Exposure to asbestos: psychological responses of mesothelioma patients

Our plain-English summary of Exposure to asbestos: psychological responses of mesothelioma patients, by A.H. Lebovits, A.P. Chahinian, J.C. Holland (American Journal of Industrial Medicine, 1983).

The study

• Authors: A.H. Lebovits, A.P. Chahinian, J.C. Holland
• Journal: American Journal of Industrial Medicine
• Published: 1983;4(3):459-66
• Cited by: 23 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001708).

Abstract

Thirty-eight patients with a diagnosis of malignant mesothelioma participated in a semi-structured interview to evaluate asbestos exposure, acquisition of increased risk information, and retrospective reporting of cognitive and behavioral reactions (particularly smoking behavior) to risk information. Twenty-eight patients (74%) had direct occupational contact with asbestos, and six patients (16%) reported indirect nonoccupational exposure to asbestos. Only two (10%) of the directly exposed patients acquired risk information from professional sources prior to diagnosis of mesothelioma. The most frequently reported reaction to learning of increased risk of cancer was a denial of the risk by minimizing personal exposure. Few patients reported being concerned about the information of increased risk. Smoking behavior did not change as a result of risk information, nor was there any increase in visits to physicians. Guidelines for psychosocial management of at-risk groups are recommended.

In plain English

This study interviewed 38 patients with biopsy-proven diffuse malignant mesothelioma (34 pleural, 4 peritoneal), most seen at Mount Sinai Hospital in New York. It asked about their asbestos exposure, how they learned of the health risk, and how they reacted. Twenty-eight had direct, mainly occupational, contact with asbestos, typically as pipefitters or shipyard workers. Six reported indirect nonoccupational exposure, and four had no determinable exposure. Of the 28 directly exposed patients, 22 had learned before diagnosis from the news media and friends that asbestos was a hazard. Only two learned from professional sources, and none from a physician. Among 24 directly exposed patients informed before diagnosis, 11 denied the risk by minimizing their personal exposure, 9 were not concerned, and 4 were concerned. None of the smokers stopped smoking after learning of the risk, and no patient increased regular physician visits. The authors noted the sample may have been referral-biased and relied on recall. They concluded that risk information should come as early after exposure as possible, from a more authoritative source than the news media.

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: Interview study (case series) using a semi-structured interview with retrospective self-reporting of asbestos exposure, risk information, smoking and reactions
• Who was studied: 38 patients with biopsy-proven diffuse malignant mesothelioma: 34 pleural and 4 peritoneal, 31 male and 7 female, mean age 58, median 7 months from diagnosis to interview. Thirty-two were interviewed as they were consecutively admitted for chemotherapy to the Department of Neoplastic Diseases at Mount Sinai Hospital, New York. Five were interviewed at home and one at another hospital. Dates of interviews are not given.
• Exposure: Asbestos, fiber type not specified. 28 patients had direct contact, primarily occupational, typically as pipefitters or shipyard workers. Their median duration of direct exposure was 5.5 years (range four days to 40 years), and the median time from first exposure to diagnosis was 37 years (range 17 to 56 years). Six had indirect nonoccupational exposure: 3 presumably household contamination, 1 environmental proximity, and 2 probable but not definite. Four had no determinable exposure.
• Main results:
  • Of the 28 directly exposed patients, 22 (79%) had learned before diagnosis, from the news media and friends, that asbestos exposure was considered a health hazard. Four did not know of the asbestos-cancer association before diagnosis. Only two learned from professional sources such as union and specialty journals, and none learned from a physician.
  • Fourteen (50%) of the 28 directly exposed patients learned of their increased risk only within the two years before diagnosis or at diagnosis.
  • Of the 28 directly exposed patients, 22 had never or very rarely used occupational precautions such as face masks. The other six had used them only sporadically.
  • Thirty (79%) of the 38 patients had smoked cigarettes at some point. Among the 30 smokers, the median was 20 years of smoking and 23 pack-years. Among directly exposed patients, none of the smokers stopped after learning of the increased risk. Eleven (39%) had stopped before learning of it.
  • Of the 24 directly exposed patients informed before diagnosis, 11 (46%) reacted with denial, minimizing their personal exposure (for example, "It was so long ago").
  • Of the same 24 patients, 9 (37% in the text) were not at all concerned and dismissed the information as unimportant, and only 4 (17%) reported being concerned about their health.
  • Only 4 patients went to a physician as a result of the asbestos information. No patient increased regular physician visits, and none actively sought more information about asbestos before their illness.
  • After diagnosis, disbelief that asbestos caused their illness was a frequent response. Patients cited the long latency and minimal exposure.
  • Sixty-five percent of patients with direct or indirect exposure denied any anger toward the asbestos industry. Several expressed gratitude for having had a good job.
• The authors' conclusion: The authors concluded that denial was a characteristic response to being at increased risk. They recommended that increased-risk information be communicated as early after exposure as possible, by a more authoritative source than the news media, ideally the family physician.
• Limitations the authors state:
  • The patients may have been a referral-biased sample and may differ psychosocially from mesothelioma patients not seen at a leading treatment center.
  • All patients had already developed an asbestos-related tumor, so comparisons to and implications for exposed but healthy individuals may be tenuous.
  • The data relied on retrospective reporting of reactions to information received, in some cases over ten years earlier.

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, Asbestos Exposure.

Related studies

• Low-dose exposure to asbestos and lung cancer: dose-response relations and interaction with smoking in a population-based case-referent study in Stockholm, Sweden — P. Gustavsson, F. Nyberg, et al. (2002)
• Psychological impact of computed tomography screening for lung cancer and occupational pulmonary disease among asbestos-exposed workers — T. Vierikko, S. Kivistö, et al. (2009)
• Psychological Distress after a Diagnosis of Malignant Mesothelioma in a Group of Patients and Caregivers at the National Priority Contaminated Site of Casale Monferrato — M. Bonafede, A. Granieri, et al. (2020)
• Interaction of asbestos, age, and cigarette smoking in producing radiographic evidence of diffuse pulmonary fibrosis — K.H. Kilburn, R. Lilis, et al. (1986)
• A study of dose-response relationships for asbestos associated disease — M.M. Finkelstein (1985)
• Pulmonary function in asbestos cement workers: a dose-response study — M. Finkelstein (1986)

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