A new UK-wide audit of mesothelioma care has just launched. Here is what the British Snapshot Mesothelioma Audit (BriSMA) sets out to do, and what we already know from the national audit it builds on.
WHAT IS BRISMA?

This autumn, Mesothelioma UK, in partnership with the June Hancock Mesothelioma Research Fund (who are supported by Hasag) announced the launch of the British Snapshot Mesothelioma Audit, known as BriSMA. BriSMA is described as a UK-wide clinical audit that will provide the first national snapshot of mesothelioma diagnosis, treatment and outcomes in almost a decade, with the stated aim of helping to identify variation in care and support future improvements.
The audit is being promoted jointly with the British Thoracic Society, the British Thoracic Oncology Group, Lung Cancer Nursing UK and the UK Pleural Society, and clinical teams across the UK are currently being invited to register their interest in taking part.

WHAT IS BRISMA FOR?
BriSMA is designed to examine what is currently happening in the care and treatment of mesothelioma and can be used by healthcare professionals to review and improve patient care. This is UK based and for mesothelioma, there has not been a comparable national snapshot for many years. Its purpose is to:
• Capture a current, UK-wide picture of how mesothelioma patients are being diagnosed and treated.
• Identify variation in care between different parts of the UK and between different treatment centres.
• Support future improvements in services for people affected by the disease.
As the audit has only just launched and is currently at the stage of inviting clinical teams to register and participate, no findings have yet been published. Any account of what BriSMA shows about current practice will have to wait until data collection and reporting are complete.

EARLIER NATIONAL MESOTHELIOMA AUDITS
While BriSMA’s own results are awaited, it is worth recapping on the earlier findings of the National Mesothelioma Audit (NMA), since this is the main existing source of UK-wide clinical data on mesothelioma care.
The NMA has been funded by Mesothelioma UK since 2016 and delivered by the Royal College of Physicians, with mesothelioma having previously been covered within the National Lung Cancer Audit. The NMA report draws on data from Public Health England, the Welsh Cancer Network, the Northern Ireland Cancer Registry, lung cancer teams in Guernsey, and the national peritoneal mesothelioma multidisciplinary team (MDT) at Basingstoke, and sets out key findings, national averages and geographical variation across an agreed set of mesothelioma service performance indicators and patient outcomes.

NATIONAL MESOTHELIOMA AUDIT REPORT 2020 (COVERING PATIENTS DIAGNOSED 2016 TO 2018)
The fourth National Mesothelioma Audit report (the previous one was published in 2018) produced by the Royal College of Physicians, was based on anonymised data from 160 health organisations and 7,210 mesothelioma patients diagnosed between 2016 and 2018 in England, Wales, Northern Ireland and Guernsey.
This report identified improved long-term survival: three-year survival increased by three percentage points for malignant pleural mesothelioma and by seven percentage points for peritoneal mesothelioma compared with the previous audit period.
Other improvements recorded included:
• Data completeness for performance status rose from 69% to 80%, and for disease stage from 54% to 65%.
• Clinical nurse specialist (CNS) support data completeness rose from 67% to 77%, with the proportion of patients actually assessed by a CNS rising from 54% to 70%.
• The proportion of patients discussed at multidisciplinary team meetings rose from 81% to 89%.
The 2020 report made nine recommendations, including that all multidisciplinary teams should appoint a clinical data lead, that at least 80% of patients should have a clinical nurse specialist present at diagnosis, that pathological confirmation should exceed 95%, and that patients with adequate performance status should be offered active anti-cancer treatment including palliative chemotherapy.

WHY THIS MATTERS FOR ASBESTOS DISEASE CLAIMS
For solicitors and asbestos support groups such as Hasag representing claimants in asbestos-related lung disease claims, national audit data of this kind is a useful source of context, even though it does not refer to any individual client’s case. The National Mesothelioma Audit’s findings on survival rates, variation in access to multidisciplinary teams, clinical nurse specialist support and pathological confirmation of diagnosis illustrate, at a national level, both the severity of mesothelioma as a disease and the degree of variation that has historically existed in the standard of care received by patients across the UK.
BriSMA, once it reports, should provide an updated and more current picture of that variation. Hasag, and many of the law firms on their panel will look to follow the audit’s progress, stay informed of its methodology, and be ready to draw on its findings once published.