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National Lung Cancer Audit pleural mesothelioma report 2016

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In collaboration with Mesothelioma UK, the NLCA has produced the second mesothelioma audit report to raise the profile of this asbestos-related cancer and to make recommendations to improve outcomes for mesothelioma patients.

Key recommendations

Data completeness

1. Data completeness for the performance status field should exceed 90%.

2. In anticipation of a validated International Mesothelioma Interest Group (IMIG) staging system planned for publication in 2017, clinical teams are encouraged to record the current non-validated IMIG tumour-nodes-metastasis (TNM) staging system at multidisciplinary team meetings for MPM patients. Once a validated staging system is available, hospital trusts should aim for an overall recording of stage in at least 90% of cases. 

3. At least 95% of patients submitted to the audit should be discussed at a multidisciplinary team (MDT) meeting, ideally a mesothelioma specialist MDT.

4. All MDTs should appoint a ‘clinical data lead’ with protected time to allow promotion of data quality, governance and quality improvement. 

Process of care

5. Pathological confirmation in life should be over 95%, as there are no specific clinico-radiological features for diagnosing mesothelioma. In view of its prognostic value, every effort should be made to pathologically subtype the MPM, and where the proportion of cases of unspecified MPM is above 10%, review of diagnostic procedures and pathological processing is recommended.

6. At least 90% of patients should be seen by a lung cancer nurse specialist (LCNS); at least 80% of patients should have an LNCS present at the time of diagnosis. 

Treatment and outcomes

7. Patients with adequate performance status should be offered active treatment including palliative chemotherapy. MDTs with lower than expected chemotherapy rates (below 60%) or low risk-adjusted odds ratio should perform detailed case note review to ascertain why. High-quality patient information should be available to guide treatment decisions.

8. For patients undergoing surgical treatment, every effort should be made to accurately record the OPCS-4 code of the procedure undertaken.

9. All patients should be offered access to relevant clinical trials even if this requires referral outside of their network.

10. Survival: Where risk-adjusted odds ratios are low, an in-depth local audit is recommended, including analysis of active treatment rates and length of the diagnostic pathway.

What we are doing

Mesothelioma is a type of cancer that develops over a long period of time, but once clinically apparent is often rapidly progressive. The cancer originates in mesothelial cells found in the thin membrane (pleura) that line the lungs and the inside of the chest wall. 

In late 2014, the contract for the NLCA was awarded to the Royal College of Physicians by the Healthcare Quality Improvement Partnership for 3 to 5 years. The contract did not include an audit for mesothelioma, and this audit is now being independently funded by Mesothelioma UK. 

There are four main aims for the mesothelioma audit:

  1. To maintain and enhance the profile of mesothelioma, a disease with poor outcome and variation in care
  2. To build upon the recommendations of the previous mesothelioma report and allow organisations to measure and demonstrate improvement over time
  3. To embed a process of data collection for mesothelioma in clinical teams linked to an infrastructure that has a robust long-term future
  4. To set new standards for mesothelioma.

Who's involved


  • Mesothelioma UK
  • National Cancer Registration and Analysis Service 
  • University of Nottingham