UK’S first ever mesothelioma organisational audit identifies variation in access to specialist cancer services

A new report from the Royal College of Physicians (RCP) and Mesothelioma UK shows that asbestos-related cancer patients who were referred to a specialist mesothelioma multidisciplinary team (MDT) in the UK were significantly more likely to benefit from access to a mesothelioma-specific clinical nurse specialist and on-site access to mesothelioma clinical trials.

National Mesothelioma Audit organisational audit report 2019

The National Mesothelioma Audit organisational audit report 2019 was produced by the Royal College of Physicians and funded by Mesothelioma UK. The audit was commissioned to obtain an accurate and up-to-date picture of mesothelioma multidisciplinary team (MDT) services across the UK, and to identify any variation in access to specialist services and treatments for mesothelioma patients.

All known lung MDTs (174) across England, Wales, Scotland and Northern Ireland were invited to take part in the audit, of which 125 (72%) MDTs actively participated in the study. Variation was identified across all participating MDTs in the access to services offered to mesothelioma patients. Overall, 17 Mesothelioma MDTs self-identified as providing specialist mesothelioma services, managing over 25 new cases per year.

Comparing service provision across all participating MDTs, patients who were referred to one of the 17 specialist mesothelioma MDTs appeared more likely to benefit from access to a mesothelioma-specific clinical nurse specialist 53% (9/17) vs 14% (18/125) and on-site access to mesothelioma clinical trials 88% (15/17) vs 33% (40/121).

The report has outlined a number of key recommendations:

  1. Each cancer alliance in England and equivalent healthcare regions in Wales, Northern Ireland and Scotland should ensure that all mesothelioma patients have regional access to local anaesthetic thoracoscopy and insertion of intrapleural catheters

 

  1. All MDTs to routinely perform tissue biopsy, when pleural cytology is suggestive of malignant pleural mesothelioma (MPM), and record histological subtype

 

  1. Each healthcare region should ensure that mesothelioma patients have the opportunity of a referral to a specialist mesothelioma MDT, defined as a provider discussing at least 25 new cases of mesothelioma each year. All peritoneal mesothelioma patients should be considered for referral to the national peritoneal MDT

 

  1. All specialist mesothelioma MDTs should consider using teleconferencing to support meeting attendance by key members, including palliative care and mesothelioma CNS support and to facilitate real-time feedback with MDTs who have referred patients

 

  1. All specialist mesothelioma MDTs should have a clear referral pathway including a referral pro forma

 

  1. All specialist mesothelioma MDTs should review the need for a palliative care representative to be included in their quorate for an MDT, in line with the NHS mesothelioma service specification

 

  1. All specialist mesothelioma MDTs should routinely record patient referrals to clinical trials and trial information including trial name and start date / completion date

 

  1. All MDTs should review their organisational alignment to the British Thoracic Society (BTS) mesothelioma guidelines, seek opportunities for peer review and actively participate in future National Mesothelioma Audit (NMA) audits

The full report can be downloaded here

Head of Services for Mesothelioma UK, Liz Darlison commented: “Mesothelioma UK would like to thank the RCP and the healthcare professionals who participated in this work. Shedding light on where centres of excellence are, in particular where clinical trials can more readily be accessed, is so important in rarer diseases. This report provides a first insight into the Mesothelioma UK treatment and care community which will be extremely useful to those living with mesothelioma and the healthcare professionals looking after them.”