Treatment and recovery: Malignant pleural mesothelioma. Jocelyn Mclean Case Manager for Thoracic Surgery RPAH

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1 Treatment and recovery: Malignant pleural mesothelioma Jocelyn Mclean Case Manager for Thoracic Surgery RPAH

2 This presenta?on Treatment - management op?ons Recovery well living programme Caring for pa?ents, carers and families during treatment and management

3 Principles of management We cannot cure but can offer treatment and care Main Goals Effec?ve pallia?on Prolonga?on of symptom free survival Individual management plan for every pa?ent

4 Principles of management Treatment plan for each pa?ent based on: Patient Factors age fitness symptoms preference Disease Factors Histology (epithelioid) Extent (<T4 & N2) Rate of progression

5 Common presen*ng symptoms Shortness of breath Fa?gue / lethargy Weight loss Dull chest pain Strategy: Relieve symptoms Control cause of symptoms

6 Controlling fluid /obtaining diagnosis Local drainage / indwelling catheter Pleuroscopy / pleurodesis via slurry Local biopsy Thoracoscopy, biopsy, pleurodesis THIS IS WHAT WE OFFER..

7 Thoracoscopy Video Assisted VAT Establish Diagnosis Biopsy Control Fluid - Talc Pleurodesis Maximise lung re-expansion pleurectomy Assess for cytoreductive therapy

8 Thoracoscopy Establish Diagnosis Talc Pleurodesis Asses Suitability Fails (fluid re-accumulates)

9 Thoracoscopy Establish Diagnosis Talc Pleurodesis Assess Suitability Fails (fluid re-accumulates) Enables self drainage of fluid when symptoma?c Pleurectomy/Decortication or Simple Drainage

10 Thoracoscopy Establish Diagnosis Talc Pleurodesis Assess Suitability Fails (fluid re-accumulates) Pleurectomy/Decortication or Simple Drainage Assessment for Subsequent Radiotherapy &/or chemotherapy

11 Fluid controlled - what therapy? Chemotherapy pemetrexed / cis (carbo) pla?n 3-6+ cycles, regular imaging to assess effec?veness of treatment Radiotherapy only for symptom control In cytoreduc?ve seyng Cytoreduc?ve treatment - trimodality therapy Chemotherapy, radical surgery - EPP, radiotherapy Complimentary therapy (s)

12 Treatment op?on - chemotherapy Consider chemotherapy Pemetrexed / doublet Cistpla?n Have a consulta?on and then make a decision Differing opinions amongst medical teams No proven correct?ming for chemo measurable disease, + - symptoma?c, Ul?mate choice is pa?ent

13 Treatment op?on - radiotherapy No proven benefit in trea?ng port sites Benefit in trea?ng symptoms, eg pain, disease tracking Developing roles for XRT being explored overseas Has a role in cytoreduc?ve therapy

14 Thoracoscopy Establish Diagnosis Talc Pleurodesis Assess Suitability Succeeds Suitability for Cytoreductive Surgery Not Suitable Fails (fluid re-accumulates) Pleurectomy/Decortication or Simple Drainage Assessment for Subsequent Radiotherapy &/or chemotherapy

15 Thoracoscopy Establish Diagnosis Talc Pleurodesis Assess Suitability Succeeds Fails (fluid re-accumulates) Suitability for Cytoreductive Surgery Pleurectomy/Decortication or Simple Drainage Suitable Not Suitable Neoadjuvant Chemotherapy Assessment for Subsequent Radiotherapy &/or chemotherapy

16 Cytoreduc*ve trimodality therapy Only offered to suitable pa*ents numbers are few Chemotherapy 3 cycles Appears to confer a survival advantage Iden?fies a subset of pa?ents with rampant disease who are not suitable for radical surgery Provides a period of adapta?on to the pa?ent and the family prior to radical surgery EPP Extrapleural pneumonectomy EPD lung spared or not spared IMRT Intensity modulated radiotherapy 6-8 weeks post surgery for 6 weeks

17 Thoracoscopy Establish Diagnosis Talc Pleurodesis Assess Suitability Succeeds Suitability for Cytoreductive Surgery Suitable Not Suitable Fails (fluid re-accumulates) Pleurectomy/Decortication or Simple Drainage Neoadjuvant Chemotherapy No Disease Progression Disease Progression Extrapleural Pneumonectomy or Lung Sparing P/D Assessment for Subsequent Radiotherapy &/or chemotherapy

18 Care and support Pa?ent, carer, family Begin at?me of diagnosis Informa?on, informa?on Equitable access to all op?ons for treatment Reality we cannot cure Hopefulness we can treat and support

19 Support and Recovery Well Living Programme Comcare Asbestos Innova?on Fund. $30,000, over 12 months. The Baird Ins?tute (TBI). Plan mee?ngs 2013 Walking is the best medicine.

20 Goals set at first mee*ng. The well living programme needed to: Meaningful support group for survivors / carers Assist survivors and carers to focus on living well aher treatment. Address nega*ve aspects of EPP QOL study reduced role and social func?oning and symptoms of fa?gue, pain, SOB and insomnia. Networking amongst survivors and carers Wriien informa?on for new pa?ents and carers Realize poten?al of group in rela?on to advocacy. Compile resources (computer based DVD, audio etc). Gain public recogni?on for what this group is doing Set a group goal

21 Actual Programme over 4 mee*ngs APRIL JUNE Op?mising living with one lung Physical and respiratory assessments Exploring carer experiences Physical and respiratory assessments (con?nuing) Understanding resilience: Survivors / carers Crea?ng opportuni?es for self- aien?on and nurturing carers. Rela?ng science to the living experience: the role of the Biobank. AUGUST Physical and respiratory assessments (con?nuing)] Pain management Wri?ng fun with words pa?ents. Music healing and relaxa?on carers.. Resilience sessions feedback - the living document. Ea?ng for Wellbeing - A self management plan. NOVEMBER Walking is the best medicine 1.5 Km walk Programme in review What has everyone been up too? Goal for Walk the Sydney City to Surf

22 2013 Walking is the best medicine. February Goal: to improve the fitness and willingness of survivors to exercise and have survivors, carers and others complete a 7 kilometre - the Iron Cove Bay Run on Sunday 4 th August in Sydney. An exercise physiologist worked one on one and via telephone to assist survivors increase their aerobic and resistance training. They maintained their own exercise records in the log book provided. A number of survivors report improvements in overall fitness, enjoyment of daily living and sa?sfac?on with life.

23 Quality Of Life Results July 2013 of12 Long Term Survivors (Ranging 3 10 Years) Ø social and role func*oning, Ø > global health, physical func*onin stable cogni*ve & emo*onal func*on < fa*gue, breathlessness, and insomnia with smaller reduc*ons in pain, cons*pa*on and appe*te loss. EORTC QLQ-C30 Mean Global Health & Functional Scales Higher score = higher QOL and level of C31D)E# functioning F0GD))# (range C31D)H# >6/.01#234/56.47# <674.5=9#234/564.47# :;656401#234/564.47# 8619#234/564.47# *+,-./01#234/564.47#!$# ""# "'#!(# '!# "!# %(# %%# %'# %&#!(# %&# %)# $%# "$# %&# "(#!"#

24 August 4 th - Sunday Morning 6 survivors & 58 carers, family and support staff participated in the 7 km walk Participant age range was 2 years to 86 years.

25 Pa*ent informa*on Launched by Her Excellency, The Governor of NSW Marie Bashir at The Baird Institute Research Conference Dinner on September 20 th 2013

26 THANK YOU ONE LUNG WONDERS

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