Malignant pleural mesothelioma in Finland: regional and gender variation

Abstract

Background: Malignant pleural mesothelioma (MPM) is a rare occupational cancer with a poor prognosis. Even with a multimodality treatment approach, the treatment outcomes remain unsatisfactory. The use of asbestos has been banned in most developed countries, but MPM continues to be a significant occupational disease also in these countries. Aim of this study is to identify modern epidemiology and assess equality in care.Methods: Our study cohort consists of 1010 patients diagnosed with MPM in Finland during 2000–2012. The data were collected from the Finnish Cancer Registry, the National Workers’ Compensation Center Registry and the National Registry of Causes of Death, Statistics Finland.Results: Women were diagnosed a mean of 4.5 years later than males (p = .001), but survival did not differ (overall median survival 9.7 months). A workers’ compensation claim was more common in males (OR 11.0 [95% CI 7.5–16.2]) and in regions with a major asbestos industry (OR 1.7 [95% CI 1.3–2.2]). One-year and three-year survivals did not differ regionally. Patients without chemotherapy treatment had an inferior survival (RR 1.8 [95% CI 1.5–2.0]). The initial survival benefit gained with pemetrexed was diluted at 51 months.Conclusions: MPM is a disease with a poor prognosis, although chemotherapy appears to improve survival time. Significant gender and regional variation exists among patients, with notable differences in diagnostic and treatment practices. Long-term outcomes with pemetrexed remain indeterminate.Impact: Emphasize centralized consult services for the diagnosis, treatment and support that patients receive for MPM, facilitating equal outcomes and compensation.