Standards of care in mesothelioma treatment

Our plain-English summary of Standards of care in mesothelioma treatment, by S.V. Harden, L. Darlison, P. Beckett, et al (British Journal of Cancer, 2020).

The study

• Authors: S.V. Harden, L. Darlison, P. Beckett, A.C. Bibby
• Journal: British Journal of Cancer
• Published: 2020;123(11):1588-1589
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The UK has the highest incidence of mesothelioma in the world, but services vary across the country partly due to uneven geographical distribution of cases. The Mesothelioma UK-funded national organisational audit has highlighted challenges in accessing diagnostic procedures such as thoracoscopy, as well as identifying examples of best practice, including access to clinical trials and specialist therapeutic procedures. To ensure equitable and optimal patient care, cancer alliances should have established referral pathways to specialist multidisciplinary team (MDT) services for discussion of all mesothelioma patients.

In plain English

This was a short invited comment, not an original study. The authors described the national mesothelioma organisational audit, funded by the charity Mesothelioma UK, which collected data on how mesothelioma services are organised across the UK. All known thoracic cancer multidisciplinary teams (MDTs) in England, Wales, Scotland and Northern Ireland were invited to take part. All 17 specialist mesothelioma MDTs (defined as managing over 25 new cases per year) and the national peritoneal mesothelioma MDT at Basingstoke completed an extra survey. The biggest local challenges were access to local anaesthetic thoracoscopy and insertion of intra-pleural catheters. Compared with local teams, patients referred to specialist MDTs were more likely to have clinical stage and histological subtype recorded. They also had more access to specialist nurses and clinical trials. Specialist MDTs varied: specialist nurses and palliative care staff were not always present, and teleconferencing was underused. The authors concluded that every cancer alliance or region should have clear referral pathways to a specialist MDT. The comment gave no numbers for these comparisons.

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: Invited comment summarising the findings of a national organisational audit (a survey of mesothelioma services) published elsewhere; not original research by the authors
• Who was studied: All known thoracic cancer MDTs across England, Wales, Scotland and Northern Ireland were invited to take part. An additional survey was completed by all 17 specialist mesothelioma MDTs (defined as managing over 25 new cases per year) and the national peritoneal mesothelioma MDT at Basingstoke. The number of teams that took part overall is not given.
• Main results:
  • At a local level, the biggest challenges identified by the audit were access to local anaesthetic thoracoscopy and insertion of intra-pleural catheters.
  • Compared with local teams, patients referred to specialist mesothelioma MDTs were more likely to have clinical stage and histological subtype recorded. No figures were given.
  • Patients discussed at specialist mesothelioma MDTs had increased access to on-site support from mesothelioma specialist nurses and to opportunities to take part in clinical trials.
  • All specialist MDTs had direct access to systemic anti-cancer therapy and radiotherapy. They also had established pathways for onward referral to the limited number of UK centres offering radical debulking pleural surgery, cytoreductive peritoneal surgery and percutaneous cervical cordotomy.
  • Specialist MDTs varied. Mesothelioma specialist nurses and palliative care team members were not universally present at specialist MDT meetings.
  • Teleconferencing facilities were considered beneficial for giving immediate feedback to referring teams but were underused by specialist MDTs.
• The authors' conclusion: The authors stated that the audit's recommendations emphasise clear referral pathways to a specialist mesothelioma MDT. Each cancer alliance or region should have designated processes so that all patients can be discussed at a specialist MDT and can access services not available locally. Specialist MDTs should offer all elements of guideline-recommended treatment, clinical trial participation and rapid feedback to referring teams.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Thoracoscopy, Clinical Trial, Multidisciplinary Team.

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