More can be done in England to give peritoneal mesothelioma patients the variety of treatment options
I have recently been instructed by a mesothelioma sufferer who lives in North America. He was exposed to asbestos whilst working and living in England in the 1960's. Shortly after being diagnosed with mesothelioma he advised me that he was about to undergo treatment known as HIPEC.
I had not come across this procedure as a treatment option for mesothelioma sufferers before so I looked into the availability of the procedure in England.
Hyperthermic Intraperitoneal Chemotherapy is a highly concentrated, heated chemotherapy treatment that is delivered directly to the abdomen during surgery. HIPEC delivers chemotherapy directly to cancer cells in the abdomen. This allows for higher doses of chemotherapy treatment and heating the solution may also improve the absorption of the chemotherapy by the tumours and destroy microscopic cancer cells that remain in the abdomen after surgery. Prior to receiving the HIPEC treatment, doctors perform cytoreductive surgery to remove visible tumours within the abdomen.
Cytoreductive surgery is accomplished using various surgical techniques. Once as many tumours as possible have been removed, the heated, sterilized chemotherapy solution is delivered to the abdomen to penetrate and destroy remaining cancer cells. The solution is 41 to 42 degrees Celsius, about the temperature of a warm bath. It is circulated throughout the abdomen for approximately 1 ½ hours. The solution is then drained from the abdomen and the incision is closed. The surgical procedure is of course very invasive and there are naturally risks associated with the procedure.
HIPEC is a treatment option for people who have advanced surface spread of cancer within the abdomen, without disease involvement outside of the abdomen. Only two NHS hospitals perform the procedure and whilst the number of procedures carried out is increasing, it still appears to not be widely accessible. The procedure is more commonly used for appendix, colorectal or ovarian cancers.
The reported advantages of HIPEC are:
- It allows for high doses of chemotherapy
- It enhances and concentrates the chemotherapy to the abdomen area
- Minimises the rest of the body's exposure to chemotherapy
- Improves chemotherapy absorption
- Reduces the side effects of chemotherapy
The most recent review of HIPEC carried out by the NHS excluded mesothelioma as a condition for which this treatment should be considered or provided.
In mesothelioma patients, HIPEC is only considered to be appropriate where there has been a diagnosis of peritoneal mesothelioma. Peritoneal mesothelioma is form of cancer affecting the inner surface of the peritoneum. It is of course rare for mesothelioma to occur anywhere other than around the lungs but in 2009 the number of reported new diagnoses of peritoneal mesothelioma in England was 2209. Median survival for peritoneal mesothelioma is thought to be 6 months.
This procedure was of course pioneered in America. In the UK it is not available for mesothelioma patients but it is available for other cancers. From the latest NICE guidance on this procedure, there has been discussion around patient safety but also significant focus has been on whether the procedure represents value for money for the NHS. In the most recent clinical commissioning policy, peritoneal mesothelioma was excluded from consideration. The policy will be reviewed again in 2016/2017. At present, the only option for mesothelioma sufferers (with peritoneal mesothelioma) is to consider funding the procedure themselves. This raises two key questions, the first whether the victim will be able to find a hospital in the UK willing to undertake the procedure and secondly will the cost of the treatment be funded by the Defendants who have negligently caused the illness. The estimated cost of the procedure is thought to be in the region of £57,000.00 per patient.
Time will tell as to how effective this treatment has been for my client but what is clear is that more can be done in England to give peritoneal mesothelioma patients the variety of options available to many others around the world when it comes to possible life extending treatment to enable them to spend more time with their families and loved ones. I hope that further consideration is given to this issue by the NHS in 2016/2017 as planned and I hope victims of this terrible disease are given more treatment options to extend their life expectancy beyond the median survival of 6 months. This procedure is not of course appropriate for all peritoneal sufferers as some will have advanced disease progression by the time the condition has been identified but there could be many hundreds each year who may benefit from this procedure.
By Dushal Mehta, Senior Associate
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