Prospective Analysis of Patterns of Care and Clinical Outcomes for People Diagnosed with Mesothelioma in Australia.

Abstract

Introduction: The Victorian Mesothelioma Outcomes Registry (VMOR) was set up in 2022 to collect clinical information and report on standards of care for people diagnosed with mesothelioma across the state, linked to an established lung cancer registry (VLCR). Australia has a high incidence of mesothelioma and the aim of this state-based registry was to collect additional clinical information about quality of care, not routinely collected by the federal Australian Mesothelioma Registry. Method(s): Hospital Health Information Services thoracic cancer coding extracts received by the VLCR for 2022 were prospectively analysed to identify patients diagnosed with mesothelioma (ICD C45). Data was collected and entered into a secure database for the following variables: diagnosis, clinical staging, co-morbidities, performance status, treatment planning, surgery, radiatiotherapy, systemic anti-cancer therapy (SACT) including chemotherapy and immunotherapy, palliative and supportive care and overall survival. Baseline VMOR reporting included assessing the feasibility of reporting on ten key clinical quality indicators (CQIs) identified through a national modified Delphi process run through TOGA (Thoracic Oncology Group Australasia) for benchmarking care: time from referral to diagnosis, discussion at a multidisciplinary meeting (MDM), documentation of asbestos exposure, performance status and histologic sub-typing, receipt of systemic anti-cancer therapy (SACT), access to a cancer nurse specialist for support, evidence of supportive care screening and (for pleural mesothelioma only) definitive management of pleural effusion and use of pleural-phase contrast CT for diagnosis. Result(s): 105 participants diagnosed with mesothelioma in 2022 from 19 health services were registered into VMOR. Median age at diagnosis was 76 years (IQR 67-82), 81% were male, 92% with pleural mesothelioma. 59% participants had referral to diagnosis in under 28 days, 67% were presented at an MDM, 94% had histologic subtype documented (60% epithelioid). 77% had a documented performance status and 65% documentation of prior asbestos exposure in medical records. Active treatment including SACT (59%), radical surgery (6%) and radiotherapy (13%) was received in combination by 69%, with 31% receiving supportive care alone. 30% had access to a cancer nurse specialist and 28% a record of supportive care screening. For pleural mesothelioma 18% had definitive effusion management. It was feasible for VMOR to collect 9/10 CQIs but not possible to ascertain use of pleural phase contrast CT based on granularity of current data collection methods. One year overall survival was 19% for the whole cohort, and significantly higher 31% (HR 4.29 p<0.001) for those receiving SACT compared to those who did not. Conclusion(s): This real-world data supports clinical trials showing improved survival for people diagnosed with mesothelioma who receive SACT and offers an opportunity to understand reasons why people did not receive SACT and variation across health services. Increasing the proportion of mesothelioma cases discussed at an MDM may help increase active treatment and access to clinical trials. Our findings highlight an unmet need to increase support for people diagnosed with this high burden disease and their carers, in particular access to cancer nurse specialists. A customised patient survey has also been introduced for 2023 to explore this further. Keywords: Mesothelioma, systemic anti-cancer therapy, cancer nurse specialistCopyright � 2024