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Outcomes and Achievements
- AECOM Australia, Benjamin Hardaker
- Asbestos Audits Queensland, Brian Sketcher
- Asbestos Diseases Reserach Institute, Glen Reid
- Asbestos Diseases Research Institute, Nico van Zandwijk
- Asbestos Diseases Society of South Australia, Ian Sheppard
- Austin Health, Malcolm Feigen
- Baird Institute, Jocelyn McLean
- Baw Baw Shire Council, Paul Cantillon
- BSC Electronics, Mark Brims
- Lung Foundation Australia, Glenda Colburn
- Southern Cross University, Rick van der Zwan
- University of Queensland, Judith Bauer
Grant amount: $107 700
Background: There is a technical gap in the measurement of risk associated with free fibres generated from asbestos-in-soil. Effective communication of asbestos-in-soil risk has been stifled by the lack of definitive measurement protocols to quantify risk, often leading to unnecessary remedies and unnecessary community concern.
Aim of project: To develop a tool that can measure the generation of asbestos fibres from asbestos-contaminated soils and thereby identify the health risk of these hazards to people. Initially the tool with be developed on a pilot-scale with the long term goal being a unit that can be used to undertake site-specific health risk assessments.
Outcomes and Achievements: The Asbestos in Soil to Air Assessment Method (ASAAM) prototype was built and tested. A peer review of the schematic design of the prototype was conducted which lead to some key design refinements.
Air sampling, swab sampling and tape lift sampling were all trialled as possible techniques to determine fibre presence. Swab sampling was shown to be the most effective sampling method, and was able to detect fibres in topsoil at 0.01% weight for weight and in sand at 0.001% weight for weight concentrations.
Discussions with NSW EPA and WorkCover NSW have highlighted a number of applications for ASAAM, including assessments of asbestos remediation and natural disaster sites. An agreement has been obtained from NSW EPA and WorkCover NSW to perform further field testing, and to validate the ASAAM under a range of environmental conditions.
Grant amount: $40 000
Background: The lack of awareness about asbestos in the home is a real concern. Asbestos is contained in many products and is not just limited to the roof. In fact, the Australian CSIRO has a listing of over three thousand products containing asbestos.
Aim of project: To promote and distribute a resource book titled Identifying Asbestos in Your Home. The book assists the home renovator to identify areas in the home that may contain asbestos and guides readers about the use of qualified asbestos removalists.
Outcomes and Achievements: A brochure and book on “Identifying Asbestos in Your Home” were developed. The brochure was released on the Channel 9 television show “The Block” and was made available in national Mitre 10 stores. A second book called “Electricians Guide to Asbestos” was also developed by AAQ.
The resource book and brochure were advertised via the AAQ website, an online media campaign (with an average weekly reach of 116,000 on Facebook), and through radio interviews. Images from the resource books were also provided to Cancer Council WA for use in their asbestos awareness programs.
Grant amount: $137 500
Background: The diagnosis of malignant pleural mesothelioma (MPM) is difficult and the process may take considerable time. At present there is a lack of accurate molecular markers to assist in the diagnostic process. To make a definitive diagnosis, a biopsy of sufficient size is needed and this can be difficult to obtain from elderly patients. The ability to diagnose based on a blood test would be a significant advance.
Aim of project: To improve the diagnostic process and therefore the treatment outcomes for MPM patients. The project will validate the performance of molecular markers (microRNAs) by comparing MPM patients with control individuals to determine whether microRNAs are sensitive and specific markers for mesothelioma.
Outcomes and Achievements: MicroRNA, miR-625-3p, was found to be present at levels four times higher in malignant pleural mesothelioma patients than in control groups. With further testing it is believed that this measure could be incorporated into a diagnostic panel of makers enabling a simpler path to the diagnosis of this disease.
The project team is planning further work to confirm the results through prospective studies, and to modify the methods used in laboratories to enable the testing of microRNAs in plasma or serum to be carried out routinely. The methods have already been used by the Lung Institute of Western Australia, while scientists at the Netherlands Cancer Institute have been taught how to process blood samples and analyse microRNA content.
Findings from this project have been presented at local and international conferences, and invited seminars, whilst data has been shared with the wider cancer research community.
Grant amount: $44 000
Background: Malignant pleural mesothelioma (MPM) is an almost invariably fatal asbestos-induced cancer affecting the lining of the thoracic cavities. Australia is amongst those countries with the highest incidence of MPM and this is expected to rise further. The diagnosis of MPM is difficult and treatment methods vary. Currently there is no standardised approach to the diagnosis or treatment of MPM.
Aim of project: To publish and disseminate evidence-based guidelines for the diagnosis and treatment of malignant mesothelioma.
Outcomes and Achievements: The National Health and Medical Research Council (NHMRC) approved the guidelines titled ‘Guidelines for the Diagnosis and Treatment of Malignant Pleural Mesothelioma’ on 2 July 2012. These guidelines are intended for health practitioners and consumer representatives as well as health service planners, managers, funders and policy makers responsible for providing services for patients with malignant mesothelioma.
