title: Demographics, management and survival of patients with malignant pleural mesothelioma in the National Lung Cancer Audit in England and Wales.
abstract: METHODS
  Malignant pleural mesothelioma (MPM) is an uncommon cancer with poor survival. We have used data collected for the UK National Lung Cancer Audit to assess current practice and to highlight regional variation in the management of mesothelioma patients, as well as to describe survival patterns in subgroups.
  
  
  RESULTS
  Our data on 8740 cases seen in hospitals in England and Wales is the largest cohort of MPM in the literature and represents approximately 80% of the total incident cases. 83% are male and median age is 73 years. Performance status is recorded in 81% and of these approximately 70% are PS 0-2. Stage is poorly recorded and unreliable in this dataset. The patient pathway is similar to lung cancer with approximately one-fifth having a non-elective referral to secondary care. A histo-cytological diagnosis is made in 87% and varies across organisations. Only 67% have anti-cancer treatment, and this also varies across organisations, but there has been an annual increase in the proportion receiving chemotherapy. Overall median survival was 9.5 months, with a 1YS of 41.4% and 3YS of 12.0%, but was strongly linked to performance status and histological subtype. Median survival also varied by cancer network from 209 days to 349 days, but appeared to increase from of 9.2 months in 2008 to 10.5 months in 2012.
  
  
  CONCLUSIONS
  Our data provide a large scale, detailed assessment of MPM epidemiology, treatment choices and outcomes. Incidence is increasing in line with predictions and uptake of treatments has generally mirrored publication of key MPM treatment trials, in particular increasing use of chemotherapy but low uptake of radical surgery. However, there is significant variation in care patterns and outcomes that may reflect limited expertise in area with low incidence. Initiatives to improve outcomes should include improved recording of clinical stage.
authors: Department of Respiratory Medicine, Royal Derby Hospital, Derby, UK; Clinical Standards Department, Royal College of Physicians, London, UK. Electronic address: paul.beckett1@nhs.net.
authors: P
authors: P
authors: Beckett
authors: Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals NHS Trust, Northern General Hospital, Herries Road, Sheffield, UK.
authors: J
authors: J
authors: Edwards
authors: University of Leicester, Hodgkin Building, Lancaster Road, Leicester, UK.
authors: D
authors: D
authors: Fennell
authors: Nottingham Respiratory Research Unit, Clinical Sciences Building, Nottingham City Hospital, NG5 1PB, UK.
authors: R
authors: R
authors: Hubbard
authors: Clinical Standards Department, Royal College of Physicians, London, UK; Department of Respiratory Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors: I
authors: I
authors: Woolhouse
authors: Clinical Standards Department, Royal College of Physicians, London, UK; Department of Respiratory Medicine, Glenfield Hospital, Leicester, UK.
authors: M D
authors: MD
authors: Peake
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D000086002:Mesothelioma, Malignant; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010997:Pleural Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D011159:Population Surveillance; D016019:Survival Analysis; D016896:Treatment Outcome; D014852:Wales / Q000453:epidemiology; D055815:Young Adult
keywords: Audit; Chemotherapy; Mesothelioma; Performance status; Stage; Surgery; Survival