Meeting the National Mesothelioma Audit standards in clinical practice: How achievable is it?

Introduction: The National Mesothelioma Audit Report 2018 highlighted variability in care of patients diagnosed with malignant mesothelioma (Royal College of Physicians, 2018; 9-11). We reviewed our practice during 2014-2018. Methods: Data for mesothelioma diagnoses in 2014-18 were obtained from the Somerset Cancer Registry and electronic patient records. Results: 59 patient notes were reviewed; 84.7% were male. Mean age was 75 years (range 50-90). Performance status (PS) was recorded in 55 (93.2%). 44 (74.6%) patients had video-assisted thoracoscopic surgery (VATS). 56 (94.9%) had pathological confirmation of mesothelioma; with pathological subtype in 44 (74.6%). 3 patients had no pathological confirmation. 2 were not investigated further due to PS 3; both died within 50 days of diagnosis. 1 had an inconclusive biopsy and the MDT felt histology would not change management. 30 (50.8%) received anti-cancer treatment: 20 (33.9%) chemotherapy, 14 (23.7%) radiotherapy (4 patients both). 17 of 37 patients with PS 0-1 received chemotherapy (45.9%). Conclusion: Audit standards were exceeded in recording PS and obtaining pathological diagnosis, but not in recording pathological subtype (Table 1). Chemotherapy rate was lower than expected despite all PS 0-1 patients being referred to oncology. This could be due to rapidly declining PS or patient choice. The findings highlight the aggressive nature of the disease and impact on treatment options.