National Mesothelioma Audit report 2018 (audit period 2014–16)

Produced by:

The National Mesothelioma Audit has been produced in collaboration with Mesothelioma UK to raise the profile of this asbestos-related cancer and to make recommendations to improve outcomes for mesothelioma patients. This is our first mesothelioma report to include results for peritoneal mesothelioma cases.

Key recommendations

Data completeness

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

2. In accordance with TNM8, clinical teams are encouraged to record clinical TNM staging at multidisciplinary team meetings for MPM patients. 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 mesothelioma multidisciplinary team (MDT) meeting.

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 should be over 95%, 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 CNS and signposted to Mesothelioma UK resources including the mesothelioma CNS helpline if there is not a locally available mesothelioma CNS; at least 80% of patients should have a CNS present at the time of diagnosis.

Treatment and outcomes

7. Patients with adequate performance status should be offered active anti-cancer treatment, including palliative chemotherapy. MDTs with chemotherapy rates (in good PS patients) below 60% 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. Where survival is below national average, an in-depth local audit is recommended, including analysis of active anti-cancer treatment rates and length of the diagnostic pathway.

Peritoneal

11. All patients should be referred for discussion at a mesothelioma MDT and signposted to Mesothelioma UK resources; patients of good PS should be considered for treatment with palliative chemotherapy.

12. For patients of good PS and epithelioid subtype refer to the national peritoneal mesothelioma MDT for consideration of cytoreductive surgery.

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. Mesothelioma can also affect the similar peritoneal membrane within the abdominal cavity, resulting in peritoneal mesothelioma.

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

There are four main aims for the mesothelioma audit:

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