Age Is Just a Number: Mesothelioma Surgery for Elderly Patients

Shared blog post from Mesothelioma Guide

In almost any explanation of mesothelioma treatment options, there is a clause. The routes available depends on numerous factors, one of which is age. This clause — that age, among other factors, could limit treatment — is usually specific to just one option: surgery.

A study published in the Annals of Surgical Oncology suggests that age might be the most often-used factor when determining if a patient is eligible for mesothelioma surgery.

Mesothelioma is a rare and aggressive cancer for which there are already limited treatments. Removing the most effective one just because of a person’s age? We at Mesothelioma Guide hope surgeons and doctors consider far more than just that number.

In Review: Mesothelioma Treatment for Elderly Patients

The study involved examining the National Cancer Database for all patients at least 80 years old with recently diagnosed nonmetastatic malignant pleural mesothelioma. In other words, the patients’ disease is in its early stages and hasn’t spread to vital organs — but it could, and likely will, if untreated.

The researchers found 4,526 patients who met the criteria and looked into the treatment approach used for each. According to the study’s results, which was published on the U.S. National Library of Medicine:

• Just 2% of the patients had surgery (likely pleurectomy with decortication) plus chemotherapy
• Around 13% had just surgery
• 22% had only chemotherapy
• 63% were “observed,” meaning they didn’t receive any curative treatment

The average age of pleural mesothelioma patients is 72 — the disease is more likely to impact the elderly than many other forms of cancer — and restricting these patients to chemotherapy or nothing is usually an early death sentence. The median survival times were:

• 4.1 months for those observed
• 9.5 months for those receiving just chemotherapy
• 12.2 months for those undergoing surgery and chemotherapy

By comparison, the figures for pleural mesothelioma patients under 80 years old were:

• 17% only underwent surgery or had surgery and chemotherapy (median survival of 17.7 months)
• 47% had just chemotherapy (median survival of 12.2 months)
• 36% were just observed (median survival of 6.6 months)

More to the Story for Mesothelioma Treatment

The argument against elderly patients having surgery — or even chemotherapy — is that their bodies may not be strong enough. Other complications may arise due to surgery. However, not every 81- or 82-year-old patient has the same health. One may have poor nutrition or other health concerns. Another could be a former marathon runner who eats healthy and exercises regularly.

While the study says the 90-day mortality rate for those having mesothelioma surgery was 28.5%, this figure does not consider the quality of patient selection. As author Justin Karush says on the Society of Surgical Oncology website, “When selecting patients with mesothelioma for surgery, it is paramount to consider the ability to offer adjuvant treatment.”

Additionally, a survival time enhanced by 200% — the difference, according to the study, between no curative treatment and surgery plus chemotherapy — could be enough reward to take the risk.

Quality of Life Due to Surgery

For people with peritoneal mesothelioma, the benefits of surgery are just as great — if not greater. A study published in the Annals of Surgical Oncology reviewed the quality of life in 46 patients who underwent cytoreductive surgery with heated intraperitoneal chemotherapy (HIPEC). The median survival of these patients was 3.4 years, and 36.5% lived for at least five years.

By comparison, only 18% of peritoneal patients in general live for at least five years, and the life expectancy of elderly patients with this disease is at most two years. While there are similar risks associated with elderly patients undergoing cytoreductive surgery with HIPEC, the increased survival time is relevant.

So is the increased quality of life. The study suggests that patients who underwent surgery experienced improved emotional well-being and social functioning, fewer emotional issues and less pain. The study concluded, “(Quality of life) returned to baseline or improved from baseline between three months and one year following surgery. Despite the risks associated with this operation, patients may tolerate HIPEC well and have good overall (quality of life) postoperatively.”

The study suggests that patients who underwent surgery experienced improved emotional well-being and social functioning, fewer emotional issues and less pain.

Unfortunately, many elderly mesothelioma patients will never get the chance to enjoy that improved quality of life since the general assumption is they should stay away from the operating room. That’s a discouraging one in the medical industry, and one we at Mesothelioma Guide hope changes going forward.

Note to Mesothelioma Patients and Their Loved Ones

If you’re a newly diagnosed mesothelioma patient, we are on your side and will do anything possible to help you through this difficult time. Most importantly, we can help you find the best treatment available.

Our patient advocate and registered nurse, Jenna Campagna, is the No. 1 resource for learning more about mesothelioma. She also can refer you to a mesothelioma specialist with a track record of success in helping patients live long past the average prognosis. Contact us to begin your path to recovery.

About the Writer, Devin Golden

Devin Golden is the content writer for Mesothelioma Guide. He produces mesothelioma-related content on various mediums, including the Mesothelioma Guide website and social media channels. Devin's objective is to translate complex information regarding mesothelioma into informative, easily absorbable content to help patients and their loved ones.