The guidelines have been forwarded to the Clinical Oncology Society of Australia (COSA) and the Thoracic Society of Australia and New Zealand (TSANZ). Dissemination of the guidelines will continue in the future, including through local medical journals and society newsletters. Using this publication as a base, ADRI intends to produce and disseminate consumer (patient) guidelines to encourage greater activism throughout their health care.
Grant amount: $35 375
Background: There is a general lack of awareness in the building and construction industry of the dangers of asbestos and the potential negative health effects from asbestos exposure.
Aim of project: To deliver workshop presentations to trade students and instructors who are involved in the ‘Doorways2Construction’ program in South Australia, about the dangers of asbestos in their workplaces and how to manage asbestos products safely.
Outcomes and Achievements: A total of 615 trade students received training through 39 workshops held in 26 city schools and 13 country schools. This training has become part of the Construction Industry Training Board of South Australia’s curriculum, and must be completed to pass the ‘Doorways2Construction’ VET course.
Grant amount: $185 500
Background: Most mesothelioma patients are likely to die of their disease within one year from diagnosis, developing severe chest pain and breathing impairment as the tumour progresses. Austin Health has developed a program to treat patients with pleural mesotheliomas with high dose radiotherapy to the hemithorax (one side of the chest) with no major side effects.
Aim of project: To improve the radiotherapy based treatment for asbestos disease sufferers with aggressive cancer mesotheliomas.
Outcomes and Achievements: The team was able to show Austin Health has been able to incorporate state of the art radiotherapy treatment using MIM Maestro software to correct for differences in patient images obtained from CT (Computed Tomography) and PET (Positron Emission Tomography) to deliver high-dose hemithoracic radiotherapy treatment. The team found that high levels of radiation dosage can be delivered specifically to a tumour within the intricately fine membrane structure of the pleura lining surrounding the lung. Austin Health is committed to refining this technique and will continue to work on this new treatment approach to optimise outcomes for patients.
Further, additional technology, specifically the four dimensional computed tomography, has been shown to help identify and correct for differences between the CT and PET images.
Grant amount: $30 000
Background: Mesothelioma is an incurable disease acquired in most cases as a result of asbestos exposure. A selection of patients with mesothelioma receive intensive trimodality treatment that involves chemotherapy, surgery and then radical radiotherapy. This treatment spans six months and is gruelling for the patient, carers and support people.
Aim of project: To provide patients with a support program of structured talks and activities to address the specific issues they have to cope with, for example, pain, fatigue, breathlessness and insomnia. By providing patients and carers with knowledge and well-living skills in a support group setting, the goal is to empower them to improve their day to day living.
Outcomes and Achievements: A living well program was initiated for patients with asbestos related disease and their carers. The program included four (4) meetings in 2012 and three (3) meetings in 2013. Topics covered during the program included physical and respiratory assessments, ‘mindfulness healing’, optimising living with one lung, resilience, a life coach session for carers, pain management, eating for wellbeing, and the role of exercise in physical and emotional wellbeing. The last support group meeting involved a charity walk in which six (6) survivors and 58 carers, supporters and friends completed a 7km charity walk. Group members were supported by an exercise physiologist and physiotherapy staff in preparation for the walk. This activity will become a regular event in the support group calendar.
A Quality of Life questionnaire was administered to 12 long term survivors in 2010, 2011 and 2013. The 2013 results showed improvements in social and role functioning and a marked reduction in the reporting of symptoms of fatigue, dyspnea (shortness of breath) and insomnia.
Ms McLean was awarded the NSW Excellence in Nursing Award (Excellence in Partnerships with Patients, Families and Carers) in September 2013, following a nomination by four (4) members of the support group. Ms McLean also co-authored a book titled “Diagnosis and treatment: the journey of a patient with malignant pleural mesothelioma”, which was launched by the Governor of NSW in September 2013.
Grant amount: $170 000
Background: Information about asbestos and its associated risks is fragmented and tends to be focused on the workplace. The consolidation of information from the different statutory authorities would assist home renovators and council staff alike to safely manage asbestos removal, storage, transport and disposal.
Aim of project: To develop a training program that will improve the knowledge, skills and awareness of local government professionals, home renovators, waste section professionals and building industry professionals in relation to asbestos.
Outcomes and Achievements: An awareness training program was delivered to 267 Gippsland regional council staff who rated the training as ‘very good’. A more formal evaluation of the training program showed that of those who responded to the online survey most felt that: asbestos was an important topic to be trained in (98%); the training had improved their knowledge (89%); respondents who attended the training were more confident in handling asbestos enquiries following the training (86%); and, respondents had used the information they had received in the training session (86%).
A media campaign called ‘Asbestos Check’ was also delivered and was designed to inform, educate and provide pathways for the community to access sound information and advice around managing the risk of asbestos in homes. A consolidated asbestos web portal, supported by the three relevant Victorian Authorities, was also launched. The program is to be used by two other Victorian Regional Waste Management Groups in 2014.
The Baw Baw Shire Council and Gippsland Regional Waste Management Group are investigating a ‘license agreement’ that will allow any qualified asbestos training service provider to gain access to the training material for the explicit purpose of conducting training.
