Mesothelioma in the 21st century. A 1-year survey of malignant mesothelioma in the South West of the UK

Introduction Malignant mesothelioma (MM) is a cancer that most commonly arises within the pleura, and carries a poor prognosis. There is a strong association with past asbestos exposure so incidence varies across the UK. In the South West of the UK there is a high incidence with many cases being due to asbestos exposure in the ship-building industry.

Aims To describe the demographics, treatment strategies and survival of patients presenting with MM across the Peninsula cancer network, a population of around 1.7 million people, over a 1-year period.

Method Cases of MM diagnosed in 2007 were identified retrospectively and reviewed following interrogation of cancer, MDT, pathology and post mortem databases for the five hospitals in the network. A full review of the clinical records was performed.

Results 81 patients were identified. Average age was 72 and 94% were male. 82.7% of patients had a performance status of 0 or 1 at presentation but 21% had a significant co-morbidity, most commonly cardiac in nature. 77.8% of patients had definite or probable asbestos exposure. At presentation symptoms had been present for a mean of 3.7 months, the commonest being breathlessness and chest pain. A definitive diagnosis was made in 84% of patients, either on histology (75%) or cytology (9%) and the epithelioid subtype was most common (40.7% of cases). VATS was the main diagnostic modality (61.7%). Despite 61.7% of patients technically being fit for chemotherapy, only 29.6% received it. Mean survival was 269 days (8.8 months). Survival was longer in those with a better performance status at presentation (PS0=344 days, PS1=270d, PS2=125d, PS3=89d), and in those who received chemotherapy (448d vs 269d).

Conclusion MM remains a common problem in the South West of the UK. Despite recent treatment advances the prognosis remains poor, with our survival data being similar to that described in earlier population based studies and in chemotherapy treatment trials. Only a small proportion of our patients received chemotherapy and this may reflect the lack of NICE guidance for use of pemetrexed which was only issued in 2008. However, those patients who recieved chemotherapy had a better survival time (14.7 months vs 8.8 month).