Facing Mesothelioma: An insight into modern health care

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Dr Andrew Lawson, a consultant doctor at the Royal Berkshire Hospital in Reading, was diagnosed with pleural mesothelioma in March 2007. Since then, his experiences have changed from that of a doctor working to save lives to that of a patient in need of vital treatment and care. Whilst undergoing treatment, Dr Lawson’s perspective as a patient has enabled him to reflect upon the health service as it is today, from the high professional care standard provided to the reality of insufficient funding for vital medication. In late 2006, Dr Lawson started suffering from bouts of fatigue which he believed was a symptom of stress. He then developed a croak in his throat which he self-diagnosed as laryngitis and treated with rest. However, a couple of days later, when his symptoms were still ongoing, he arranged to see a duty physician who advised him to undergo a chest x-ray. The following day, Dr Lawson was told that the x-rays had revealed a shadow on his right lung. He immediately contacted a consultant physician whom he knew at Royal Brompton Hospital, who arranged for a CT scan. Results of the scan revealed a thickening in the pleura around Dr Lawson’s lungs. Following a biopsy, it was later confirmed that the pleural thickening was Mesothelioma. Pleural mesothelioma is a rare form of lung cancer that affects the membrane that lines the inner surface of the chest wall called the pleura. In Dr Lawson’s case, the cancer had grown around the lining of his right lung. Pleural mesothelioma is associated almost exclusively with exposure to asbestos. With about 1,800 deaths per year at present in the UK, expected to rise to about 2,500 new cases when the epidemic peaks between 2010 and 2015, it is the most common work-related death. Between 2006 and 2020, it is estimated that up to 30,000 people will die of the disease in the UK alone. There is a long ‘lag time’ between exposure to asbestos and the development of mesothelioma; this varies from a minimum of about 10 years upwards, the average interval being in the order of 30 to 40 years. Dr Lawson is 48-years old and grew up in the countryside. In considering when his exposure to asbestos took place, he concluded that his only possible exposure would have been during his years of medical training, when he spent his days working within the old London teaching hospitals. Upon reflection, he recalled that many of the corridors had steam pipes heavily lagged with asbestos. In fact, many halls of residence were converted old asbestos factories. This exposure occurred just over 30 years, which fit the average development time for the disease. As with many victims of the disease, Dr Lawson was only diagnosed with mesothelioma during its advanced stage and was advised that radiation and surgery was regrettably no longer a viable option for successful treatment. Dr Lawson then learnt of the relatively new drug called Alimta which, whilst not providing a cure for mesothelioma, does offer the potential to increase average survival time by a third. However, though regarded as the frontline treatment for the disease, Alimta is not widely available on the NHS The reason for this is one of cost-effectiveness. The reality is that a course of treatment of Alimta costs more than £30,000. Whilst the drug is readily available for sufferers of the disease in Scotland, Australia and many European countries, it is very limited in most of England. NICE considered the approval of Alimta for use in treatment of mesothelioma victims looking at both the potential benefit to patients and in particular the cost effectiveness. It was concluded that Alimta was not cost effective even though it is the only drug that has proved to be effective in prolonging the life-span of many victims of mesothelioma. Dr Lawson commented: “There is nothing intrinsically wrong with limiting certain treatments on cost grounds, but we need to be honest and open that that is what we are doing. I have always been a supporter of effective financial management in the NHS; deciding not to make Alimta available made no sense since this is really the only treatment available to mesothelioma patients.” Dr Lawson was fortunate that his oncologist at the Chelsea and Westminster Hospital was still able to prescribe Alimta from a very limited supply. However, many mesothelioma patients are not so lucky and for them, they cannot rely on the resources nor the support of their NHS trust. Dr Lawson commented on this sad reality: “Patricia Hewitt maintains that a modern health and social care system has to be completely focused on the needs of its users. Yet most sufferers of mesothelioma will not be provided with drugs which may prolong their life”. Despite recognising the unfortunate lack of resources available, Dr Lawson was proud and grateful for the high standard of care adopted by the medical professionals who organised his treatment. He has undergone two cycles of chemotherapy thus far and has been informed that he is responding well to the treatment. Mesothelioma is now attracting greater awareness and recognition of the lack of resources for this illness is increasing. One can only hope that this will lead to better resources and treatment for those suffering from the disease.


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