Mesothelioma is an asbestos-related disease that affects thousands across the UK. Mesothelioma UK releases a report called the National Mesothelioma Audit every two years.
The Audit outlines the facts and figures relating to the number of cases of mesothelioma, the treatment options chosen, the route to diagnosis and survival rates. The most recent National Mesothelioma Audit (NMA) was published on 28 May 2020 At 27 pages, the report can be quite difficult to interpret for mesothelioma sufferers and their carers so we have broken down some of the key findings below.
What is mesothelioma?
Mesothelioma is a type of cancer, the only known cause of which is exposure to asbestos. It can affect the lining of the lungs (pleural mesothelioma) or the lining of the abdomen (peritoneal mesothelioma).
What is the National Mesothelioma Audit?
The report summarises mesothelioma statistics from 1 January 2016 to 31 December 2018 across England, Wales, Northern Ireland and Guernsey.
The NMA is commissioned and funded by Mesothelioma UK, a charity dedicated to providing specialist support and information for UK mesothelioma patients and their carers.
These audits are prepared in an attempt to improve the quality of care across health services for those suffering with mesothelioma. The collected data highlights geographical variances and emphasises the importance of collaboration across Health Boards with the aim of developing consistent approaches to diagnosis, treatment and support across nations.
Pleural mesothelioma – key findings
We saw 7,210 new cases of pleural mesothelioma during the period 1 January 2016 and 31 December 2018. Perhaps not surprisingly, 83.3% of those diagnosed were male and the average age at diagnosis was 75.7 years.
Pleural mesothelioma can be classified by the type of cell that it affects. The three classifications are sarcomatoid, epithelioid or biphasic and the prognosis and treatment options will change depending on the classification.
It is encouraging to see there has been an increase in the number of cases classified which is crucial in making decisions about treatment options.
People are living longer after being diagnosed compared to the figures from the previous report. It is reassuring to see that 40% of patients are now surviving to 1 year post-diagnosis, and 10% of patients are surviving to 3 years, compared to 35% and 7% previously. While the report did not draw any conclusions as to why we have seen these improvements, there have been improvements in diagnostic processes, referrals to specialists and treatment plans over the last two years so it is possible that all of these contributed to these improvements in patient outcomes.
48% of patients received anti-cancer treatment to include palliative chemotherapy, radical debulking surgery and/or palliative radiotherapy. The role of radical debulking surgery remains controversial.
Radical debulking surgery involves removing the affected parts of the pleura, the lung, the diaphragm and/or pericardium. The resection of all four is known as an extrapleural pneumonectomy whereas, if only parts of the pleura is removed, it is known as a pleurectomy. This is major surgery and not suitable for most mesothelioma patients. It can have serious risks and side effects. The purpose of the surgery is to remove the cancer, but it is inevitable that cancer cells will be left behind meaning the cancer is likely to come back. It can also be difficult for surgeons to appreciate the full extent of the tumour until the operation has started.
40% of patients underwent chemotherapy with Pemetrexed Carboplatin being the most popular drug combination used. Clinical trials are still the recommended second line treatment under the NHS but we know that immunotherapy is also available in a private setting.
There has previously been debate surrounding the benefits of radiotherapy. 14.8% people still underwent radiotherapy during this period and it is recommended that this should still be considered, particularly for those with localised pain above the site of underlying disease.
Peritoneal mesothelioma – key findings
There were 260 new peritoneal mesothelioma cases reported between 2016 and 2018 and the average age at diagnosis was 68, notably lower than the pleural mesothelioma figure. In addition, men were affected more than women, but with a split of 64%: 36% which is less striking than for pleural mesothelioma.
The number of referrals from English hospitals to the specialist team in Basingstoke has doubled compared to the previous two year period which suggests more awareness of the disease among front line healthcare workers and allows more specialist input for patients.
47% of patients received active treatment to include systemic therapy, radical debulking surgery and/or radiotherapy.
Again, it is good to see a slight improvement in the survival rates, with an increased 1 year survival from 38% to 40%, and an increased 3 year survival rate from 15% to 18%.
Geographical differences
The report includes a detailed table showing the different diagnostic procedures, treatment and survival rates across different Health Boards. The disparity in the figures reflects the difference in medical opinions towards certain treatment methods, the ease of access to a specialist Multidisciplinary Team (MDT), the availability of a local Clinical Nurse Specialist (CNS) and, most likely, the demographic and age of patients in a particular area.
Diagnostic and support measures
It is encouraging to see that the diagnostic processes and support measures in place for these patients have improved since the last audit. There has been an increase in the number of patients discussed by an MDT, which can be a crucial step in achieving a diagnosis.
It is also really important for mesothelioma patients to have the support of a specialist nurse. In Wales, 88% of patients are seen by a CNS, whereas in Guernsey, patients do not have access to a local CNS. Hopefully this is something that can be rectified in due course.
Summary
Medical professionals and nurses are doing an admirable job of diagnosing, treating and supporting mesothelioma sufferers. However, there are areas in each Health Board where further progress can be made, whether that is with regards to reporting, referring to MDTs or ensuring that a specialist nurse is there to support every patient.
Learning from other Health Boards and working collaboratively should help to achieve a consistent approach across all nations, to ensure that mesothelioma patients are diagnosed at the earliest opportunity and that they receive the very best treatment, care and support following their diagnosis.
The National Mesothelioma Audit Report 2020 can be accessed through the RCP London website.
More importantly, if you or anyone you know is suffering unusual symptoms related to your chest or stomach, please seek medical advice as soon as possible. GP surgeries remain open for telephone consultations during the current pandemic and it is important that you do not wait to seek medical advice.
The specialist asbestos solicitors at Hugh James have acted on behalf of many people with mesothelioma and have assisted them in applying for government benefits, and making a civil compensation claim.
