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Moshammer en Neuberger concluderen dat de verslechtering van de conditie van de longen een betere voorspeller is van de levensverwachting is dan de kennis over de hoeveelheid asbest waaraan iemand is blootgesteld. Volgens Christensen et al. is er een relatie tussen het aantal asbestvezels dat in de longen aangetroffen wordt en de levensverwachting van een mesothelioompatiënt.
Bron: Moshammer, H. & Neuberger, M. (2008). Lung function predicts survival in a cohort of asbestos cement workers. Int Arch Occup Environ Health. 2008 Apr 12. ABSTRACT

PURPOSE: To study the predictive power of respiratory screening examinations a cohort of asbestos workers was followed from active work in an asbestos cement plant until death.

METHODS: From a cohort with data on individual exposure since first employment 309 workers who had a preventive medical examination in 1989/1990 were observed until death or the end of 2006. The impact of asbestos exposure (fibre years) and of smoking history on lung function was examined by linear regression, on specific causes of death and total mortality by Cox regression. The prognostic value of lung function, chest X-ray, and various clinical findings regarding total mortality was also examined by Cox regression.

RESULTS: Lung function proved to be the best predictor of survival apart from current smoking. Depending on the lung function variable an impairment by the interquartile range resulted in a hazard ratio of 1.5-1.6 while for current smokers it was 2.3. An increase of 70 fibre years (interquartile range) led to a hazard ratio of only 1.1. Lung function was influenced by asbestos exposure, current (but not former) smoking, and by pathological X-ray findings. The risk for pleural mesothelioma was dominated by time since first exposure to crocydolite in the pipe factory while the risk for bronchial cancer increased with smoking and total fibre years. An unexpected finding was an increase of gastric cancer in asbestos cement workers.

CONCLUSION: Lung function decrease predicts risk of premature death better than exposure history and regular spirometry should therefore be offered as primary screening to all former asbestos workers. In workers with a history of high cumulative exposure or rapid lung function decrease or radiological signs (diffuse pleural thickening or small irregular opacities) more sensitive techniques (high resolution computer tomography) need to be applied. All smokers with a history of asbestos exposure should be given free smoking cessation therapy to prevent premature death and lung cancer in particular.

Bron: Christensen, B.C. et. al. (2008). Asbestos burden predicts survival in pleural mesothelioma. Environmental  Health Perspectives, Jun;116(6):723-6.

Abstract

Background: Malignant pleural mesothelioma (MPM) is a rapidly fatal asbestos-associated malignancy with a median survival time of <1 year following diagnosis. Treatment strategy is determined in part using known prognostic factors. OBJECTIVE: The aim of this study was to examine the relationship between asbestos exposure and survival outcome in MPM in an effort to advance the understanding of the contribution of asbestos exposure to MPM prognosis. Methods: We studied incident cases of MPM patients enrolled through the International Mesothelioma Program at Brigham and Women's Hospital in Boston, Massachusetts, using survival follow-up, self-reported asbestos exposure (n=128), and a subset of cases (n=80) with quantitative asbestos fiber burden measures. Results: Consistent with the established literature, we found independent, significant associations between male sex and reduced survival (p<0.04), as well as between nonepithelioid tumor histology and reduced survival (p<0.02). Although self-reported exposure to asbestos was not predictive of survival among our cases, stratifying quantitative asbestos fiber burden [number of asbestos bodies per gram of lung (wet weight)] into groups of low (0-99 asbestos bodies), moderate (100-1,099), and high fiber burden (>1,099), suggested a survival duration association among these groups (p=0.06). After adjusting for covariates in a Cox model, we found that patients with a low asbestos burden had a 3-fold elevated risk of death compared to patients with a moderate fiber burden [95% confidence interval (CI), 0.95-9.5; p=0.06], and patients with a high asbestos burden had a 4.8-fold elevated risk of death (95% CI, 1.5-15.0; p<0.01) versus those with moderate exposure. Conclusion: Our data suggest that patient survival is associated with asbestos fiber burden in MPM and is perhaps modified by susceptibility.

