Chapter 10 – Medical Research
Mesothelioma and other asbestos-related cancers generally have a long latency period and high mortality rate. Areas that appear to cause particular concern in the medical community are the lack of early diagnosis measures for mesothelioma and the lack of effective treatment options to increase the survival rate of mesothelioma patients. The need to support research into these diseases is given further emphasis by the recent spread into broader segments of the population. This chapter deals with supporting and coordinating such research efforts.
ISSUES
DIAGNOSIS AND TREATMENT OF ASBESTOS-RELATED DISEASES
Underpinning all of the consultations and submissions to the review was a strong desire to prevent future asbestos-related disease, together with a wish for better diagnosis and treatment. While asbestosis, which is contracted as a consequence of intensive exposure to asbestos, is becoming a less frequent diagnosis due to effective preventive measures and the bans on asbestos use, the incidence of mesothelioma has continued to rise. It is no longer an infrequent diagnosis and its incidence is projected to continue to rise for years to come. The review was informed that the diagnostic process in patients with mesothelioma can be difficult and problematic, and may take several weeks. Frequently, additional expert advice is needed to ascertain the diagnosis. Treatment decisions are affected by this delay. Despite modest improvements in treatment in recent years, the prognosis of patients with mesothelioma has remained poor and median survival following diagnosis remains less than 12 months. Novel methods to improve the diagnostic process of asbestos-related cancers are urgently needed, as are more effective means for the treatment of mesothelioma.
SUPPORT FOR MEDICAL RESEARCH IN AUSTRALIA
Mesothelioma and other asbestos-related diseases receive low levels of research funding compared to other forms of cancer. When financial support for oncological research in Australia was reviewed recently, it was apparent that research into cancers with poor prognosis, such as mesothelioma and lung cancer, is receiving significantly less support than research into more favourable cancer diagnoses such as breast cancer.107
A report compiled by Cancer Australia concerning funding for cancer research projects noted that overall funding in Australia was $84.9 million in 2003, $91.7 million in 2004 and $115.1 million in 2005 (not including fellowships, infrastructure and equipment). Less than 5 per cent of this funding was attributed to lung-related cancers, which includes mesothelioma. The report also noted that unlike other cancers such as breast cancer, leukaemia and melanoma, funding for research into asbestos-related cancers was relatively low.108
According to figures provided by the National Health and Medical Research Council (NHMRC), approximately $15.4 million was allocated to mesothelioma research between 2000 and 2011. This includes the oversight of a small ongoing $5 million fund provided by the former James Hardie Industries under the terms of the final Asbestos Injuries Compensation Fund Agreement in 2006.* It should be noted NHMRC funding relies on organisations successfully applying for grants.
In 2006, James Hardie wrote to their shareholders to seek their approval to establish a long-term compensation fund for Australian asbestos-related personal injury claims against former James Hardie subsidiaries. Notably, James Hardie cited a report by KPMG in 2006, which stated:
‘An actuarial and insurance industry review undertaken by KPMG actuaries in August 2004, which was updated to September 2006, estimated that the total cost of Australian asbestos liabilities in relation to personal injury claims may exceed $9 billion, although KPMG actuaries acknowledged the uncertainty in predicting a definitive figure.’ 109
Chapter 10 – Medical Research 52 There are a number of research groups with major research activities (preclinical, translational, clinical and
epidemiological) in Australia. Because of the manner in which funding for medical research into asbestos-related diseases is conducted, the climate for research funding in Australia could be best described as competitive. If so, rather than driving effective collaborative research efforts, this could have a consequence that researchers become more isolated.
STAKEHOLDER COMMENTS
Although not covered by the review’s terms of reference, a number of submissions received from community organisations, unions and medical specialists identified medical research and patient management as requiring attention.
Dr Malcolm Feigan noted in his submission:
‘Mesothelioma is probably the only cancer whose cure rate has not significantly benefitted from medical advances in surgery, chemotherapy or radiotherapy, better screening tools and diagnostic imaging. With a new wave of cases being diagnosed after home renovations, the problem of finding a medical solution is becoming more pressing.’110
CONCLUSION
As with a number of the other areas dealt with by the review, it became apparent that there were gaps in asbestos disease reporting data and knowledge, particularly in relation to the sharing of information across jurisdictions. The gathering and sharing of information and knowledge concerning the incidence of asbestos-related disease throughout Australia should be better coordinated.
Research into asbestos-related disease should be driven by excellence. National cooperation should be encouraged to avoid redundancy or duplication of effort. In making funding decisions, governments and funding bodies should also consider the magnitude of expenses that are, and will be, made to compensate asbestos victims – and the other economic imposts of asbestos-related disease. There is a national economic imperative to reduce this cost by funding medical research into asbestos-related disease.
The review has concluded that more funding is required for research into asbestos-related disease; and this would be best achieved by supporting the effective cooperative research efforts already established in Perth, Sydney and elsewhere. Sufficient Commonwealth funding should be provided for a coordinated national research effort to discover ways of preventing or curing asbestos-related cancers. This, in combination with the range of other asbestos management measures mentioned elsewhere, could enable Australia to become the first nation to dramatically reduce and then eliminate deaths from asbestos.
RECOMMENDATION
10. The Review recommends that there be sufficient funding for a coordinated national research effort into ways of preventing or curing asbestos-related disease, particularly mesothelioma.