A national survey into the management of mesothelioma treatment in the UK concludes that a new dynamic approach could help improve care and survival rates for patients, including the creation of specialist centres.

The National Lung Cancer Audit in England and Wales, 2008 – 2012, which was published on 30 March 2015, highlights the need for “experience and expertise” in a multi-disciplinary approach to help treatment centres improve their handling of a “complex” asbestosis disease.

A wide variation in managing mesothelioma

Over a five year period, 8,740 mesothelioma cases were analysed across England and Wales, in which a wide variation was found in the way doctors manage mesothelioma. The results of the analysis reveal that only 67 per cent of mesothelioma patients received any anti-cancer treatment at all.

During the same period, the average survival time indicated by the survey results did show a positive increase – from 9.2 months in 2008 to 10.5 months in 2012 – as the number of patients receiving chemotherapy also increased.

Incidence of mesothelioma continues to rise

However, researchers were concerned to find that the incidence of mesothelioma is estimated to continue rising until a predicted peak in 2020. The widespread use of asbestos in the production of insulation products had already began to decline around forty years ago – from the late 1970s and from when the dangerous brown and blue fibre types were first banned in 1985.

However the health risk of exposure to asbestos was always likely to continue in the millions of public, private and commercial properties already constructed – and were still being built. White asbestos – considered ‘low-risk’ because of its different fibre type – was allowed to continue being used across the construction industry for at least another ten years until imports were finally halted in 1999.

According to the survey results, the number of mesothelioma cases continued to rise every year, as follows:

  • 2008 – 1,310 cases
  • 2009 – 1,688 cases
  • 2010 – 1,717 cases
  • 2011 – 1,735 cases
  • 2012 – 1,885 cases

Cases under-reported

More worryingly still, the researchers suggest that cases of mesothelioma are almost certain to be under-reported and official figures may only represent 80 per cent of all cases diagnosed in the UK across the five year survey period.

In addition, the study found that the overall median one-year survival for mesothlioma was just over 41 per cent and the three-year survival was only 12 per cent. However, median survival is shown to vary at different centres, which could range from 209 days to 349 days.

Negative view of mesothelioma management

A key outcome of the research underlines a need for transforming a negative view of mesothelioma management towards renewing a ‘good practice’ approach. Organisations are called upon to increase their focus on the investigation and robust treatment of mesothelioma cancer patients.

As a result of the ongoing lack of success in finding a successful treatment for mesothelioma, it seems “most specialists consider the disease to be incurable.” The survey discovered a “significant variation in care patterns and outcomes that may reflect limited expertise in areas with low incidence ( of mesothelioma).”

Treatments used “sparingly”

According to the study, there has been a decline of mesothelioma patients across the UK undergoing aggressive surgery to combat the disease. One recent clinical trial had concluded that there was ‘no survival advantage’ to this type of surgery although a second showed ‘little advantage’ to the less aggressive, keyhole-type surgery.

Even multimodal treatment – chemotherapy, radiotherapy and surgery – which has become the standard of mesothelioma care, was used only sparingly. The study found that just 286 patients received all three treatments and only 1,048 patients received two of the three treatment options. In some centres, the use of chemotherapy could vary from 46 per cent to 71 per cent.

The research concludes that a patient’s chances of survival would be improved if the experience and expertise of medical and nursing staff were developed to allow patients access to a whole range of options in diagnosis and treatment therapy.