Een 46-jarige Australische vrouw is zwanger geworden kort nadat zij door haar artsen genezen was verklaard van de ziekte mesothelioom.
Inmiddels is zij vijf maanden zwanger. Volgens deskundigen behoort zij tot de ‘derde golf’ van asbestslachtoffers in Australië; mensen die als kind in een omgeving speelden waar met asbest werd gewerkt. Bron: The Age, 26 juli 2008.

Er is een relatie tussen het aantal asbestvezels dat in de longen aangetroffen wordt en de levensverwachting van een mesothelioompatiënt.

Dat concluderen Amerikaanse onderzoekers na onderzoek bij 80 mesothelioompatiënten. Deze relatie wordt waarschijnlijk wel beïnvloed door de aanleg/gevoeligheid van de patiënt. Andere factoren die de levensverwachting beïnvloeden zijn het geslacht en het type tumor.

Bron: Christensen, B.C. et. al. (2008). Asbestos burden predicts survival in pleural mesothelioma. Environmental  Health Perspectives, Jun;116(6):723-6.

Abstract

Background: Malignant pleural mesothelioma (MPM) is a rapidly fatal asbestos-associated malignancy with a median survival time of <1 year following diagnosis. Treatment strategy is determined in part using known prognostic factors. OBJECTIVE: The aim of this study was to examine the relationship between asbestos exposure and survival outcome in MPM in an effort to advance the understanding of the contribution of asbestos exposure to MPM prognosis. Methods: We studied incident cases of MPM patients enrolled through the International Mesothelioma Program at Brigham and Women's Hospital in Boston, Massachusetts, using survival follow-up, self-reported asbestos exposure (n=128), and a subset of cases (n=80) with quantitative asbestos fiber burden measures. Results: Consistent with the established literature, we found independent, significant associations between male sex and reduced survival (p<0.04), as well as between nonepithelioid tumor histology and reduced survival (p<0.02). Although self-reported exposure to asbestos was not predictive of survival among our cases, stratifying quantitative asbestos fiber burden [number of asbestos bodies per gram of lung (wet weight)] into groups of low (0-99 asbestos bodies), moderate (100-1,099), and high fiber burden (>1,099), suggested a survival duration association among these groups (p=0.06). After adjusting for covariates in a Cox model, we found that patients with a low asbestos burden had a 3-fold elevated risk of death compared to patients with a moderate fiber burden [95% confidence interval (CI), 0.95-9.5; p=0.06], and patients with a high asbestos burden had a 4.8-fold elevated risk of death (95% CI, 1.5-15.0; p<0.01) versus those with moderate exposure. Conclusion: Our data suggest that patient survival is associated with asbestos fiber burden in MPM and is perhaps modified by susceptibility.

Mesothelioompatiënten die in aanmerking komen voor operatieve verwijdering van de tumor hebben, volgens chirurg en oncoloog dr. Robert Cameron van de Universiteit van Californië. (UCLA), de meeste baat bij een multimodale behandeling. Deze behandeling bestaat uit een operatie, bestraling en chemotherapie. Patiënten zouden hierover zowel advies moeten vragen aan een thoracaal chirurg als aan een oncoloog. Bron: www.mesothel.com, 21 mei 2008. Meer http://www.mesothel.com/

