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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Foundation Announces Grant To Help Hospitals Create Palliative Care Programs

The most fragile patients often receive the most intensive medical care, and research shows their comfort too often takes a back seat to curative treatment or intervention. Unveiling its signature philanthropic program, Sojourns, The Regence Foundation aims to foster best practices, leadership and collaboration that help people with life-threatening and incurable illness to access quality palliative care in their own community.

Palliative care is a holistic approach that treats the whole person, including management of pain and other discomfort, at any stage of disease while supporting caregivers and families. Depending on a patient’s needs and goals for care, palliative care may be combined with or supplant curative therapies.

“Increasingly, research shows that patients’ treatment desires and comfort are overlooked,” said Michael Alexander, Regence Foundation board chair. “The Regence Foundation seeks to identify best practices in which treatment and care meet with patient and family desires, and to extend those practices to our members, whether they are suffering years with a life-threatening illness or facing a limited prognosis.”

The Regence Foundation’s Sojourns Pathway grants will promote hospital- and community-based palliative care services that help patients, families, and medical and other health professionals get a clear understanding of effective treatment options and patient desires, increasing patient engagement in treatment decisions.

Grants target three phases: Hospitals that need to plan a palliative care program; those that seek to implement a plan for a program and those with a program that seek to expand it through partnerships with other community organizations. Deadlines vary, but the Foundation began accepting proposals for “Innovation” grants on July 20, 2009.

Through an arrangement with the University of California San Francisco Palliative Care Service and Palliative Care Leadership Center, hospitals that receive planning grants will receive training in how to build and sustain an effective palliative care program. Palliative Care Leadership Centers (PCLC) is a national training and mentoring initiative, with direction and technical assistance provided by the Center to Advance Palliative Care (CAPC).

To learn more about Sojourns and to download the Requests for Proposals (RFPs), visit the Regence Foundation Web site.

The Regence Foundation is the corporate foundation of The Regence Group, the largest health insurer in the Northwest/Intermountain region and a not-for-profit independent licensee of the Blue Cross and Blue Shield Association. A 501(c)3 grantmaking organization, the Foundation partners with organizations driving significant change in health care delivery and accessibility in Idaho, Oregon, Utah and Washington.

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Japanese Court Awards Compensation To Former Military Base Employee

A district court has awarded 76 million yen (approx. 800,000 dollars) to the family of a former US naval base employee who died of lung cancer after being exposed to asbestos.

Hitoshi Taimi worked at the United States naval base in Yokosuka for 18 years and during that time he was exposed to asbestos while performing work on air conditioning and ventilation systems.

In April 2006, 11 years after he last worked on the base, Taimi was diagnosed with lung cancer and proceeded to file a lawsuit the next year. Sadly he passed away 10 days later at age 51.

Two years later a district court ruled that the Japanese government was liable for his death because it manages the hiring of base workers and knew about the dangers of asbestos exposure but failed to take appropriate safety measures.

Japan's defense ministry has not indicated whether it plans to appeal the verdict but if the decision stands, it will set an interesting precedent for future lawsuits.

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Public Libraries Around Nation Facing Asbestos Remediation

As the nation's public libraries age, they - like schools - face updates that result in closures, often because older buildings like schools and libraries contain significant amounts of asbestos that represent a threat to public health.

Asbestos, a fibrous mineral widely used in insulation, floor and roofing tiles, tile glues, and some ceiling panels up to the 1970s, when U.S. health officials began to recognize its dangers, is the most common cause of certain illnesses, namely asbestosis - a severe, debilitating respiratory disease - lung and digestive system cancers, and mesothelioma.

Mesothelioma is a particularly lethal form of cancer that commonly lies dormant for several decades before producing enough symptoms to allow for diagnosis. When finally diagnosed, however, most patients are given about a year to live. Fewer than 10 percent live five years, even with second generation chemotherapy agents like Alimta, combination therapies, and radical surgery to remove tumors.

The Wilson Library in Bellingham, Washington - which was closed for asbestos remediation and remodeling recently - was reopened and then closed again from approximately 8:45 a.m. to 9:25 a.m, Pacific time, Friday morning due to an error in the ventilation system's automatic programming.

The remediation and remodeling was scheduled to be completed on Thursday, and the ventilation system automatically set to run again on Friday morning.

Unfortunately, the project was not completed on time, but the ventilation system went on again regardless.

Students and library employees were evacuated as soon as the error was realized, about 8:45, and allowed to return about an hour later, after air quality tests were conducted to insure that the library's air was free of asbestos particles.

The Wilson Library, as part of Western Washington University (WWU), falls under the U.S. Environmental Protection Agency's (EPAs) Asbestos Hazard Emergency Response Act (AHERA) guidelines in terms of asbestos management, so students, faculty and staff were sent e-mails informing them of the nature of the event and the reasons behind the closure and re-opening.

AHERA guidelines mandate that all schools, whether public private or denominational, inspect for asbestos; create an asbestos hazard plan; provide yearly information on asbestos hazards and the plan; inform of any abatement actions that take place (or are planned); designate a contact/liaison person to manage the asbestos plan; and provide custodial staff with asbestos-awareness training.

