Mesothelioma Services in England:
Improving Outcomes
Dr Mick Peake
Consultant Respiratory Physician Glenfield Hospital, Leicester National Lead Clinician, Lung Cancer Cancer Services Collaborative Programme
UK Mortality 2002
Source:Cancer Research UK
Mesothelioma: areas of highest incidence 1981-2000
Males Area
West Dumbartonshire Barrow-in-Furness Plymouth Portsmouth
Females SMR* No.
637 593 396 388 8.9 7 15.9 11.1
Area
Barking & Dagenham Sunderland Blackburn West Dumbartonshire
SMR* No.
649 575 484 451 2.6 4 1.5 1.1
South Tyneside
North Tyneside Southampton Eastleigh
357
340 325 303
9.3
11 10.3 4.7
Newham
Leeds S Ribble Swale
348
328 367 297
1.4
5.7 0.8 0.8
Medway
Barking & Dagenham Renfrewshire Newham
298
294 256 250
9.4
7.3 6.4 6.8
Kirklees
Chorley Southampton Nottingham
226
279 221 216
Source: HSE
2
0.6 1.1 1.4
*Standardised Mortality Ratio.
Mesothelioma: areas of lowest incidence 1981-2000
Males Area Kensington & Chelsea Herefordshire Scottish Borders Monmouthshire Newcastle-u-Lyme SMR 39 34 32 32 30 No. 0.75 1 0.6 0.45 0.6 Hull Leicester North Somerset Cardiff Canterbury Females Area SMR 32 31 30 28 26 No. 0.2 0.2 0.15 0.2 0.1
Cheltenham
Bridgend Ryedale Merthyr Tydfil
29
29 27 27
0.5
0.6 0.25 0.25
Rotherham
Dumfries & Galloway Doncaster Warwick
26
25 22 17
0.15
0.1 0.15 0.05
Powys
Staffordshire Barnsley Worcester
26
25 22 16
0.6
0.4 0.8 0.2
Eastbourne
Brighton & Hove Wealden Hinckley & Bosworth
15
14 12 0
0.05
0.1 0.1 0
Mesothelioma: Range of incidence per MDT in England
• Currently the same MDTs manage lung cancer and mesothelioma • Approximately 155 lung MDTs in England • Current deaths in England pa 1500 • Mean annual caseload per MDT 10 • Range of Standardised Mortality Ratio (males) 16 – 637 • Range of annual MDT case load 1 - 41
Would you want your mother to be managed for her breast cancer by a team that was seeing less than 10 cases of breast cancer per year?
• Diagnosis
Mesothelioma-specific issues
– Radiology – Biopsy (e.g. CT guided pleural biopsy) – Pathology
• Staging
– Radiological – Surgical
• Treatment
– – – – Pleurodesis and other palliative therapy (including cordotomy) Radiotherapy to drain site Chemotherapy Surgery (with combination chemo-radiotherapy)
• Support & Advice
– Patient group – Nursing – Medico-legal
• Research
• Diagnosis (pleural effusion)
Mesothelioma-specific issues
– Radiology – Biopsy (e.g. CT guided pleural biopsy) – Pathology
• Staging
– Radiological – Surgical
• Treatment
– – – – Pleurodesis and other palliative therapy (including cordotomy) Radiotherapy to drain site Chemotherapy Surgery (with combination chemo-radiotherapy)
• Support & Advice
– Patient group – Nursing – Medico-legal
• Research
• Diagnosis
Mesothelioma-specific issues
• Staging
– Radiology – Biopsy (e.g. CT guided pleural biopsy) – Pathology – Radiological – Surgical – – – – Pleurodesis and other palliative therapy (including cordotomy) Radiotherapy to drain site (only 37% in one recent study) Chemotherapy Surgery (with combination chemo-radiotherapy)
• Treatment
• Support & Advice
– Patient group – Nursing – Medico-legal
• Research
• Diagnosis
Mesothelioma-specific issues
• Staging
– Radiology – Biopsy (e.g. CT guided pleural biopsy) – Pathology – Radiological – Surgical – – – – Pleurodesis and other palliative therapy (including cordotomy) Radiotherapy to drain site (only 37% in one recent study) Chemotherapy (only 8% in one recent study) Surgery (with combination chemo-radiotherapy)
• Treatment
• Support & Advice
– Patient group – Nursing – Medico-legal
• Research
Advances in Mesothelioma Care
• Diagnosis & staging
– – – – – – – – – CT, PET and CT guided biopsy Medical thoracoscopy Mediastinoscopy ?Mesothelin Chemotherapy (including Pemetrexed – Alimta) Surgery: Extrapleural pneumonectomy and pleurectomy Cordotomy for intractable pain (Radiotherapy to the drain site) Supportive care (nursing)
• Treatment
• Research
• Patient and carer information
– MESO-1 – MARS
Initial strategy
•
•
Each cancer network was asked in May to nominate a network lead clinician and lead nurse for mesothelioma To date 5 have yet to make nominations Tasks:
a) b) – – – – – – c)
• • • •
A report will be compiled and presented to the DoH Lung Cancer & Mesothelioma Advisory Group (LCAMAG) for review LCAMAG is preparing a Mesothelioma Framework National CSC Mesothelioma Conference as part of ‘Mesothelioma week’ late February 2006 Use of the LUCADA audit project to review case load & treatment in the future
to become a national resource to review: the local incidence the level of local specialist interest/expertise/advice the extent to which mesothelioma patients are discussed in MDTs the local (network/regional/supra-regional) referral pathways what protocols are locally agreed (pleural effusion) clinical trial entry Assess the feasibility and acceptance of network-wide or regional MDTs
Networks with no nominated leads
• • • • • Mid Trent Mount Vernon North Trent NW Midlands Yorkshire
Initial strategy
•
•
Each cancer network was asked in May to nominate a network lead clinician and lead nurse for mesothelioma To date 5 have yet to make nominations Tasks:
a) b) – – – – – – c)
• • • •
A report will be compiled and presented to the DoH Lung Cancer & Mesothelioma Advisory Group (LCAMAG) for review LCAMAG is preparing a Mesothelioma Framework National CSC Mesothelioma Conference as part of ‘Mesothelioma week’ late February 2006 Use of the LUCADA audit project to review case load & treatment in the future
to become a national resource to review: the local incidence the level of local specialist interest/expertise/advice the extent to which mesothelioma patients are discussed in MDTs the local (network/regional/supra-regional) referral pathways what protocols are locally agreed (pleural effusion) clinical trial entry Assess the feasibility and acceptance of network-wide or regional MDTs