The second mesothelioma report, launched today by RCP London, demonstrates improvement in the number of people diagnosed with malignant pleural mesothelioma (MPM) surviving for more than 1 year*.
Despite this improvement, overall survival rates still remain poor, with only 43% of patients still alive at one year from initial diagnosis. Funded by Mesothelioma UK, the report uses data from over 2,000 patients diagnosed with MPM in England during 2014, the largest dataset for mesothelioma in the UK.
MPM is a type of cancer that develops in the thin membrane surrounding the lungs and the inside of the chest wall, over a long period of time. Approximately 90% of cases are linked to asbestos exposure and once diagnosed often progresses rapidly.
The Lung Cancer Audit Report for Mesothelioma also highlights regional variation in the treatments and interventions received by those suffering with MPM. In general, anti-cancer treatment and use of palliative chemotherapy has increased since the previous audit in 2014, with 36.5% of all patients receiving it compared to 34% in the last audit. Use of radiotherapy for MPM appears to have reduced since the last audit and was received by 16.5% of patients compared to 29% previously. Although surgical intervention is rare, the number of procedures taking place has increased since the last audit from 2.3% to 5.2%.
It is important for a mesothelioma diagnosis to be confirmed by a laboratory pathologist to ensure individuals receive appropriate care. This process is known as pathological confirmation. The report shows high pathological confirmation rates for mesothelioma with an increase in sub-classification since the previous audit, although this remains variable across regions. This more specific information about the exact type of mesothelioma an individual has, is recommended because differences in subtypes influence prognosis and response to treatment options, and can affect eligibility for clinical trials.
Recommendations in the report are aimed at trusts and relate to three key areas: process of care, treatment and outcomes.
- At least 90% of patients submitted to the audit should be discussed at an MDT meeting, ideally a mesothelioma specialist MDT
- Pathological confirmation rates should sit at a minimum of 95% and subtyping is strongly recommended
- More than 90% of patients should be seen by a lung cancer nurse specialist (LCNS) and at least 85% of patients should have a LNCS present at the time of diagnosis.
- Where appropriate patients should be offered active treatment, including palliative chemotherapy.
- High quality patient information should be available to patients in order to guide and support effective treatment decisions.
- All patients should be offered access to relevant clinical trials, regardless of geographic location.
Dr Susan Harden, clinical oncologist at Addenbrooke’s Hospital and clinical lead for the National Lung Cancer Audit said:
We are delighted to publish the second national pleural mesothelioma audit report in collaboration with Mesothelioma UK.
We encourage all clinical teams involved in caring for patients with mesothelioma to critically review these results and identify areas where further improvements could be made.
The RCP has a long history of working to improve the quality of care across health services, and would like to thank Mesothelioma UK for its support in facilitating and partnering this invaluable audit.
Liz Darlison, Mesothelioma UK Director of Services said:
Mesothelioma UK is delighted to be supporting the national audit in mesothelioma. This report is a perfect example of what can be achieved when experts and charities work closely together.
Insight into the treatment and care received across the UK is vital if we are going to work toward a nationwide equitable service. With so many advances in our understanding of cancer and in the clinical trials and treatments available it is vital that we keep fully abreast of the standard and patterns of care being received.
Mesothelioma UK consider this report is just the start in what we hope becomes a very productive collaboration that sees ongoing improvement in the treatment, care and more importantly the outcomes of those living with Mesothelioma.
*Overall, survival rates for patients with MPM are gradually improving over time with new data showing 43% surviving 1 year, compared with 40% in 2008–2012 ( taken from:National Lung Cancer Audit Report 2014 Mesothelioma: report for period 2008 to 2012).
The mesothelioma audit is delivered by the National Lung Cancer Audit (NLCA) at the Royal College of Physicians and is independently funded by Mesothelioma UK. The audit collects and publishes data on mesothelioma patients including demographics, referral pathways, investigation, treatment and outcomes. This collaboration reviews current practice to highlight regional variation in care standards with the aim to directly improve mesothelioma services and achieve better outcomes for those living with mesothelioma.
National Lung Cancer Audit
The National Lung Cancer Audit (NLCA) is an established and valued national clinical audit whose work dates back to 2003. It currently forms part of the National Clinical Audit Programme. The NLCA programme is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP)*, and is managed by the Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians.
Mesothelioma UK is a national resource centre dedicated to providing specialist mesothelioma information, support and improved care and treatment for all UK mesothelioma patients, their carers and healthcare professionals. The centre promotes the development of specialist mesothelioma nursing practice and funds specialist nursing posts around the UK.
Mesothelioma UK Charitable Trust is based at the University Hospitals, Leicester. Their services are free of charge and rely entirely on donations, legacies, fundraising and sponsorship for financial support. For more information, please visit www.mesothelioma.uk.com or email firstname.lastname@example.org
Patient story: Mavis Nye, aged 74
I was exposed to asbestos through washing my husband’s work clothes when I was just married in 1960…I was 68 years old when first diagnosed with mesothelioma. Finding centres of excellence, clinical trials and generally active clinicians has been a continuous self-investigated job!
Initially I couldn’t breathe and luckily enough I had an X-ray as my arms were numb and hands were twisting. A bed was arranged by the GP who had me booked into A&E to have my lung drained of 7 litres of fluid which when tested had MPM cells showing. So therefore I was diagnosed 4 June 2009, on our wedding anniversary. I was booked in for the talc op and then chemo.
After 15 months a scan showed growth so I was entered into a trial but I might have had theplacebo as my meso kept growing. I had cisplatin and Alimta again, which held the disease back for a while and then I had Gem/Carbo but that failed after 2 months.
Faced with no more treatment I had to research trials and managed to find a phase I trial available in London. This has turned my life around well it has actually saved my life. I have had complete response and I’m in remission. I dread to think how it would have all turned out if I wasn’t computer literate.
The 2014 audit report provided the first details about the standard of care across our country and the variation that we, the patients, know exists.
Thank you Meso UK for investing in this excellent initiative that is the first step along the road to making sure we know what is happening and where. Perhaps we can then start to encourage improvement in those areas most needing it.