BTS guideline for the investigation and management of malignant pleural mesothelioma

Our plain-English summary of BTS guideline for the investigation and management of malignant pleural mesothelioma, by I. Woolhouse, L. Bishop, L. Darlison, et al (BMJ Open Respiratory Research, 2018).

The study

• Authors: I. Woolhouse, L. Bishop, L. Darlison, D. de Fonseka, A. Edey, J. Edwards, C. Faivre-Finn, D.A. Fennell, S. Holmes, K.M. Kerr, A. Nakas, T. Peel, N.M. Rahman, M. Slade, J. Steele, S. Tsim, N.A. Maskell
• Journal: BMJ Open Respiratory Research
• Published: 2018;5(1):e000266
• Cited by: 29 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The full guideline for the investigation and management of malignant pleural mesothelioma is published in Thorax. The following is a summary of the recommendations and good practice points. The sections referred to in the summary refer to the full guideline.

In plain English

This article is a summary of the British Thoracic Society (BTS) guideline on investigating and managing malignant pleural mesothelioma. The full guideline was published in Thorax. It is a set of recommendations, not a study of patients. A guideline group searched the medical literature in December 2014, updated the search in July 2016, rated the evidence using SIGN methods, and graded each recommendation from A (strongest evidence) to D. The background section named breathing in asbestos dust as the main cause of mesothelioma. The recommendations included:

• taking a thorough lifelong occupational history, including relatives' or partners' jobs, to find "para" exposure (Grade D)
• not using biomarkers alone to diagnose the disease (Grade B) or to screen for it (Grade C)
• offering talc or indwelling pleural catheters for symptomatic fluid around the lung (Grade A)
• not offering extra-pleural pneumonectomy (Grade B)
• offering patients in good condition first-line cisplatin and pemetrexed (Grade A)
• giving patients and carers accurate, understandable information about compensation (Grade D)

The authors acknowledged that little high-quality evidence existed for some questions. In those cases they used lower-grade evidence and expert consensus.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Clinical practice guideline (summary of the recommendations and good practice points of the full BTS guideline published in Thorax)
• Who was studied: People with suspected or proven malignant pleural mesothelioma in the UK. The intended users are GPs and hospital and community clinicians. Non-pleural mesothelioma was excluded. The literature search ran from December 2014, with an update in July 2016.
• Exposure: Exposure was not studied. The background names breathing in asbestos dust as the main cause of mesothelioma. The guideline recommends a lifelong occupational history that includes relatives' and partners' occupations, to identify para exposure.
• Main results:
  • Recommendation: take a thorough occupational history covering all occupations throughout life (Grade D).
  • Recommendation: do not offer biomarker testing to screen for malignant pleural mesothelioma (Grade C).
  • Recommendation: do not offer video-assisted thoracoscopic partial pleurectomy (VATS-PP) over talc pleurodesis (Grade A).
  • Recommendation: offer patients with good performance status (WHO 0–1) first-line cisplatin and pemetrexed (Grade A).
  • Recommendation: do not routinely offer prophylactic radiotherapy to chest wall procedure tracts (Grade A).
  • Recommendation: offer patients and carers accurate and understandable information about compensation for malignant pleural mesothelioma (Grade D).
• The authors' conclusion: The authors stated that the guideline's aim was to provide detailed, evidence-based guidance for investigating suspected malignant pleural mesothelioma and for the care of people with proven disease.
• Limitations the authors state:
  • The authors acknowledged that little high-quality evidence existed for some clinical questions. For those questions, low-grade evidence and expert consensus were used.
  • Cost-effectiveness was not considered in detail.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Thorax.

Related studies

• British Thoracic Society Guideline for the investigation and management of malignant pleural mesothelioma — I. Woolhouse, L. Bishop, et al. (2018)
• Introducing the new BTS guideline: the investigation and management of pleural malignant mesothelioma — I. Woolhouse, N.A. Maskell (2018)
• Guidelines of the European Respiratory Society and the European Society of Thoracic Surgeons for the management of malignant pleural mesothelioma — A. Scherpereel, P. Astoul, et al. (2010)
• Guidelines of the French Speaking Society for Chest Medicine for management of malignant pleural mesothelioma — A. Scherpereel, French Speaking Society for Chest Medicine (SPLF) Experts Group (2007)
• Diagnostic surgical pathology in lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines — A.M. Schwartz, M.K. Rezaei (2013)
• Vulvar sarcomas: Short guideline for histopathological recognition and clinical management. Part 2 — A.A. Chokoeva, G. Tchernev, et al. (2015)

Browse more research in BMJ Open Respiratory Research, or return to medical research.