Background:
Malignant pleural mesothelioma (MPM) is a frequent asbestos related malignancy seen in the Australian population. Specialist centres have been established across Australia in the public sector. Many patients are referred or choose to have their care in the private sector. We aimed to identify patients managed at our facility (St John of God Hospital, Subiaco, WA) and to describe their presentation, management and outcomes.
Methods:
We conducted a retrospective cohort study of patients managed for MPM at our centre between January 2011 and December 2016. Data captured included demographics, presenting symptoms, investigations, disposition, management and survival.
Results:
Fifty-four patients were included; mean age 75 years (range 54-93 years), 88% male. 96% of patients had confirmed prior asbestos exposure. Initial symptoms included dyspnoea (52%), weight loss (45%), chest pain (45%) and cough (40%). Tissue sampled included pleural fluid (75%), open pleural biopsy (18%), thorascopic biopsy (40%) and imaging guided biopsy (36%). Morphologic subtypes were identified in 78% of patients: epitheliod 50%; sarcomatoid 18%; biphasic 10%. Surgery was performed in 11% of patients with partial or complete pleurectomy or decortication. 34% of patients underwent pleurodesis. 64% of patients received systemic therapy, with most (87%) receiving platinum based chemotherapy with pemetrexed. 41% of patients received two or more lines of chemotherapy. The median survival time was 14 months (range 1 -72 months). The median time to referral to palliative care was 4.5 months. 26% of patients were referred to a tertiary centre (19% for clinical trials; 7% to a mesothelioma subspecialist).
Conclusions:
A significant cohort of patients with MPM were managed at our centre over the study period. Given the magnitude of cancer care conducted in the private sector, it is important to audit and understand the care of patients with tumours such as MPM in this setting.