M e sotheliom a. a UK nursing and inform ation project. Mavis Robinson Project Manager

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1 M e sotheliom a a UK ursig ad iform atio project Mavis Robiso Project Maager

2 Mesotheliom a Mesothelioma is a cacer. It most commoly affects the outer liig of the lugs (the pleura). I over 70% of cases it is caused by exposure to asbestos ad there is ofte a 20 to 40 years time lapse betwee the exposure to asbestos ad the developmet of this disease.

3 W h y was there a eed for this project? Previous rarity of the disease has led to a lack of kowledge amogst may Health professioals. As a cosequece of this patiets ad carers have foud iformatio very difficult to obtai. It is ecessary to meet the eeds of the icreasig umbers of sufferers.

4 W hat are the objectives of the project? To improve the stadards of ursig care give to patiets. To iform ad educate health professioals ad others ivolved i care. To provide accurate,accessible, up to date iformatio about the disease to patiets ad carers.

5 The two-year project pla To establish a Natioal Iformatio Telephoe Lie for Health professioals, Patiets ad Carers. To form a coutrywide etwork of Lug Cacer specialist urses who will receive extra traiig to eable them to teach ad deal with ay queries i their areas. To improve the geeral level of ursig kowledge about the disease.

6 Progress of the project pla to date the telephoe lie The telephoe iformatio lie was established i July It operates for two days per week.

7 Review of the calls received i the first year 203 calls have bee received from patiets ad carers. ( the majority of calls are from wives ad widows of patiets) 315 calls have bee received from professioals. (204 of these from urses)

8 Aalysis of major reasos for patiets / carers calls Most wated more detailed iformatio about the disease The majority wated writte iformatio May queries about latest treatmet ad trials available May queries about beefits ad legal positio May wated to kow what to expect as the disease progresses May cocers about symptom cotrol Several calls from bereaved spouses who had received little iformatio prior to the death of their parters

9 Aalysis of major reasos for professioal calls Nurses Maily requestig detailed iformatio about the disease to pass o to their patiets. Questios cetre particularly o symptom cotrol, beefits, sources of asbestos exposure, latest treatmets ad trials, research etc. How best to orgaise future care for their patiets. Solicitors May requests for writte iformatio about the disease for their ow kowledge ad to give to cliets.

10 Cot... Doctors Maily requests for writte iformatio to give to their patiets. Support groups/iformatio Services Maily askig for writte material for their library services

11 Progress to date Nursig Network 34 Specialist Nurses have ow bee erolled ito the Mesothelioma Nurses Network. These urses have all atteded exteded traiig days o the subject. They are based i areas of high icidece of the disease i the UK. These urses are committed to teachig other urses about the disease to improve future care. These urses will become a resource i their ow areas whe iformatio is required about mesothelioma.

12 Future plas A pla is beig developed to improve geeral ursig kowledge of the disease. Material is beig prepared to direct urses to sources of iformatio ad assistace for themselves ad for patiets.

13 What is Mesothelioma? A eoplasm arisig from mesothelial cells which lie serous cavities. The commoest site is the pleura The secod commoest site is the peritoeum Rarely it ca affect the serous coat of the testicle.

14 Cliical Features Ofte presets isidiously with achig chest pai, icreasig breathlessess ad commoly a pleural effusio. The geeral coditio of the patiet is usually quite good ad the diagosis frequetly comes as a great shock.

15 How the disease progresses. The tumour spreads by local ivasio of the chest wall, the brachial plexus, the mediastium ad across the diaphragm. It does ot usually ivade the lug. Distat lymph ode ivolvemet does occur but is rarely a problem The tumour frequetly tracks dow the biopsy woud site.

16 Symptoms Icreasig breathlessess as the eoplasm thickes ad obliterates the pleural space. Itractable pai caused by ivasio ito the chest wall Muscular weakess of the upper limb ad pai caused by ivasio ito the brachial plexus ad root of the eck.

17 Symptoms cot. Ivasio ad ecasemet of the oesophagus ad the great veis ca result i dysphagia ad perhaps symptoms of SVC obstructio. Ivasio of the pericardium may produce a effusio ad cardiac arrhythmias. Ivasio across the diaphragm ca produce peritoeal deposits with ascites.

18 Establishig the diagosis. Aspiratio ad draiage of fluid Closed eedle biopsy Thoracoscopy - VATS procedure Ope biopsy at thoracotomy Diagosis ad differetiatio is very difficult. Mesothelioma is very similar histologically to adeocarcioma

19 Causative factors Over 70% of cases are related to asbestos exposure There is frequetly a year latecy period sice exposure Rarely other causes may be - Erioite, Radiotherapy to the thorax, repeated iflammatio of the pleura, SV 40, hereditory factors.

20 Stadard treatmet. Biopsy ad cofirmatio of diagosis. Pleurodesis. Radiotherapy to biopsy sites.(withi3/52) Good symptom cotrol. Bv

21 Network Nurses Established

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1 Barnes D and Lombardo C (2006) A Profile of Older People s Mental Health Services: Report of Service Mapping 2006, Durham University.

1 Barnes D and Lombardo C (2006) A Profile of Older People s Mental Health Services: Report of Service Mapping 2006, Durham University. The Natioal Audit Office udertook a self-assessmet cesus of Commuity Metal Health Teams for Older People (CMHTs) betwee September ad December 2006. The overall fidigs are preseted i the Natioal Audit Office