Mesothelioma is one of the 20 most common cancers for men in the UK. This is largely a reflection of the widespread historic use of asbestos in the UK in buildings and in industry, and historic traditional male occupations including shipbuilding, the railways and construction.
HSE statistics published earlier this year show that in 2018 the number of mesothelioma deaths in Great Britain remained static when compared with the previous six years, at just under 2,500. Sadly, the legacy of asbestos shows little sign of abating.
Most people who develop mesothelioma do so in the lungs, but it can also occur in the peritoneum (abdomen), the testicles and even occasionally the eyes. In this article I plan to explore the incidence of peritoneal mesothelioma, analyse who develops it, and what treatments and support are available. Anyone diagnosed with mesothelioma will find that some of the treatment regimes and clinical trials apply to both pleural and peritoneal mesothelioma.
Incidence of peritoneal mesothelioma
A wealth of information can be found on the Mesothelioma UK website (www.mesothelioma.uk.com) or through asbestos support groups.
The latest National Mesothelioma Audit – published in 2020 - which collated data for the three years to 2018 found that during that time 3.6% of mesotheliomas diagnosed were in the peritoneum.
A higher percentage of women go on to develop peritoneal mesothelioma than men. Overall, 17% of mesothelioma diagnoses are in women, but for peritoneal patients over one third are female. The average age at diagnosis is also slightly younger, 71 compared with 76.
A higher proportion of women who go on to develop peritoneal mesothelioma, and the younger age profile, some women are being diagnosed in their 30s or even younger. Agonising decisions then often need to be made about the timing and range of treatment options, considering the impact on any wish to have a family. My heart totally goes out to anyone in this situation.
Support from the Basingstoke specialist team and HASAG
The depth of knowledge in the specialist team in Basingstoke and the counselling support offered by HASAG are a lifeline. There is a new mum in the peritoneal mesothelioma support group which shows people can sometimes preserve their option to have children as well as have treatment for their mesothelioma.
Given how rare peritoneal mesothelioma is, it’s perhaps unsurprising that some treatment and clinical trials are only available to those with pleural mesothelioma. For example, the first line immunotherapy regime Ipilimumab and Nivolumab (Ipi-Nivo) which was permitted through the Early Access to Medicines Scheme (EAMS) in the aftermath of the first wave of COVID-19 was only available for pleural mesothelioma. However, Nivolumab was available for later as a second line treatment for both pleural and peritoneal mesothelioma. Recent NICE approval of Ipi-Nivo applies to both Pleural and Peritoneal Mesothelioma.
The difference in treatment options is possibly a reflection that some clinical trials possibly had to focus on the more common pleural mesothelioma. However, if you do find yourself confused about any treatment you would like to receive, Sam Westbrook, the specialist peritoneal Mesothelioma UK nurse at Basingstoke, can advise. Sam is so very helpful. Despite working in Intensive Care and family support in COVID waves 1 and 2, the support offered at Basingstoke has continued to go from strength to strength. Sam was planning a Peritoneal Mesothelioma Patient and Carer Day in April 2020, but it had to be delayed because of the pandemic and instead went ahead in June 2022, it was a great success. In the thick of it all Sam also established an excellent monthly virtual support group, which is always very well attended, and with a global reach!
Indeed, anyone diagnosed with peritoneal mesothelioma should consider pushing for a referral to Basingstoke to consider their treatment options. The specialist team there have revolutionised the care for many peritoneal mesothelioma patients in the last few years. They have an excellent track record of assessing patients’ suitability for radical surgery to “debulk” the tumour, and of successfully carrying out the surgery in appropriate cases. Indeed, surgery for peritoneal mesothelioma is more common than for pleural mesothelioma! The team at Basingstoke can oversee specialist chemotherapy and sometimes advise on what, if any, immunotherapy or other treatment might be available on the NHS.
An exciting new proposal to further improve the treatment options for peritoneal patients is also on the horizon. A collaboration between Mesothelioma UK, the Mavis Nye Foundation and HASAG means that funding for a PIPAC machine has been made available to the specialist team at Basingstoke. PIPAC stands for Pressurised Intra-Peritoneal Aerosol Chemotherapy. In practice this means that the chemotherapy drug can be introduced to exactly where it is needed, in a move that will hopefully reduce side effects and result in improved results. PIPAC is minimally invasive surgery, and I understand it can be administered in an hour or so. PIPAC has shown promise for bowel and ovarian cancer, and I have everything crossed that it will improve treatment for peritoneal mesothelioma as well.
It is so impressive what specialist charities can achieve with targeted funding and support. I take my hat off to HASAG, the lovely Mavis Nye and Mesothelioma UK, who work so tirelessly to support patients with peritoneal as well as pleural mesothelioma, and to improve their treatment options and support.
Sam Westbrook – 0800 169 2409 or mesothelioma.uk.com
HASAG – 02380 010015 or hasag.co.uk
Mavis Nye Foundation - mavisnyefoundation.com