A new report from the Royal College of Physicians (RCP) and Mesothelioma UK has revealed that mesothelioma patients in the UK are experiencing increased overall survival rates. The report shows that three-year survival for patients with this asbestos-related cancer increased by three per cent for malignant pleural mesothelioma and by seven per cent for peritoneal mesothelioma.
The fourth annual National Mesothelioma Audit report is produced by the Royal College of Physicians, is funded by Mesothelioma UK and focuses on factors including long-term survival, levels of clinical nurse specialist support and treatment type.
The National Mesothelioma Audit report 2020 provides a summary of key findings, national averages and geographical variance across an agreed list of mesothelioma service performance indicators and patient outcomes. The audit was commissioned to disseminate results on the quality of care for patients diagnosed with malignant mesothelioma in England, Wales, Northern Ireland and Guernsey. It is based on anonymised patient data from 160 health organisations and 7,210 mesothelioma patients diagnosed between 2016 and 2018.
Overall data completeness has improved with performance status increased to 80 per cent from 69 per cent, stage increased to 65 per cent from 54 per cent and clinical nurse specialist (CNS) support increased to 77 per cent from 67 per cent.
Diagnostic and support measures were also found to be improved with more patients being discussed at multi-disciplinary meetings (up to 89 per cent from 81 per cent) and being assessed by a CNS (up to 70 per cent from 54 per cent).
The report makes nine key recommendations:
1. Data completeness for performance status and stage (MPM) should each exceed 90 per cent
2. All MDTs should appoint a ‘clinical data lead’ with protected time to allow promotion of data quality, governance and quality improvement
3. All mesothelioma cases should be discussed in a timely fashion by an MDT that reviews a sufficient number of cases to maintain expertise and competence in the diagnosis and treatment of MPM
4. At least 80% of patients should have a CNS present at the time of diagnosis and 90% should be signposted to Mesothelioma UK resources including the mesothelioma CNS helpline if there is not a locally available mesothelioma CNS
5. Pathological confirmation should be over 95 per cent and where the proportion of cases of unspecified MPM is above 10 per cent, review of diagnostic procedures and pathological processing is recommended
6. Patients with adequate PS should be offered active anticancer treatment, including palliative chemotherapy
7. MDTs with chemotherapy rates (in good PS patients) below 60 per cent should perform detailed case note review to ascertain why. High-quality patient information should be available to guide treatment decisions
8. Palliative radiotherapy should be considered for symptom control, including localised pain in MPM, where the pain distribution matches areas of underlying disease
9. All PM patients should be referred for discussion at a mesothelioma MDT and signposted to Mesothelioma UK resources; patients with good PS should be considered for treatment with palliative chemotherapy; for patients with good PS and epithelioid subtype consider referral to the national peritoneal mesothelioma MDT
Head of Services for Mesothelioma UK, Liz Darlison commented: “The improvements across the board in service performance and patient outcomes are significant and it’s particularly encouraging to see the increased survival rates for both malignant pleural and peritoneal mesothelioma patients.
“Mesothelioma UK would like to thank the RCP and the healthcare professionals who participated in this work. We’re committed to the National Mesothelioma Audit and are ambitious to develop it further. Reports like this are vital if we are to provide patients with equitable access to first class care and treatment and improve their outcomes.”