Western Washington University's Director of Environmental Health and Safety, Gayle Shipley, and WWU staff acted in accordance with the university's AHERA planning by advising of the action taken; i.e., the 8:45 closure, but clearly one step in the process was missed or the ventilation system would not have come back on when it did, and this may be why the EPA strongly recommends its six-step plan to insure that at least one individual is cognizant of all phases of asbestos remediation, monitoring and information dissemination.

That more libraries, both public and collegiate, will face asbestos remediation of some kind in the near future is a given. In Minnesota, the Waseca Public Library is getting ready to close from July 30 to August 23 to enable workers to remove old asbestos tiles and replace them with carpeting. And in Minneapolis, the historic Southeast Library - designed by renowned Minnesota modernist architect Ralph Rapson in 1964 - was closed in 2006 as part of budget reorganization but now faces reopening thanks to the Minneapolis/Hennepin County Library systems merger.

Southeast Library will admittedly need asbestos abatement and a new roof, but its demolition (which was discouraged by historians who appealed to the City of Minneapolis Heritage Preservation Commission and the City Council to designate the building as an historic landmark) has been avoided.

According to one study, it is as costly and time-consuming to demolish a building with asbestos and remove the debris to an approved landfill as it is to perform asbestos remediation and return the structure to use. This is primarily because asbestos abatement has to take place even where demolition is planned, and because hazardous waste landfills are becoming increasingly crowded, leading to higher and higher costs for dumping asbestos debris.

n fact, the real cost of restoring, reusing and re-purposing older buildings lies in renovation and retrofitting, not in asbestos remediation.

Sources: KEYC, Minnesota Independent, The Western Front, Preservation Alliance of Minnesota

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Mesothelioma Cases In Australia Estimated To Rise Between 2014 and 2017

The Safe Work Australia Council posted a new report on mesothelioma at their inaugural June 10th meeting in Sydney. The report, titled "Mesothelioma in Australia: Incidence 1982 to 2005, Deaths 1997 to 2006," suggests that new incidences of mesothelioma are not expected to peak until after 2010. Specifically, the report predicts that the peak will occur sometime between 2014 and 2017.

As we all know that Mesothelioma is a rare type of lung cancer that is associated with the inhalation of asbestos. Asbestos is a natural fiber that is frequently used in construction, automotive and other products. When inhaled, the asbestos fibers become lodged in the lungs. Over time, this results in scarring and the formation of cancerous cells in the lung walls.

Though the safe production, use and control of asbestos has been dramatically improved in Australia over the years, the continued growth of mesothelioma incidence rates can be attributed to the long latency period of the disease. In many cases, symptoms of mesothelioma do not manifest until 20 to 50 years following initial asbestos exposure. This means that many aging Australians are still manifesting the disease from exposure that occurred prior to the initiation of Australian asbestos regulation.

Australia has been tracking the number of new mesothelioma cases in the country since 1982. Between the years of 1982 and 2005, the number of new mesothelioma cases rose from 156 to 597. This number is expected to continue to rise through at least 2014.

Additional statistics cited in the report include:

1. 80 to 90 percent of all new mesothelioma cases in Australia were reported in men
2. Age standardization of mesothelioma cases rose from 1.2 per 100,000 in 1982 to 2.8 per 100,000 in 2005
3. Mesothelioma death rates rose between the years of 1997 and 2006, with a maximum of 545 in 2004
   

Source: OHS Online

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Gene Test Predicts Survival with Mesothelioma

NEW YORK (Reuters Health) - A 4-gene expression ratio test accurately predicts survival in patients with malignant pleural mesothelioma, according to a report in the May 6th Journal of the National Cancer Institute.

"Molecular profiling may seem complex, but it can be easily simplified for specific cases for clinical use so that any physician can find it useful," Dr. Raphael Bueno from Harvard Medical School, Boston, told Reuters Health.

Dr. Bueno and colleagues used results of a prospective clinical trial to evaluate the ability of the 4-gene expression ratio test to predict overall survival and cancer-specific survival in 120 patients undergoing surgery for malignant pleural mesothelioma.

Patients assigned by the test to the good outcome group had significantly better median overall survival (16.8 months) and median cancer-specific survival (21.9 months) than did patients assigned by the test to the poor outcome group (9.5 months and 15.9 months, respectively), the authors report.

Based on a multivariable analysis, the gene ratio test appeared to provide additional predictive information beyond that provided by current pathological staging methods.

The repeatability of the test results was 88.5% for tumor specimen analyses and 93.4% for pleural biopsy specimens, the researchers note.

Within-patient reproducibility of prognosis predictions was 96.1% using tumor specimens and 94.1% using pleural biopsies.

"Patients assigned to the predicted poor outcome group, particularly when other established prognostic factors such as histology and lymph node status are also suggestive of poor outcome, could be counseled to forgo surgery, which would not benefit them, and to seek best supportive care," the investigators propose."

Patients whose gene ratio test results predict a good prognosis after surgery may more confidently select the treatment option that includes surgery."

Dr. Bueno said that similar tests could prove useful in "lung cancer, bladder cancer, prostate cancer, breast cancer, etc." He added that the test is already being used at their clinical lab.

J Natl Cancer Inst 2009;101:678-686.

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