Month: February 2012

Are Mesothelioma Patients Getting the Straight Story From Their Doctors?

• Nancy Meredith
• For Your Family

The results of a recent survey of doctors found that an alarming number of them believe it is okay to tell a patient an “untruth” or to put a positive spin on a patient’s prognosis. This is counter to the trust that mesothelioma patients place in their physicians to act in their best interest. When facing life-threatening diseases, such as mesothelioma, patients believe they are presented with the complete, honest facts about their prognosis, disease progression and treatment options so they can take an active role in their treatment plan.

Empowering patients to take charge of their treatment is an important step in cancer care. “You are in charge of your own health, and you are your best health advocate,” says Elizabeth Cohen in her book, “The Empowered Patient: How to get the Right Diagnosis, Buy the Cheapest Drugs, Beat Your Insurance Company, and Get the Best Medical Care Every Time.” However, taking charge could lead a patient down the wrong path if that patient is not fully informed.

Mesothelioma is a fatal cancer of the lining of the lung and abdomen that has been directly linked to asbestos exposure. Treatment often includes chemotherapy and radiation, but researchers have recently begun focusing on patient-centric care with treatments targeting the patients’ unique characteristics. Personalized mesothelioma care optimizes the potential for success. An effective personalized plan requires full disclosure from both the patient and the physician.

Data recently compiled from a 2009 survey of 1,891 U.S. physicians, and published in Health Affairs, found “behavior that is in conflict with at least some of the tenets of the Charter on Medical Professionalism,” according to an article in News @JAMA. In the survey, the doctors were asked questions regarding honesty as laid out by the Charter. The Charter, according to the survey authors, “requires openness and honesty in physicians’ communication with patients.”

The survey found that more than half of physicians in the previous year had described a patient’s prognosis in a more positive manner than warranted. In addition, 20% of the physicians surveyed did not completely agree that a doctor should always tell the truth. In fact, 10% admitted to telling a patient “something untrue” in the previous year.

The authors concluded that their findings “raise concerns that some patients might not receive complete and accurate information from their physicians, and doubts about whether patient-centered care is broadly possible” unless physicians focus more on open, honest communications.

Study lead, Lisa Iezzoni, MD, MSC, professor of medicine at Harvard Medical School and director of the Mongan Institute for Health Policy at Massachusetts General Hospital, in Boston, admitted that there are different reasons for doctors to not be fully truthful. However, she said, “at the end of the day, patients need accurate information about their health.”

In January 2011, the American Society of Clinical Oncology published guidelines encouraging physicians to discuss a patient’s treatment options and preferences immediately after their terminal diagnosis so the treatment can be individualized from the start. The guidelines pointed out that physicians should assess a patient’s options, goals and preferences early in his treatment. This conversation cannot happen if the doctor has not given the patient an honest prognosis.

Close to 3,000 new cases of mesothelioma are diagnosed each year in the United States. Although there is no cure for mesothelioma, it can be treated with varying degrees of success through the use of surgical procedures, chemotherapy and radiation. The prognosis for mesothelioma patients is usually grim, with the average survival time varying from 4 – 18 months after diagnosis.

Sources :

• Health Affairs
  http://content.healthaffairs.org/content/31/2/383.abstract
• News @JAMA
  http://newsatjama.jama.com/2012/02/08/survey-some-physicians-not-always-honest-or-frank-with-patients/

McGill Reviews Research After Questions Raised About Links to Asbestos Industry

• Nancy Meredith
• Asbestos Exposure, Research

The dean of Medicine at McGill University said in a statement Thursday that the prestigious Canadian research university will conduct a preliminary inquiry into accusations that a McGill researcher had allowed his research to be influenced by the asbestos industry. Canada remains one of the world’s leading producers of asbestos, a mineral fiber that causes serious respiratory diseases including lung cancer and mesothelioma, a cancer of the lining of the lungs and abdomen.

Dr. David Eidelman, vice principal of health affairs and dean of medicine at McGill, said a review was being undertaken to ensure that the research of Prof. J. Corbett McDonald, who is now retired, was conducted according to rigorous scientific standards. “The allegations in the media … are very serious and must be address,” Eidelman said in the statement.

A documentary last week on the CBC, Canada’s national public television and radio network, outlined how an institute established by the Quebec Asbestos Mining Association paid McGill Prof. Corbett McDonald and other researchers at least $1 million between 1966 and 1972 for research on the health effects of chrysotile asbestos. In the documentary, Professor David Eidelman of Brown University, claimed that some of the researchers altered the literature to minimize or misrepresent the health effects of chrysotile asbestos. The documentary suggested the research was still being cited by the asbestos industry and Canadian government to support Canada’s continued involvement in asbestos mining.

According to McGill University, Prof. Corbett McDonald and colleagues began in 1966 to investigate the mortality rates of approximately 11,000 Quebec miners and millers of chrysotile, a type of asbestos fiber. Asbestos exposure remains an occupational hazard for many workers. The researchers published their findings in articles in peer reviewed scientific journals from 1971 to 1998. The researchers acknowledged in the journal articles that the research was funded in part by the Institute of Occupational and Environmental Health of the Quebec Asbestos Mining Association.

