Mesothelioma: are nurses being put at risk in the workplace?
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Mesothelioma: are nurses being put at risk in the workplace?

Peter Allmark Research associate, Division of nursing and midwifery at the University of Sheffield
Angela Tod Professor of older people and care, Division of nursing and midwifery at the University of Sheffield
Liz Darlison @darloliz Consultant nurse, University Hospitals of Leicester NHS Trust

The cancer, caused by asbestos, could affect more staff than statistics suggest, say our expert authors

Malignant mesothelioma is an aggressive, rare cancer caused by exposure to and inhalation of asbestos fibres. The cancer is associated with traditionally male-dominated industries that use asbestos, including asbestos mining and disposal, and the construction industry.

Nursing Standard. 35, 12, 14-16. doi: 10.7748/ns.35.12.14.s10

Published: 02 December 2020

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Picture credit: iStock

Although the UK has the highest rates of mesothelioma in the world, the Office for National Statistics (ONS) recorded only 177 mesothelioma deaths in the category of health and social welfare professionals between 2002 an 2015. ONS analysis concluded that non-industrial workplaces, such as hospitals, had little or no evidence of increased risk compared with the general population.

This analysis, however, does not tally with the experience of many mesothelioma nurse specialists, or with that of others who work in the area, such as the charity Mesothelioma UK or legal professionals. These experts report seeing far greater numbers than the official statistics suggest.

Some healthcare professionals have publicly reported their experiences of developing the illness. In some cases, they have reported difficulties in getting a diagnosis because mesothelioma is believed to be so rare in healthcare workers.

Are nurses at risk from asbestos?

For this reason, Mesothelioma UK commissioned the University of Sheffield to complete a study to find out what the experience of presentation, diagnosis, treatment and care was like for healthcare professionals and other NHS workers. The full study report (tinyurl.com/mesothelioma-report) was published at the end of September 2020.

Data show that at least 81% of organisations running hospitals in the UK have sites containing asbestos.

Following a BBC freedom of information request to 243 NHS trusts or health boards in 2018, 198 out of the 211 (94%) organisations that responded said their hospitals contained asbestos.

Blue or brown asbestos is often removed from buildings as it is considered high risk.

White asbestos is considered lower risk and is generally left in situ and monitored in case it is visibly damaged.

However, it is not the visible material in white asbestos that poses risks but the invisible fibres that are released from it.

Improved air monitoring might be more effective in picking up such fibres, particularly as damage is not always easy to detect when asbestos is hidden behind walls or floors.

Because mesothelioma is such an aggressive disease, the time from diagnosis to death is usually fairly short – most people who develop the cancer die because of it.

Deaths among nurses

According to the ONS data, 114 of the 177 deaths of healthcare professionals between 2002 and 2015 were among nurses.

We asked NHS Resolution how many healthcare workers had sued the NHS, claiming they had developed mesothelioma after being negligently exposed to asbestos at work.

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Asbestos is the term for a group of minerals made of microscopic fibres

Picture credit: iStock

Between 2004 and 2019, there were 1,229 such claims, according to data provided under freedom of information laws.

All of these were NHS workers who had developed mesothelioma, although only about half of this group had won their claim against the health service by showing it was due to negligent exposure at work.

Unfortunately, NHS Resolution would not provide a breakdown of the figures by job or profession.

Even going by claims, this higher figure underestimates the true extent of mesothelioma among current and former NHS staff as it only includes those who actually made a claim against the health service.

Many who develop mesothelioma will not make a claim because, for example, their legal team is unable to identify a specific incidence of negligent exposure to asbestos.

Many nurses have careers ranging across many sites and this makes tracing difficult It is therefore impossible to say how many nurses develop mesothelioma. We can, however, say with some certainty that the ONS figures are too low.

The 1,229 claims are likely to include those made by NHS non-clinical staff, but it is also likely that nurses make up a large proportion of the figures. So, these figures underestimate the actual figure of NHS staff who develop mesothelioma but by how much, we do not know.

How can I help colleagues following a mesothelioma diagnosis?

  • » Remember the person is a patient first and a professional second. Unless actively requested, patients should not be spoken to as a team member, with the bluntness that goes with it

  • » Some nurses may mourn the loss of their professional role following diagnosis. Suggesting they use their skills to help fellow patients, for example through support groups, can be a good way to channel this

  • » A mesothelioma diagnosis does not imply that there is ‘nothing that can be done’ to help the patient. There is often much that can be done, including immunotherapy, financial help and referral to a clinical nurse specialist. Most patients should consider discussing their case with a specialist legal firm to ascertain whether their condition is due to negligent exposure to asbestos

In 2019 we reviewed the literature relating to professionals’ experience of developing mesothelioma, including published academic papers, blogs, YouTube broadcasts and other online information.

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Number of claims received between 2004 and 2019

Picture credit: Source: NHS Resolution: Freedom of Information Request #3992. Data correct as at 31/08/2019

Symptoms and diagnosis

Seven former healthcare workers who had developed mesothelioma, including nurses, healthcare assistants and doctors or their partners, also shared their experiences with us.

Our interviewees reported many physical symptoms that were similar to those of other patients with mesothelioma, such as pain, nausea and breathlessness.

They also reported strong emotional reactions; for some, this was exacerbated by knowledge of the condition and its poor prognosis. In other cases, knowledge of the link to asbestos left some puzzled about the provenance of their cancer.

One healthcare assistant told us: ‘I kept thinking, well where could I have had it from, you know?’

Diagnoses were sometimes associated with an attempt to locate potential asbestos exposure outside the workplace on the part of the diagnosing clinician.

One nurse described a conversation with her consultant in which she was questioned about where her parents worked and her living situation to determine a link with asbestos.

She told the doctor there was no link: ‘I said, no, we’ve never had any asbestos in any houses that we’ve lived in.’

Some healthcare professionals felt a sense of anger or disappointment that they had been exposed to the risk in their workplace, in an environment that is supposed to be about healthcare.

One nurse says: ‘I’ve dedicated 44 years of my life and, you know, that dedication is what’s killing me now. It’s ironic.’

The data we reviewed suggested that, in general, technical care was good but sometimes emotional care fell short. One issue highlighted was the way in which healthcare professionals sometimes treat patients who are also their colleagues.

Sometimes healthcare professionals with mesothelioma report being treated more like colleagues than patients, despite the devastating diagnosis.

One nurse described how receiving her diagnosis from a colleague was ‘horrendous’ because of a perceived lack of compassion.

Another nurse said she was shell-shocked by the news but found the response from her nurse lacked empathy. ‘She just said I’m so sorry about your diagnosis – take these and if you do nothing else then ring this number. And that was it. I walked out. I thought, I’ve just been told I’ve got a terminal illness, and all I’ve got is a bunch of leaflets.’

On the other hand, there were many reports of positive treatment and the 26 clinical nurse specialists working across the UK from the charity Mesothelioma UK were highly regarded by interviewees.

Report recommendations

At present, the UK relies on specifications set in 1969, when Asbestos Regulations came into force. We recommend the UK improves the monitoring of levels of asbestos using techniques that are now widely available and used in other countries.

We suggest that the healthcare workforce should be taught about asbestos, its dangers and its management, perhaps at induction and update days.

We also propose that, when leaving the health service, staff should be reminded that asbestos exists in most NHS premises and that asbestos-related illness is a possibility that should be borne in mind if the symptoms are present.

The Healthcare Staff Mesothelioma Asbestos Guidance Study tinyurl.com/mesothelioma-report

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