The United Kingdom needs a more universal, multidisciplinary approach to the treatment of malignant pleural mesothelioma to improve survival times and overcome the no-hope attitude that too often surrounds this diagnosis.
Researchers in the U.K. analyzed 8,740 mesothelioma cases from England and Wales over a five-year period and found a startling variation in how doctors manage the disease, sparking a call for more experienced specialty centers to treat it.
Researchers also estimated that the incidence of mesothelioma will continue to rise in the U.K. until it peaks in 2020, despite the decades-long decline in the use and production of asbestos-containing products.
“We recognize a nihilism in the management of mesothelioma here,” lead researcher Dr. Paul Beckett, department of respiratory medicine at Royal Derby Hospital in London, told Asbestos.com. “Our hope is that by highlighting good practice, we can encourage organizations to be more aggressive in their investigation and treatment of patients.”
According to the analysis, only 67 percent of the mesothelioma patients received any anti-cancer treatment. The patient group was part of the U.K. National Lung Cancer Audit from 2008 to 2012.
“Although our study was not designed to determine whether care is better in larger and more specialized [centers], we can see that in a lot of [centers] there are not enough cases to build up the sort of experience and expertise that is needed to manage this complex disease,” Beckett said. “There is room for improvement.”
Survival Rates Rising Too Slowly
Average survival time in the study increased from 9.2 months in 2008 to 10.5 months in 2012, rising with an increase in the number of patients receiving chemotherapy in recent years, according to the analysis.
The number of mesothelioma cases in the study rose annually:
- 2008: 1,310 cases
- 2009: 1,688 cases
- 2010: 1,717 cases
- 2011: 1,735 cases
- 2012: 1,885 cases
However, cases of mesothelioma are notoriously underreported. The authors estimated these numbers represent only 80 percent of all cases diagnosed in the country during those years.
The overall median one-year survival was 41.4 percent and the three-year survival was only 12 percent. Median survival varied at different centers, ranging from 209 days to 349 days.
“There is significant variation in care patterns and outcomes that may reflect limited expertise in areas with low incidence,” the authors write. “Most specialists consider the disease to be incurable.”
There currently are no guidelines in the U.K. for the management of the disease, according to the authors.
There has been a decline in U.K. patients opting for aggressive surgery to combat the disease, stemming from a pair of clinical trials. The well-publicized MARS trial concluded that there was no survival advantage to radical surgery. A subsequent trial called MesoVATS showed little advantage to the less aggressive video assisted thoracoscopic surgery (VATS).
Need for Multidisciplinary Care
Multimodal treatment, which has become the standard of care in many specialty centers, was used only sparingly. Only 286 patients received the three-pronged approach of chemotherapy, surgery and radiation. Only 1,048 patients received two of the three treatment options.
Decisions on therapy, according to the study, were often influenced by the particular centers where the patients were treated. For example, the use of chemotherapy for patients varied from 46 percent to 71 percent, depending upon the center.
“Addressing the regional variation in diagnostic and treatment pathways for MPM will improve survival,” the authors wrote. “The findings reinforce … the need to develop the experience and expertise of medical and nursing staff to ensure that patients have access to the whole range of diagnostic and therapeutic options.”