title: Treatment patterns and survival analysis in 9014 patients with malignant pleural mesothelioma from Belgium, the Netherlands and England.
abstract: BACKGROUND
  Pleural mesothelioma has a dismal prognosis and is refractory to local treatment. Combination chemotherapy can increase median survival by several months and was gradually introduced in the period 2003-2006. Elderly patients may be unfit for chemotherapy but little is known about age-related treatment practice. To determine treatment patterns and current survival outcome, three large population-based registries were queried in a uniform manner.
  
  
  METHODS
  Data from the Belgian Cancer Registry, the Netherlands Cancer Registry and the UK National Lung Cancer Audit were analyzed for patients diagnosed with pleural mesothelioma since 2007. Treatment patterns and survival rates were compared between countries and age-groups.
  
  
  RESULTS
  The study included 900, 2306 and 5808 patients from Belgium, the Netherlands and England, respectively. Fifty-nine percent of patients were 70 years or older and 84% were men. Chemotherapy use decreased with advancing age and was used more often in Belgium (60%) than in the Netherlands (41%) and England (37%). For patients aged 70-79 years, chemotherapy use was 55%, 36% and 34% in the respective countries. Median survival was 10.7 months in Belgium versus 9.2 months for the Netherlands and 9.5 months for England. Survival rates decreased with advancing age. On average, median survival was 5.6 months longer for patients treated with chemotherapy, irrespective of age.
  
  
  CONCLUSIONS
  Combined analysis of data from three countries with high mesothelioma rates demonstrates that chemotherapy has become standard treatment for younger patients. Elderly patients currently account for more than half of all cases and less toxic treatment options will be required to improve their prospects.
authors.affiliation: Netherlands Comprehensive Cancer Organisation (IKNL), Vasteland 78, 3011 BN Rotterdam, The Netherlands. Electronic address: R.Damhuis@iknl.nl.
authors.forename: R A
authors.initials: RA
authors.lastname: Damhuis
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Hucknall Road, Nottingham NG5 1PB, UK.
authors.forename: A
authors.initials: A
authors.lastname: Khakwani
authors.affiliation: Belgian Cancer Registry, Rue Royale 215 BP 7, 1210 Brussels, Belgium.
authors.forename: H
authors.initials: H
authors.lastname: De Schutter
authors.affiliation: Department of Respiratory Medicine, Nottingham University Hospital, City Campus, Hucknall Road, Nottingham NG5 1PB, UK.
authors.forename: A L
authors.initials: AL
authors.lastname: Rich
authors.affiliation: Department of Thoracic Oncology, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
authors.forename: J A
authors.initials: JA
authors.lastname: Burgers
authors.affiliation: Department of Thoracic Oncology, Multidisciplinary Oncological Center Antwerp, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium; Respiratory Medicine, Ghent University, De Pintelaan 185, 9000 Gent, Belgium.
authors.forename: J P
authors.initials: JP
authors.lastname: van Meerbeeck
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D003131:Combined Modality Therapy; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008654:Mesothelioma / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010997:Pleural Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D012042:Registries; D016896:Treatment Outcome; D055815:Young Adult
keywords: Chemotherapy; Elderly; Pleural mesothelioma; Survival