The Cancer Health Empowerment For Living Without Pain Study May Benefit Mesothelioma Patients

Cancer-related pain is common and under-treated. This article describes a study designed to test the effectiveness of a theory-driven, patient-centered coaching intervention to improve cancer pain processes and outcomes.

Methods: The Cancer Health Empowerment for Living without Pain (Ca-HELP) Study is an American Cancer Society sponsored randomized trial conducted in Sacramento, California.

A total of 265 cancer patients with at least moderate pain severity (Worst Pain Numerical Analog Score >=4 out of 10) or pain-related impairment (Likert score >= 3 out of 5) were randomly assigned to receive tailored education and coaching (TEC) or educationally-enhanced usual care (EUC); 258 received at least one follow-up assessment. The TEC intervention is based on social-cognitive theory and consists of 6 components (assess, correct, teach, prepare, rehearse, portray).

Both interventions were delivered over approximately 30 minutes just prior to a scheduled oncology visit. The majority of visits (56%) were audio-recorded for later communication coding.

Follow-up data including outcomes related to pain severity and impairment, self-efficacy for pain control and for patient-physician communication, functional status and well-being, and anxiety were collected at 2, 6, and 12 weeks.DiscussionBuilding on social cognitive theory and pilot work, this study aims to test the hypothesis that a brief, tailored patient activation intervention will promote better cancer pain care and outcomes. Analyses will focus on the effects of the experimental intervention on pain severity and impairment (primary outcomes); self-efficacy and quality of life (secondary outcomes); and relationships among processes and outcomes of cancer pain care.

If this model of coaching by lay health educators proves successful, it could potentially be implemented widely at modest cost. [Clinical Trials Identifier: NCT00283166]

Author: Richard KravitzDaniel TancrediRichard StreetDonna KalauokalaniTim GrennanTed WunChristina SleeDionne Evans DeanLinda LewisNaomi SaitoPeter Franks
Credits/Source: BMC Cancer 2009, 9:319

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Unlicensed Asbestos Removal Will Be Penalised

The Health and Safety Executive (HSE) is warning the building trade that companies and contractors will face prosecution if they remove asbestos without a licence.

It follows HSE's successful prosecution of three contractors who carried out unlicensed asbestos removal at Kelford School in Rotherham in 2006.

Mansell Build Ltd (previously Birse Build Ltd) of Cheadle Hulme, Cheshire,was fined £12,500 and ordered to pay £12,500 costs. Andrew Brightmore, a former manager of ARB Agriplant Ltd was fined £2,500 and ordered to pay £500 costs and Gary Cusack was fined £500 and ordered to pay £250 costs. Both are of Thurcroft, Rotherham. All were prosecuted for health and safety breaches at Rotherham Magistrates' Court.

Mansell Build Ltd, the principal contractor, was employed to carry out work to remove asbestos insulating board ceilings at the school. The work should have been carried out by a contractor licensed by HSE, but the company contracted to carry out the work, ARB Agriplant Ltd, did not have a licence.

Now in administration, ARB Agriplant Ltd then subcontracted the work to Gary Cusack, another unlicensed contractor.

All contractors failed to implement basic requirements to prevent the spread and exposure to asbestos to both those removing the materials and to others working at the school at the time.

After the removal work had been completed, Mansell Build Ltd allowed other contractors to work in those areas without verifying which areas were free from asbestos. It was then found that these areas were contaminated with asbestos.

Following the incident ARB Agriplant Ltd provided a forged asbestos licence and a falsified clearance certificate to Mansell Build Ltd, claiming that the work had been undertaken by a licensed contractor and that the area was free from asbestos.

Speaking after the case, HSE inspector David Bradley said:

"Those responsible for employees have a legal duty to protect their health and safety and in the case of asbestos they should know that any disturbance of such a dangerous material should only be tackled by licensed workers.

"In this case, the contractors responsible put others in a dangerous situation, which could have been avoided had the work been carried out by a licensed contractor.

"Asbestos is the biggest cause of work-related deaths in the UK, which is why there are strict rules in place to prevent exposure. HSE has published a wealth of advice for employers to help them reduce the risks associated with asbestos."

Around 4,000 people a year die from asbestos-related diseases. For more information here.

Notes

1. Mansell Build Limited and Andrew Brightmore were charged under Section 3(1) Health & Safety at Work Act which states: 'It shall be the duty of every employer to conduct his undertaking in such a way as to ensure, so far as is reasonably practicable, that persons not in his employment who may be affected thereby are not thereby exposed to risks to their health or safety.'

