Current Asbestos Exposure and Future Need for Palliative Care in India

Our plain-English summary of Current Asbestos Exposure and Future Need for Palliative Care in India, by A.V. Jadhav, N.C. Gawde (Indian Journal of Palliative Care, 2019).

The study

• Authors: A.V. Jadhav, N.C. Gawde
• Journal: Indian Journal of Palliative Care
• Published: 2019;25(4):587-591
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Asbestos-related diseases (ARDs) are incurable but entirely preventable. Due to India's continuing use of asbestos, ARD patients will increase to a high number in the next three to four decades. This will increase the burden on palliative care system which is in nascent stage presently. Palliative care is the mainstay of the management of ARDs. Unfortunately, the burden on palliative care is likely to increase due to multiple factors contributed by India's demographic and economic changes. In the near future, there will be at least 12.5 million ARD patients and 1.25 million asbestos-related cancer patients worldwide, and half of these will be in India. It is high time to introspect about our ability to engage with this future problem. The paper also discusses the organization of this future problem of ARDs and possible action points toward future access to palliative care for ARD patients.

Copyright: © 2019 Indian Journal of Palliative Care.

In plain English

This was a perspective article, not a study with its own data. The authors argued that India's continuing use of asbestos will raise the number of people with asbestos-related diseases, and so the need for palliative care, over the coming decades. Citing government figures, they noted that India imported 310,592 tonnes of asbestos in 2016–17. They also noted that a government planning document reported no asbestos-related diseases, which they linked to incorrect diagnosis and under-reporting. Using a published estimate of one mesothelioma death for every 170 tonnes of asbestos consumed, they calculated that India's roughly 350,000 tonnes of annual use would mean more than 2000 mesothelioma deaths. Citing earlier studies, they wrote that asbestosis incidence in India among primarily exposed people varies from 20% to 60%, depending on the intensity and duration of exposure and the asbestos type. They also wrote that only 1%–2% of Indians have access to palliative or supportive care. The authors concluded that both an asbestos ban and a better health-system response are needed, because palliative care needs will continue for decades even after a ban.

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: Perspective (opinion and policy) article drawing on published data and estimates; no original data collected
• Who was studied: No study population. The paper discusses India as a whole: its asbestos use, people exposed to asbestos, and its palliative care system.
• Exposure: Asbestos in general (no specific fiber type analysed). The paper covers primary (occupational) exposure, secondary ('take-home') exposure of family members, and environmental exposure near mines and factories.
• Main results:
  • Citing a government source, the authors reported that India imported 310,592 tonnes of asbestos in 2016–17, and 355,686 and 396,493 tonnes in the previous years.
  • Asbestosis and asbestos-related cancers are notifiable under the Mines Act, 1952, yet no asbestos-related diseases were reported according to the government's 12th five-year plan document. The authors attributed this to incorrect diagnosis and under-reporting.
  • The authors started from cited figures: a 7–8 fold higher mesothelioma risk among exposed people and a background incidence of 2 to 4 per 100,000. From these, they deduced that mesothelioma incidence among exposed individuals may be between 14 and 32 per 100,000.
  • Using a cited estimate of one mesothelioma death per 170 tonnes of asbestos consumed, the authors estimated that India, with about 350,000 tonnes of annual use, will have more than 2000 mesothelioma deaths.
  • Citing earlier studies, the authors stated that asbestosis incidence in India among primarily exposed people varies from 20% to 60%, depending on the intensity and duration of exposure and the asbestos type.
  • Citing other sources, the authors wrote that only 1%–2% of Indians have access to some form of palliative or supportive care. The Pallium India directory lists 159 centers outside Kerala and 316 centers in Kerala.
• The authors' conclusion: The authors concluded that both an asbestos ban and a better health-system response to asbestos-related diseases are needed. In their view, the burden on palliative care will continue for decades even after a complete ban, and India needs to be ready for it.
• Limitations the authors state:
  • The authors noted that there are few large studies of secondary and environmental asbestos exposure in India.

Topics

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Palliative Care.

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