Patterns of care for malignant pleural mesothelioma patients compensated by the Dust Diseases Board in New South Wales, Australia

Our plain-English summary of Patterns of care for malignant pleural mesothelioma patients compensated by the Dust Diseases Board in New South Wales, Australia, by S.C. Kao, S. Clarke, J. Vardy, et al (Internal Medicine Journal, 2013).

The study

• Authors: S.C. Kao, S. Clarke, J. Vardy, P. Corte, C. Clarke, N. van Zandwijk
• Journal: Internal Medicine Journal
• Published: 2013;43(4):402-10
• Cited by: 16 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Background: The silent epidemic of mesothelioma in Australia is steadily increasing, and 30% of cases occur in New South Wales (NSW).

Aim: To describe the patterns of care and outcomes of patients with malignant pleural mesothelioma (MPM) in NSW.

Methods: MPM patients in NSW applying for compensation at the NSW Dust Diseases Board from 2007 to 2009 were included. Survival from time of diagnosis was determined by the Kaplan-Meier method. The Chi-squared test was used to determine if there was an association between utilisation of treatment and geographical location.

Results: A total of 138 patients was included: median age was 72.5; 91.3% male; 60.1% epithelial subtype; and 65.2% lived in major cities. All patients had at least one chest X-ray and computed tomography scan, and 21% had a positron emission tomography scan; 93.5% and 4.3% had histological or cytological confirmation respectively. Thoracoscopy (59.4%) was the most commonly used diagnostic procedure. Treatment utilisation: 53.6% chemotherapy; 35.5% radiotherapy; 9.4% extrapleural pneumonectomy (EPP); and 72.5% had palliative care involvement. There were no major differences in treatment utilisation between patients living in major cities and those in regional NSW (chemotherapy P = 0.42; radiotherapy P = 0.13 and palliative care P = 0.60), except for a higher rate of EPP in regional patients (16.7% vs 5.6%; P = 0.03). Median survival was 9.7 versus 12.3 months for city and regional patients respectively (P = 0.22).

Conclusion: Survival and treatment utilisation was not significantly different between MPM patients living in major cities and regional NSW, except for a higher rate of EPP in patients in regional NSW.

© 2012 The Authors; Internal Medicine Journal © 2012 Royal Australasian College of Physicians.

In plain English

This study described how people with malignant pleural mesothelioma in New South Wales, Australia, were diagnosed and treated, and how long they survived. The authors reviewed Dust Diseases Board and Medicare records for 138 patients who successfully claimed compensation between March 2007 and March 2009. All had occupational asbestos exposure, and 49 (35.5%) also had non-occupational exposure. Of the 138 patients, 53.6% received chemotherapy, 35.5% radiotherapy and 9.4% radical surgery (extrapleural pneumonectomy). Palliative care teams were involved for 100 patients (72.5%). Median survival was 10.6 months. Patients given chemotherapy or radical surgery lived longer, but the authors cautioned that fitter patients may have been chosen for these treatments. City and regional patients did not differ significantly in survival or in most treatments. More regional patients had radical surgery (16.7% versus 5.6%). Care generally met international guidelines, except for recording of tumour subtype and stage. The authors noted a small sample, 38% declining to take part, and compensation covering treatment costs, which may overstate treatment use.

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: Patterns-of-care study based on review of NSW Dust Diseases Board and Medicare Australia records, compared with international guideline benchmarks
• Who was studied: 138 patients with malignant pleural mesothelioma from New South Wales who successfully applied for Dust Diseases Board compensation between March 2007 and March 2009. Median age was 72.5, 91.3% were male, and 126 had died. Patients with peritoneal mesothelioma were excluded.
• Exposure: Asbestos exposure: occupational in all 138 patients (100%), with additional non-occupational exposure in 49 (35.5%). Fiber types are not reported. The mean latency from first exposure to diagnosis was 45.7 years and the median was 49.8 years.
• Main results:
  • Of all 138 patients, 74 (53.6%) received chemotherapy and 49 (35.5%) received radiotherapy.
  • Radical surgery (extrapleural pneumonectomy) was attempted in 13 patients (9.4%), 10 of them as part of a multimodality approach.
  • Palliative care teams were involved in the care of 100 patients (72.5%).
  • Median survival for all patients was 10.6 months, and 6% survived 5 years or more.
  • Median survival was 15.7 months in patients considered fit for and given chemotherapy, versus 5.4 months in those not considered fit for or not given it (P < 0.001).
  • Median survival was 37.1 months in patients who had radical surgery, versus 9.7 months in those who did not (P = 0.001).
  • Survival did not seem to be affected by radiotherapy: median 13.6 months with radiotherapy versus 8.9 months without (P = 0.09).
  • More patients from regional NSW (8 of 48, 16.7%) than from major cities (5 of 90, 5.6%) had radical surgery (P = 0.03). Chemotherapy, radiotherapy and palliative care use did not differ significantly between the two groups.
  • Survival did not differ significantly by location. Median overall survival was 9.7 months (95% confidence interval 7.0 to 12.3) for major-city patients and 12.5 months (95% confidence interval 8.6 to 16.3) for regional patients (P = 0.22).
  • Major-city patients were more likely to die at their usual place of residence (P = 0.02), and regional patients were more likely to die in hospital.
  • Diagnosis and treatment generally met international benchmarks, with two deficiencies. Histological subtype was stated in 88 patients (64%), and clinical tumour stage was recorded in 3 (2%).
• The authors' conclusion: The authors concluded that, apart from a higher rate of extrapleural pneumonectomy in regional NSW, there did not appear to be differences in diagnosis, treatment, survival or benchmark compliance between city and regional patients. They added that there remains room for improvement in the management of mesothelioma.
• Limitations the authors state:
  • Because patients came from the compensation board, the sample was selected and biased towards patients with occupational exposure.
  • The sample was relatively small, and a significant number (38%) declined to participate.
  • The cohort represented only about a third of all mesothelioma cases in NSW.
  • Vetting by the compensation board's Medical Authority may have led to extra diagnostic tests, which could overestimate compliance with diagnostic guidelines.
  • Compensation and reimbursement of medical expenses could have improved access to specialised treatment, which could overestimate treatment use and outcome compared with the general mesothelioma population.
  • Longer survival with chemotherapy and radical surgery may reflect selection bias, and the data could not be adjusted for patient performance status because that information was not available.

Topics

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

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Mesothelioma, Chest X-Ray, Thoracoscopy, Chemotherapy, Extrapleural Pneumonectomy (EPP), Palliative Care, Median Survival.

Related studies

• Validation of prognostic factors in malignant pleural mesothelioma: a retrospective analysis of data from patients seeking compensation from the New South Wales Dust Diseases Board — S.C. Kao, J. Vardy, et al. (2013)
• Compensation scheme for complementary and alternative medicine use in asbestos-related diseases in New South Wales, Australia — C. Oak, H.J. Choi, et al. (2012)
• Occupational exposure to asbestos in New South Wales, Australia (1970-1989): development of an asbestos task exposure matrix — R.A. Hyland, D.H. Yates, et al. (2010)
• Patterns of care and survival among patients with malignant mesothelioma in the United States — L. Enewold, E. Sharon, et al. (2017)
• Patterns in the incidence, mortality and survival of malignant pleural and peritoneal mesothelioma, New South Wales, 1972-2009 — M.J. Soeberg, N. Creighton, et al. (2016)
• Factors associated with survival in a large series of patients with malignant pleural mesothelioma in New South Wales — A. Linton, N. Pavlakis, et al. (2014)

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