Study Finds Mesothelioma Therapies Underutilized in Women
June 15, 2020
A multicenter research team of specialists has uncovered a surprising underutilization of treatments for pleural mesothelioma cancer in women.
Clinical Lung Cancer recently published the findings, which showed a significant sex-based disparity in the receipt of care for women when compared with that of men.
Women were 15% less likely to receive aggressive mesothelioma surgery that has proven its worth in extending lives for this cancer, which has no definitive cure. They also were 20% less likely to receive chemotherapy than were men.
“This is concerning, absolutely,” Dr. Charles Simone, chief medical officer at the New York Proton Center and one of the researchers told The Mesothelioma Center at Asbestos.com. “We should be making sure that women are getting full access to the most advanced treatments, just as men are.”
The study was the largest, most robust analysis ever on the topic using a national hospital-based registry that included more than 18,000 patients. It was taken from the National Cancer Database.
Researchers were from the Perelman School of Medicine at the University of Pennsylvania, Allegheny General Hospital in Pittsburgh, the MD Anderson Cancer Center at the University of Texas and the New York Proton Center.
“A patterns-of-care assessment exposed concerning disparities in receipt of treatment, as females were less likely to receive chemotherapy and surgery, despite deriving great benefit from receipt of all therapies,” the authors wrote. “Such underutilization of therapy in females is unexpected.”
Women with Pleural Mesothelioma Still Live Longer
The report also confirmed earlier, smaller studies that have shown women with malignant pleural mesothelioma typically live longer than men with the disease.
In the cohort being studied, women had an overall survival rate of 45.3% at one year and 25.7% at two years, compared to men at 38.4% and 16.3%. The mean overall survival was 20.8 months for women and 15.8 months for men.
This survival advantage typically has been attributed to younger age, histology (more epithelioid variety) and fewer comorbidities at the time of diagnosis.
“The study crossed off one important reason women may do better. It’s not because they are treated more aggressively,” Simone said. “As we’ve seen, if anything, they are treated less aggressively than their male counterparts.”
Mesothelioma Surgery Increases Survival
Women account for only 20% to 25% of all pleural mesothelioma cases. The cancer is caused by the inhalation or ingestion of asbestos fibers. A large majority of cases involve occupational exposure to the toxic mineral.
With surgery, women increased their survival times to 63.7% at one year and 42.6% at two years. With chemotherapy alone, women had overall survival of 59.4% and 32.3%. With trimodality therapy (surgery, chemotherapy and radiation), the numbers soared to 82.1% and 51.6%.
The sexual disparity in treatment was puzzling because the survival advantages women have also are factors that typically make them better surgical candidates.
Less than 25% of all patients diagnosed with pleural mesothelioma undergo aggressive surgery. Too often, the disease already has metastasized before it is diagnosed.
“More women than men seem to have all three of the checkmarks that drive who is a surgical candidate,” Simone said. “One thing we can’t control is that maybe women were more likely to decline the surgery that is offered. But that seems unlikely. It’s too big a difference.”
Women Missing Mesothelioma Treatment Opportunity
Many of the mesothelioma specialists believe women survive longer than men because of underlying biological and hormonal differences.
The authors estimated that overall survival would improve for women by 6.7 months at one year and 10.8 months at two years with surgery or chemotherapy.
“Potential survival benefits of these magnitudes appear highly clinically significant,” the authors wrote. “Our findings may have therapeutic implications. Carefully selected women with epithelioid histology may benefit from more aggressive treatment compared to men, in order to take advantage of a sex-based advantage in outcomes.”