Koolstof nanobuisjes, een van de belangrijkste nieuwe moleculen in de nanotechnologie, kunnen in het buikvlies van muizen een ontstekingsreactie veroorzaken die lijkt op het beginstadium van mesothelioom. Dat blijkt uit een studie die deze week is gepubliceerd in het tijdschrift Nature Nanotechnology. Volgens Ken Donaldson (universiteit van Edinburgh), één van de auteurs, is het te vroeg om te concluderen dat mensen die in contact komen met nanobuisjes daar ook echt kanker van kunnen krijgen. De muizen kregen de nanobuisjes namelijk ingespoten in hun buikvlies. Om het risico voor mensen te bepalen moet vast staan hoeveel nanobuisjes mensen inademen en of die moleculen in het long- of buikvlies terecht kunnen komen. Nanobuisjes bestaan uit koolstofatomen die op een speciale manier met elkaar zijn verbonden. Ze worden al jaren verwerkt in consumentenproducten als tennisrackets, schokbestendige fietssturen en auto-onderdelen. Bron: NRC en kennislink, 22 mei 2008. Meer http://www.kennislink.nl/

Een studie in het medische tijdschrift Lancet meldt dat honderden mesothelioompatiënten van een groep van 409 geen baat hadden bij een chemokuur met mitomycin, vinblastine en cisplatine. Behandeling met vinorelbine verdient echter nader onderzoek. Bron: BBC news, 15 mei. Muers, M.F., et. al. (2008). Active symptom control with or without chemotherapy in the treatment of patients with malignant pleural mesothelioma (MS01): a multicentre randomised trial. Lancet 2008. 371:1685-94. Meer http://news.bbc.co.uk/

Muers, M.F., et. al. (2008). Active symptom control with or without chemotherapy in the treatment of patients with malignant pleural mesothelioma (MS01): a multicentre randomised trial. Lancet 2008. 371:1685-94.
BACKGROUND: Malignant pleural mesothelioma is almost always fatal, and few treatment options are available. Although active symptom control (ASC) has been recommended for the management of this disease, no consensus exists for the role of chemotherapy. We investigated whether the addition of chemotherapy to ASC improved survival and quality of life. METHODS: 409 patients with malignant pleural mesothelioma, from 76 centres in the UK and two in Australia, were randomly assigned to ASC alone (treatment could include steroids, analgesic drugs, bronchodilators, palliative radiotherapy [n=136]). to ASC plus MVP (four cycles of mitomycin 6 mg/m2, vinblastine 6 mg/m2, and cisplatin 50 mg/m2 every 3 weeks [n=137]). or to ASC plus vinorelbine (one injection of vinorelbine 30 mg/m2 every week for 12 weeks [n=136]). Randomisation was done by minimisation, with stratification for WHO performance status, histology, and centre. Follow-up was every 3 weeks to 21 weeks after randomisation, and every 8 weeks thereafter. Because of slow accrual, the two chemotherapy groups were combined and compared with ASC alone for the primary outcome of overall survival. Analysis was by intention to treat. This study is registered, number ISRCTN54469112. FINDINGS: At the time of analysis, 393 (96%) patients had died (ASC 132 [97%], ASC plus MVP 132 [96%], ASC plus vinorelbine 129 [95%]). Compared with ASC alone, we noted a small, non-significant survival benefit for ASC plus chemotherapy (hazard ratio [HR] 0.89 [95% CI 0.72-1.10]. p=0.29). Median survival was 7.6 months in the ASC alone group and 8.5 months in the ASC plus chemotherapy group. Exploratory analyses suggested a survival advantage for ASC plus vinorelbine compared with ASC alone (HR 0.80 [0.63-1.02]. p=0.08), with a median survival of 9.5 months. There was no evidence of a survival benefit with ASC plus MVP (HR 0.99 [0.78-1.27]. p=0.95). We observed no between-group differences in four predefined quality-of-life subscales (physical functioning, pain, dyspnoea, and global health status) at any of the assessments in the first 6 months. INTERPRETATION: The addition of chemotherapy to ASC offers no significant benefits in terms of overall survival or quality of life. However, exploratory analyses suggested that vinorelbine merits further investigation.

