188:drug therapy* / Q000473:pathology; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D010166:Palliative Care; D000068437:Pemetrexed; D011446:Prospective Studies; D011788:Quality of Life
chemical_list: D014408:Biomarkers, Tumor; D005971:Glutamates; D000068437:Pemetrexed; D006147:Guanine; D016190:Carboplatin; D002945:Cisplatin