2. Gary Cusack was charged under section 3(2) of the Health & Safety at Work Act which states: 'It shall be the duty of every self-employed person to conduct his undertaking in such a way as to ensure, so far as is reasonably practicable, Page 5 that he and other persons (not being his employees) who may be affected thereby are not thereby exposed to risks to their health or safety.'

Source : HSE

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Are You Safe From Vermiculite Insulation?

The US Environmental Protection Agency (EPA) offices have received a large number of phone calls from citizens concerned about vermiculite insulation in their home that might be contaminated with asbestos. If you suspect vermiculite insulation is in your home, the safest thing is to leave the material alone. If you decide to remove or must otherwise disturb the material due to a renovation project, consult with an experienced asbestos contractor. EPA is gathering more information about vermiculite insulation and other products containing vermiculite. Here are the following information that provides a common sense approach to help you find out what kind of insulation is in your home and decide what to do if you have vermiculite insulation:

Vermiculite is a naturally occurring mineral that has the unusual property of expanding into worm-like accordion shaped pieces when heated. The expanded vermiculite is a light-weight, fire-resistant, absorbent, and odorless material. These properties allow vermiculite to be used to make numerous products, including attic insulation.

Do i have vermiculite insulation?
Vermiculite can be purchased in various forms for various uses. Sizes of vermiculite products range from very fine particles to large (coarse) pieces nearly an inch long. Vermiculite attic insulation is a pebble-like, pour-in product and is usually light-brown or gold in color. The pictures below show several samples of vermiculite attic insulation.

Is vermiculite insulation a problem?
Prior to its close in 1990, much of the world’s supply of vermiculite came from a mine near Libby, Montana. This mine had a natural deposit of asbestos which resulted in the vermiculite being contaminated with asbestos. Attic insulation produced using vermiculite ore, particularly ore that originated from the Libby mine, may contain asbestos fibers. Today, vermiculite is mined at three US Facilities and in other countries which have low levels of contamination in the finished material.

How does asbestos cause health problems?
Asbestos can cause health problems when inhaled into the lungs. If products containing asbestos are disturbed, thin, lightweight asbestos fibers are released into the air. Persons breathing the air may breathe in asbestos fibers. Continued exposure increases the amount of fibers that remain in the lung. Fibers embedded in lung tissue over time may result in lung diseases such as asbestosis, lung cancer, or mesothelioma. Smoking increases your risk of developing illness from asbestos exposure.

What should I do if I have vermiculite attic insulation?
DO NOT DISTURB IT. Any disturbance has the potential to release asbestos fibers into the air. Limiting the number of trips you make to your attic and shortening the length of those trips can help limit your potential exposure. EPA and ATSDR strongly recommend that:

• Vermiculite insulation be left undisturbed in your attic. Due to the uncertainties with existing testing techniques, it is best to assume that the material may contain asbestos.
  
• You should not store boxes or other items in your attic if retrieving the material will disturb the insulation.
• Children should not be allowed to play in an attic with open areas of vermiculite insulation.
• If you plan to remodel or conduct renovations that would disturb the vermiculite, hire professionals trained and certified to handle asbestos to safely remove the material.
• You should never attempt to remove the insulation yourself. Hire professionals trained and certified to safely remove the material.

What if I occasionally have to go into my attic?
EPA and ATSDR strongly recommend that homeowners make every effort not to disturb vermiculite insulation in their attics. If you occasionally have to go into your attic, current best practices state you should:

• Make every effort to stay on the floored part of your attic and to not disturb the insulation.
  
• If you must perform activities that may disturb the attic insulation such as moving boxes (or other materials), do so as gently as possible to minimize the disturbance.
  
• Leave the attic immediately after the disturbance.
  
• If you need work done in your attic such as the installation of cable or utility lines, hire trained and certified professionals who can safely do the work.
• It is possible that vermiculite attic insulation can sift through cracks in the ceiling, around light fixtures, or around ceiling fans.
  
• You can prevent this by sealing the cracks and holes that insulation could pass through. Common dust masks are not effective against asbestos fibers. For information on the requirements for wearing a respirator mask, visit the OSHA website

What are the next steps?
The guidance provided in this brochure reflects the current testing technology and knowledge of precautions one may take regarding vermiculite attic insulation. EPA is initiating further studies on vermiculite attic insulation and pursuing other asbestos related issues. Additional information will be provided to the public via the EPA and ATSDR web sites and through additional outreach materials as it becomes available.

Is my health at risk from previous exposures to the asbestos in the insulation?