Woede, schuld en verwijten zijn de eerste reacties op de fatale diagnose maligne mesothelioom. Die woede en verwijten zijn gericht op de veroorzakers van de ziekte: werkgevers en de overheid. Britse mesothelioompatiënten hebben veel behoefte aan informatie, psychosociale en emotionele steun, ook omdat ze naast hun lichamelijke lijdensweg met complexe, medische en financiële zaken te maken krijgen. Bron: Hughes, N. &amp. Arber, A. (2008). The lived experience of patients with pleural mesothelioma. International Journal of Palliative Nursing, 14, nr. 2. p. 66-71.

Hughes, N. &amp. Arber, A. (2008). The lived experience of patients with pleural mesothelioma. International Journal of Palliative Nursing, 14, nr. 2. p. 66-71.
Abstract
This paper reports on a research study of five patients diagnosed with mesothelioma. The study used a phenomenological approach to explore patients’ lived experience using in-depth interviews.
The findings identify that patients have many unmet psychosocial and emotional needs and that there was a lack of information provided to patients about specialist supportive and palliative care
services. A number of the patients found specialist supportive care by chance rather than by referral. In addition, patients were involved in complex medico-legal matters in relation to asbestos exposure, and this was an additional burden for them and their spouse or carer. A feeling of social isolation was also reported and a number of patients would welcome the opportunity to meet with
other people in the same situation as themselves. In conclusion, there is a lack of attention to the emotional needs of this group of patients, which means that supportive care resources are not
being accessed in a timely and flexible manner.

Chemotherapie is momenteel de behandeling die het meest wordt toegepast bij niet-operabele mesothelioompatienten. Het gebruik van antifolaten in combinatie met platinum geeft daarbij de grootste kans op langere overleving. Bij patienten die wel geopereerd kunnen worden biedt een combinatie van opereren, bestralen en chemo (trimodale of multimodale behandeling) de beste overlevingskansen. Er is geen standaardtherapie voor de tweedelijnsbehandeling. Bron: Fennell, D., et al. (2008). Advances in the systemic therapy of malignant pleural mesothelioma. Nature Clinical Practice, 5, 3, p. 136-147. Kaufman, A.J. &amp. Pass, H.I. (2008). Current concepts in malignant pleural mesothelioma. Expert Rev. Anticancer Ther. 8(2), 293-303.

Kaufman, A.J. &amp. Pass, H.I. (2008). Current concepts in malignant pleural mesothelioma. Expert Rev. Anticancer Ther. 8(2), 293-303.
Abstract
Malignant pleural mesothelioma (MPM) is a rare but lethal cancer associated with asbestos exposure. Worldwide, the incidence of MPM is expected to increase over the next 20 years. The molecular and genetic profiling of MPM tumors and patients, and improved understanding of the pathogenesis of MPM may lead to novel diagnostic, preventative and therapeutic strategies. Treatment options for MPM remain limited and no consensus exists at this time. Multimodality therapy that combines surgery, chemotherapy and radiation offers the best chance for long-term survival in select patients.

Fennell, D., et al. (2008). Advances in the systemic therapy of malignant pleural mesothelioma. Nature Clinical Practice, 5, 3, p. 136-147.
Abstract
Malignant pleural mesothelioma is an aggressive thoracic malignancy associated with exposure to asbestos, and its incidence is anticipated to increase during the first half of this century. Chemotherapy is the mainstay of treatment, yet sufficiently robust evidence to substantiate the current standard of care has emerged only in the past 5 years. This Review summarizes the evidence supporting the clinical activity of chemotherapy, discusses the use of end points for its assessment and examines the influence of clinical and biochemical prognostic factors on the natural history of malignant pleural mesothelioma. Early-phase clinical trials of second-line and novel agents are emerging from an increased understanding of mesothelioma cell biology. Coupled with high-quality translational research, such developments have real potential to improve the outlook of patients at a time of increasing incidence.