In the research, McDonald demonstrated that asbestos is a carcinogen linked to lung cancer and mesothelioma. But the research also suggested that the health risks of chrysotile asbestos could be greatly minimized by reducing exposure and that chrysotile asbestos —the type of asbestos mined in Canada—was significantly safer than other types of asbestos.

Eidelman said it is true that Prof. McDonald drew different conclusions about the possible safe use of chrysotile asbestos than most scientists do today. “Holding scientific views that are different from those of the majority does not constitute research misconduct,” Eidelman said.

Eidelman said the outcome of the preliminary review conducted by a Canada Research Chair would determine whether there is a need for further investigation.

British Family Painful Reminder that Mesothelioma Can Develop from Secondhand Asbestos Exposure

• Nancy Meredith
• For Your Family

While most cases of mesothelioma affect individuals who were directly exposed to asbestos in the workplace, men who worked around asbestos, and brought the fibers home on their clothing, shoes and in their hair, may have inadvertently exposed their children and spouses to the hazards of the deadly toxin. One family in England is now dealing with this phenomenon as eight siblings, whose only exposure came from contact with the fibers that adhered their father who worked with asbestos products, battle mesothelioma and other asbestos-related diseases.

Asbestos is a known carcinogen and is proven to cause lung cancer, asbestosis, mesothelioma, a serious cancer caused by breathing in the asbestos fibers that then become lodged in the thin membrane that lines and encases the lungs, and other respiratory diseases. Even small amounts of asbestos and infrequent exposure can create a risk for contracting mesothelioma or other asbestos-related diseases.

According to the Yorkshire Post, two sisters in the family just died of mesothelioma caused by secondhand exposure they had to asbestos decades ago. The other siblings suffer from pleural plaques, emphysema and scarred lungs. They are also still at risk of developing mesothelioma. Their father worked at Cape Asbestos in Hebben Bridge, Yorkshire from the 1930’s through 1958. He died of lung cancer 10 years after leaving the company.

The family recalled that they would play with their father when he returned home from work with his clothes still covered in asbestos dust. “I remember my mother shaking his overalls and dust going everywhere,” said one sibling. She added that as children they would sometimes accompany their father to work on Sunday and would play in the piles of asbestos dust.

Most cases of mesothelioma are diagnosed 30 years or more after exposure. Currently there is no known cure for mesothelioma, and the average survival time varies from 4 – 18 months after diagnosis. According to Professor Julian Peto, of the London School of Hygiene and Tropical Medicine and the Institute of Cancer Research, the UK now has the highest death rate in the world from mesothelioma, with over 2,000 deaths a year.

Rise in Asbestos Use in U.S. Increases Urgency to Ban Cancer Causing Fiber

• Nancy Meredith
• Asbestos Exposure, Mesothelioma

The president of the Asbestos Disease Awareness Organization said that she was appalled by a recent U.S. government report showing a dramatic increase in asbestos imports into the United State in 2011. Asbestos, a mineral fiber, is a cause of cancer in humans, including mesothelioma, a cancer of the lining of the lung and abdominal cavity. Many nations have banned asbestos because it’s toxic, but the United States still allows the import of raw asbestos and asbestos-containing products.

Linda Reinstein, co-founder and president of the ADAO, an advocacy group, said the asbestos industry had argued for years that importation and exposure to asbestos have been gradually decreasing, but the new report shows that simply isn’t accurate.

According to the 2012 United State Geological Survey of mineral commodities, U.S. industries consumed 1,100 metric tons of asbestos from January through July 2011, compared to 820 metric tons during the same period in 2010. The difference represents a 34 percent increase in consumption, Reinstein said.

The U.S. Geological Survey report estimated that roofing felt materials account for about 60 percent of U.S. consumption of asbestos. The chlorine manufacturing industry, which utilizes asbestos diaphragms in the manufacturing of industrial chemicals, accounted for about 30 percent of asbestos consumption, the report said. The United States still has asbestos diaphragm cell plants.

The use of asbestos creates an occupational hazard of asbestos exposure. Asbestos exposure in the chlorine industry arises form the transport and storage of sacks of raw asbestos. Cutting open and empty sacks of asbestos and transferring asbestos into slurry mixing tanks and handling empty bags can cause additional exposures, according to testimony presented by environmental consultant Barry Castlemen to a U.S. Senate committee. The handling and storage of asbestos diaphragms presents another possible source of asbestos exposure, he said.

More than 30 years ago, the International Agency for Research on Cancer declared asbestos a human carcinogen, yet workplace exposure continues throughout the United States.

Reinstein called on Congress and the president to prohibit the importation of raw asbestos and asbestos-containing products. “I have lost my husband, Alan, to mesothelioma, a disease caused by asbestos exposure,” Reinstein said in a prepared statement. “Nothing can bring him or the hundreds of thousands of other victims back to life, but we can begin by aggressively preventing exposure thus eliminating deadly diseases.”

Approximately 3,000 people in the U.S. are diagnosed with mesothelioma each year. Most are older workers, retired workers and veterans who had workplace exposure to asbestos. Most people diagnosed with mesothelioma do not notice any symptoms of the disease for 20 years to 40 years after exposure.

For more information about mesothelioma, click here.