The key aim of this guideline is to provide detailed, evidence-based guidance for the investigation of suspected malignant pleural mesothelioma (MPM) and the subsequent care and management of individuals with proven MPM. The main cause of mesothelioma is breathing in asbestos dust—approximately 85% of all male mesotheliomas are attributable to occupational asbestos exposure. Products containing asbestos were banned in the UK in 1999. The latency between first exposure and development of the disease is typically 30–40 years. Only two-thirds of patients in England and Wales receive active anticancer treatment (chemotherapy, radiotherapy and surgery) for MPM and overall median survival is poor at 9.5 months, with 1-year and 3-year survival rates of only 41% and 12%, respectively. The poor survival rates, taken together with the significant variation in treatment and outcomes across the UK, highlight the need for an evidence-based guideline to facilitate the highest standards of care for all patients with mesothelioma in the UK.3
Target audience for the guideline
Given the nature of MPM, the majority of the guideline will be relevant to secondary care-based specialists; however, symptom recognition, management and follow-up are all relevant to community-based specialities.
Intended users include primary care general practitioners (GPs) and practice nurses; hospital specialist teams in respiratory medicine, oncology, thoracic surgery and palliative care; hospices/community teams; specialist nurses (including lung cancer and palliative care); radiologists; pathologists.
Areas covered by the guideline include (1) the epidemiology and incidence of mesothelioma in the UK and worldwide, (2) the preferred investigation pathway of suspected cases of MPM, (3) consider special situations including:
(4) biomarkers, (5) role of mesothelioma MDTs, (6) outline best practice in oncological management, (7) role of chemotherapy, (8) place for radiotherapy, (9) role of surgery, (10) guidance on palliation in MPM, (11) guidance on providing patients with relevant disease-specific information, including medicolegal/compensation issues, (12) summary of future therapeutic agents that might be available within the next 5 years and (13) summary of major MPM recommendations.
Non-pleural mesothelioma is excluded from this guideline.