Een 77-jarige man die met asbest heeft gewerkt, 45 jaar heeft gerookt, en bij wie longkanker in de familie op jonge leeftijd voorkomt, heeft bijna 10 x zoveel kans om binnen vijf jaar longkanker te krijgen als iemand met dezelfde kenmerken die nooit gerookt heeft. Cassidy et al. ontwikkelden een model waarmee geschat kan worden hoeveel kans iemand heeft binnen 5 jaar longkanker te krijgen. Meer onderzoek is nodig. Bron: Cassidy, A. et al., (2008). The LLP risk model: an individual risk prediction model for lung cancer. British Journal of Cancer, 98, 270-276.

Cassidy, A. et al., (2008). The LLP risk model: an individual risk prediction model for lung cancer. British Journal of Cancer, 98, 270-276.
Abstract
Using a model-based approach, we estimated the probability that an individual, with a specified combination of risk factors, would develop lung cancer within a 5-year period. Data from 579 lung cancer cases and 1157 age- and sex-matched population-based controls were available for this analysis. Significant risk factors were fitted into multivariate conditional logistic regression models. The final multivariate model was combined with age standardised lung cancer incidence data to calculate absolute risk estimates. Combinations of lifestyle risk factors were modelled to create risk profiles. For example, a 77-year-old male non-smoker, with a family history of lung cancer (early onset) and occupational exposure to asbestos has an absolute risk of 3.17% (95% CI, 1.67&ndash.5.95). Choosing a 2.5% cutoff to trigger increased surveillance, gave a sensitivity of 0.62 and specificity of 0.70, while a 6.0% cutoff gave a sensitivity of 0.34 and specificity of 0.90. A 10-fold cross validation produced an AUC statistic of 0.70, indicating good discrimination. If independent validation studies confirm these results, the LLP risk models&rsquo. application as the first stage in an early detection strategy is a logical evolution in patient care.

Bij veel mensen die vóór 1980 in een vermiculietfabriek in Libby, Montana hebben gewerkt zijn afwijkingen aan de longen te zien, zoals pleurale verdikking. Ook lage blootstellingsniveaus kunnen longafwijkingen veroorzaken. Oorzaak zijn de amfibool asbestvezels die in de vermiculietmijn voorkwamen.Bron: Rohs, A.M. e..a. (2008).

Lockey, J.E., (2008). Low-level fiber-induced radiographic changes caused by Libby vermiculite: a 25-year follow-up study. American Journal of Respiratory and Critical Care Medicine, Mar 15.177(6):630-7.

ABSTRACT
RATIONALE: From 1921 to 1990, vermiculite ore from Libby, Montana, was shipped worldwide for commercial and residential use. A 1980 study of a manufacturing facility using Libby vermiculite was the first to demonstrate a small but significant prevalence of pleural chest radiographic changes associated with amphibole fibers contained in the ore. OBJECTIVES: This follow-up study of the original cohort evaluated the extent of radiographic changes and cumulative fiber exposure (CFE) 25 years after cessation of exposure. METHODS: From the original cohort of 513 workers, 431 (84%) were living and available for participation and exposure reconstruction. Of these, 280 (65%) completed both chest radiographs and interviews. Primary outcomes were pleural and/or interstitial changes. MEASUREMENTS AND MAIN RESULTS: Pleural and interstitial changes were demonstrated in 80 (28.7%) and 8 (2.9%) participants, respectively. Of those participants with low lifetime CFE of less than 2.21 fiber/cc-years, 42 (20%) had pleural changes. A significant (P &lt. 0.001) exposure-response relationship of pleural changes with CFE was demonstrated, ranging from 7.1 to 54.3% from the lowest to highest exposure quartile. Removal of individuals with commercial asbestos exposure did not alter this trend. CONCLUSIONS: This study indicates that exposure within an industrial process to Libby vermiculite ore is associated with pleural thickening at low lifetime CFE levels. The propensity of the Libby amphibole fibers to dramatically increase the prevalence of pleural changes 25 years after cessation of exposure at low CFE levels is a concern in view of the wide national distribution of this ore for commercial and residential use.