Occupational asbestos exposure: how to deal with suspected mesothelioma cases--the Dutch approach

Our plain-English summary of Occupational asbestos exposure: how to deal with suspected mesothelioma cases--the Dutch approach, by P. Baas, N. van 't Hullenaar, J. Wagenaar, et al (Annals of Oncology, 2006).

The study

• Authors: P. Baas, N. van 't Hullenaar, J. Wagenaar, J.P. Kaajan, M. Koolen, M. Schrijver, N. Schlösser, J.A. Burgers
• Journal: Annals of Oncology
• Published: 2006;17(5):848-52
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Patients with asbestos-related diseases, such as malignant mesothelioma (MM), are not uniformly treated in Europe when they apply for compensation. In The Netherlands, the Institute of Asbestos Victims (IAV) acts on behalf of patients with a malignant mesothelioma. In the majority of cases, the diagnosis is clear but in some, uncertainty remains. In these cases a specialist opinion of the Mesothelioma Group of the Dutch Thoracic Society (DTS) is required. The process of data handling and final outcome for these patients is discussed and compared with the situation in other European countries.

Materials And Methods: Dutch patients with a possible malignant mesothelioma and occupational exposure to asbestos presented their cases to the IAV. In 10% of the cases, pathological confirmation of a malignant mesothelioma could not be obtained. These cases were presented to the Mesothelioma Group to obtain a clinical diagnosis based on clinical reports, occupational history, X-ray examination and other factors. Each case was reviewed by three independent pulmonologists experienced in MM. The majority view was binding for acceptance or rejection of the diagnosis.

Results: In the period January 2000 until May 2005, the IAV received 1747 cases for compensation. In 161 cases no definitive diagnosis could be made on pathology and were presented to the Mesothelioma Group. Of these cases, 117 (73%) were considered to be compatible with the clinical diagnosis malignant pleural mesothelioma. Forty-four cases (27%) were rejected. In 75% of the cases (112 of 150), the conclusion of the three independent specialists was unanimous; in 11 cases one specialist refrained from a diagnosis. The median time from request to submission of the report was 34 days (range 1-185 days).

Conclusions: Compared with other European countries, this approach, as determined by the IAV and Mesothelioma Group of the DTS, is an effective and rapid way to investigate claims of patients with a possible occupationally related malignant mesothelioma.

In plain English

This article described how the Netherlands handled compensation claims for suspected mesothelioma when tissue samples could not confirm the diagnosis, and analysed the procedure's first years. Claims went to the Institute of Asbestos Victims (IAV). When pathologists could not make a diagnosis, three independent lung specialists from the Mesothelioma Group of the Dutch Thoracic Society reviewed the case, and the majority view was binding. Between January 2000 and April 2005, 1747 patients applied to the IAV. In 161 cases there was not enough pathology data, and these went to the specialists. More than half of these patients had died by the time of review. Probable mesothelioma was accepted in 117 cases (73%) and rejected in 44 (27%). The specialists agreed in 112 of the 161 cases. In 38 cases one specialist disagreed, and in 11 cases a specialist gave no conclusion. Median handling time was 34 days (range 1 to 185). The authors also compared compensation rules in seven European countries. They concluded that the Dutch protocol was quite unique and gave clarity about the diagnosis in an acceptable time.

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: Descriptive analysis of all claims referred to an expert panel by a Dutch compensation institute, with a table comparing compensation rules in European countries
• Who was studied: 1747 patients who applied to the Dutch Institute of Asbestos Victims for compensation between January 2000 and April 2005. Of these, 161 cases lacked sufficient pathology data and were reviewed by the Mesothelioma Group.
• Exposure: Occupational exposure to asbestos as a condition for compensation. No fiber types, products or doses were studied.
• Main results:
  • Of the cases reviewed by the Mesothelioma Group, probable mesothelioma was accepted in 117 (73%) and rejected in 44 (27%).
  • The three specialists' decisions were concordant in 112 of the 161 cases. In 38 cases one panel member reached a discordant conclusion.
  • In 11 cases a specialist gave no conclusion.
  • The median handling time for the reviewed cases was 34 days (range 1 to 185 days).
  • More than half of the reviewed patients had already died at the time of review, which ruled out further diagnostic procedures.
  • Among the reviewed patients, over 72% were aged 62 to 80 years at application and 9% were younger than 60.
• The authors' conclusion: The authors concluded that the Dutch reimbursement protocol for suspected malignant mesothelioma with proven occupational asbestos exposure was quite unique among European countries. They also concluded that it allowed the IAV to provide clarity about the diagnosis in an acceptable time frame.

Topics

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

Medical terms in this study, explained in our Lexicon: Asbestos Exposure, Mesothelioma, Malignant Mesothelioma, Occupational Exposure, Occupational History, Pathology, Pleural Mesothelioma.

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• Baseline predictors of negative and incomplete pleural cytology in patients with suspected pleural malignancy - Data supporting 'Direct to LAT' in selected groups — S. Tsim, S. Paterson, et al. (2019)
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