If you removed or disturbed the insulation, it is possible that you inhaled some asbestos fibers. Also the disturbance may have resulted in the fibers being deposited into other areas of the home. Exposure to asbestos increases your risk of developing lung disease. That risk is made worse by smoking. In general, the greater the exposure to asbestos, the greater the chance of developing harmful health effects. Disease symptoms may take several years to develop following exposure. If you are concerned about possible exposure, consult a physician who specializes in lung diseases (pulmonologist).

Where can I get information on testing or removal of the insulation?
EPA and ATSDR strongly recommend using a trained and certified professional to conduct removal work. Removing the insulation yourself could potentially spread asbestos fibers throughout your home, putting you and your family at risk of inhaling these fibers.

For certified asbestos removal professionals in your area, refer to your local Yellow Pages. Your State Environmental Agency can confirm that the company’s credentials are current. You can find your State Agency here.

Currently, there are specific technical issues involving vermiculite sampling that can complicate testing for the presence of asbestos fibers and interpreting the risk from exposure. EPA and ATSDR are not recommending at this time that homeowners have vermiculite attic insulation tested for asbestos. As testing techniques are refined, EPA and ATSDR will provide information to the public on the benefits of testing that produce more definitive and accurate test results.

What if I have work-related exposure to vermiculite?
Workers who have had significant past exposure, or have significant ongoing exposure to asbestos, to vermiculite from Libby, or to other asbestos contaminated materials should consider getting a medical exam from a physician who knows about diseases caused by asbestos. For more information and to obtain a fact sheet concerning occupational exposure to vermiculite, contact the National Institute for Occupational Safety and Health (NIOSH) at: 1-800-35-NIOSH.

Where can I get more information?
Information on the Agency’s guidance on asbestos and vermiculite, including insulation and horticultural products, has previously been available on EPA’s website. Additional information on vermiculite and asbestos is available from the following sources:

General Information EPA’s Toxic Substances Control Act (TSCA) Assistance Information Service: Asbestos Line:

1-800-471-7127 EPA Asbestos Ombudsman: 1-800-368-5888 EPA's Asbestos Home Page

Health Information

Agency for Toxic Substances and Disease Registry (ATSDR)

Worker Safety

Occupational Safety and Health Administration (OSHA)
National Institute for Occupational Safety and Health (NIOSH)

For Consumer Products:

Consumer Product Safety Commission (CPSC)

For Mineralogy

United States Geological Survey (USGS)

Prepared by the United States Environmental Protection Agency, National Institute for Occupational Safety and the Agency for Toxic Substances and Disease Registry, May 2003. EPA publication 747-F-03-001

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Learn The Different Treatments Used For Pleural Mesothelioma

Treatment of mesothelioma differ according to a stage that a patient has progressed to at the time of diagnosis. Provided below is an example of the types of treatment that a pleural mesothelioma patient will undergo at various stages of the disease. We have identified the stages using the Butchart staging system.

Stage I Mesothelioma Treatment
Surgical intervention is most commonly recommended for pleural mesothelioma patients having a Stage I diagnosis. The procedures that are likely to be performed are pleurectomy/decortication or extrapleural pneumonectomy. Post surgery, doctors may further evaluate the patient to determine if chemotherapy or radiation treatment is necessary. It is often determined with stage I mesothelioma that those adjunct therapies are not required.

Stages II, III Mesothelioma Treatment
When mesothelioma has progressed to stages II and III the cancer cannot be cured. At these stages medical treatment focuses on alleviating the severity of the symptoms and keeping the patient as comfortable as possible in order to optimize quality of life. For example, if there is significant fluid build-up in the chest the doctor may order that it be drained. Additionally, there may be instances where removing some or all of the tumor and / or undergoing chemo or radiation treatments will provide symptom relief. Clinical trials at some of the larger cancer centers in the country may also offer different treatment options for patients in these stages.

Stage IV Mesothelioma Treatment
When a patient has been diagnosed with stage IV mesothelioma the prognosis is very unfavorable. At this stage, the cancer has usually metastasized throughout the body to other organs and as with stages II and III, cannot be cured. In this stage, symptoms generally increase in severity and pain management becomes the primary focus of the medical team.

Therapies such as chemotherapy and radiation are typically not offered at this stage unless they are needed to support pain management objectives. Oftentimes families find that it is most helpful to seek out additional support through a local Hospice program. Hospice programs focus on providing patient care, developing a pain management protocol and providing support for both the patient and family members at this difficult time. Patients with stage IV mesothelioma may also be interested in participating in specialized clinical trials offered at leading cancer hospitals and centers and are encouraged to seek out those programs if desired..

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