Jonathan Burton
WHEN Pharmacy in Practice asked me to pen an article for them I thought I’d break from the usual pharmacy chat and write about the medical condition mesothelioma and tell my dad’s story.
It’s a type of cancer that affects the lining of organs, usually it’s the lungs that are affected (‘pleural mesothelioma’) and it’s almost always caused by exposure to asbestos, although doesn’t usually develop until at least 20 years after exposure. The basics are explained here.
Until around 3 years ago I’d honestly never heard of mesothelioma. I knew that asbestos was nasty stuff, was still around in old buildings and could cause serious lung conditions, but as a pharmacist I’d never known any more than that.
In early 2015 my dad was struggling with a persistent cough. He was a healthy guy, had never smoked, in his mid to late 60s, and had just retired from his work as a plumber. He’d been a plumber for as long as I could remember, but before that had worked as a building apprentice and for various construction firms.
After being prescribed a couple of courses of antibiotics for his cough with little improvement a locum GP decided to order some chest X-rays and pleural effusion was identified. This is fluid in the pleural cavity around the lungs. From there more tests were done and the cancer was confirmed.
Although asbestos was banned in the UK in the 90s, it turns out dad must have been exposed to the stuff in his early career, which involved working for a local Council in school buildings.
Perhaps unsurprisingly he initially found his diagnosis quite crushing. Recently retired with a lot to live for (including four young grandchildren), dad was told he probably had a year of life left. He would probably feel relatively well until the last few weeks.
He had a decision to make, do nothing in terms of treatment (and hit the bucket list quickly!), have the affected lung completely removed, or have the pleural lining of the lung removed. Dad asked for my help to make his decision.
It was the first time I’d ever seen him put in a position where he honestly didn’t know what to do. There were pros and cons to each option but eventually he opted for a pleurectomy i.e. to have the lining of the lung removed, and as is usually the case in mesothelioma this was bundled together with chemotherapy & some radiotherapy.
The surgery went well. Dad coped with the chemo well and recovered quickly, he even attended some local support groups for mesothelioma survivors. He was always realistic about the prognosis of his disease but also encouraged when he met one or two guys with similar work backgrounds who were 4-5 years along from their surgery. Alas, in dad’s case the illness took a more common and predictable path and within a few months sadly he passed away.
So why am I telling this story?
Well, maybe if dad’s story helps raise awareness of mesothelioma anyone reading this will at least know a little more about the disease, how it presents and the current treatment options. Perhaps you will come across a patient (or their family) with a recent diagnosis, or recovering from surgery, or at the end of life and feel better informed and more able to help and advise.
Please ask about work history if dealing with a symptom presentation such as a persistent cough in older patients.
I am grateful to the GP who carefully took dad’s work history and decided it was best to investigate his symptoms further — he was actually feeling better at this point and almost didn’t go to that appointment! The care he received was excellent, from diagnosis to his last few days in the hospice.
Here are some further references if you’d like to read more about Mesothelioma:
Patient.info information on mesothelioma
Jonathan is a community pharmacist independent prescriber with an interest in treating common clinical conditions. Jonathan is also the vice chairperson of the Royal Pharmaceutical Society Scottish Pharmacy Board