Grant amount: $250 000
Background: Asbestos fibres are in the air we breathe every day. Increasing concentration of airborne fibres causes increased risk of asbestos disease. Currently, asbestos fibre measurement is achieved by manually counting fibres that have been sucked onto a filter. The results are available hours to weeks after the exposure.
Aim of project: To find and develop a portable device that will alert personnel to an increase in airborne asbestos fibres within minutes.
Outcomes and Achievements: Three different methods for capturing asbestos fibres were trialed as part of the development of a real time air-based asbestos fibre early warning system. The methods included capturing fibres in water, capturing fibres onto electrically charged glass, and capturing images of fibres in air using a laser trigger. Capturing images in the air proved to be most successful.
The first successful fibre image capture was achieved in August 2013 with the prototype being able to detect fibres smaller than 0.2um in diameter. A patent application for the image capture of fibre in air methodology will be pursued. The determination that asbestos fibres are extremely hydrophobic indicated that more research into the use of water sprays to control asbestos dust may be needed.
The capture of fibres on electrically charged glass methodology was not practical for detecting fibres in environments where minimal maintenance is likely, however, this method may have an application in detecting pollen, biological particles such as bacteria, and biological weapons such as anthrax. The project has resulted in a breakthrough for the first low to medium cost system to capture images of fibres in air. Commercial success will depend on the outcome of further trials.
Grant amount: $125 000
Background: Patients who are affected by asbestos-related diseases are a vulnerable group of people with a shortened life expectancy. They have multiple physical, psychological and legal concerns which need to be addressed in a timely fashion through a very convoluted health system. The existing system is fragmented and results in inconsistent and disjointed approaches to care and treatment for these patients.
Aim of project: To develop an educational program for nurses to provide support and coordinated care for patients diagnosed with asbestos-related disease.
Outcomes and Achievements: A blended learning program aimed at establishing a cohort of highly trained nurses across Australia was developed and delivered. The first graduation ceremony for nurses took place in Canberra and led to the development of a Mesothelioma Nurse Special Interest Group.Feedback from the nurses indicated that the four day face-to-face intensive workshop and online education program were of excellent value, highly relevant to them and improved their knowledge and understanding of issues relating to asbestos related disease. The Lung Foundation Australia will seek accreditation from the Australian College of Nurses and the Cancer Nurses Society of Australia for the online component of the education program in early 2014.
Grant amount: $114 347
Background: Significant research exists on the impact of asbestos-related diseases on the health of an individual but less is known, within Australia or internationally, about the nature and extent of the disadvantage experienced by people with an asbestos-related disease, their carers and family members.
Aim of project: To identify and understand negative changes in the social, psychological, and economic activities of individuals and families living with asbestos-related illnesses. The key goal is to provide data that can inform the development of strategies and policies to overcome the range of disadvantages caused by these illnesses.
Outcomes and Achievements: A report focusing on the impact of an asbestos-related diagnosis on the psychological well-being of individuals was launched in February 2014. The research also looked beyond the individual to the carers, families and community to explore and understand the impact of the social and economic issues associated with such a diagnosis. The findings identified that carers may be at a greater risk of psychological distress than those diagnosed with an asbestos related disease, and that most carers are in need of some sort of support themselves. Women carers in particular were found to be providing constant care and support to others, often at the expense of their own physical and mental health.
A peer-to-peer online community, called the Dusted Community, was created in recognition of the impact asbestos-related disease has on the health and mobility of people and their carers. The main aim of the online community was to provide support, connectedness and camaraderie amongst carers and individuals managing an asbestos-related diagnosis / disease.“Perhaps online communities such as this is the way forward in helping provide support for those feeling isolated while dealing with this deadly disease” Joanne Wade, Senior Asbestos Lawyer, Slater and Gordon.
Grant amount: $45 800
Background: There are currently gaps in knowledge about how nutritional status, body composition and dietary intake affect the quality of life of mesothelioma patients. In diseases similar to mesothelioma where cancer wasting is a feature, poor nutritional status, loss of lean body mass and inadequate dietary intake have a negative impact on the quality of life of patients.
Aim of project: To determine the nutritional status, body composition and dietary intake and quality of life of patients with mesothelioma and to compare the results with other groups with cancer cachexia. This research will advance the theory and evidence base for the nutrition care process. It will be used to develop targeted individualised nutrition intervention programs that may significantly contribute to current treatment and positive outcomes for this patient group.
Outcomes and Achievements: The project identified that patients with mesothelioma are significantly more likely to be malnourished or at risk of malnutrition compared to those with asbestosis. The Patient Generated Subjective Global Assessment (PG-SGA) tool was found to be a reliable and important tool to investigate the nutritional status, levels of malnutrition and quality of Life in patients with an asbestos-related disease.
Interest has been expressed in funding further nutritional research as a result of this study, in particular, the development of nutritional resources and intervention programs for those with asbestos-related diseases.
Initial discussions have been held regarding a student dietician led university clinic targeting nutrition intervention advice for people diagnosed with mesothelioma.
Findings from the study were presented at the QARDS Asbestos Week symposium in Brisbane in November 2013.
For more information please contact the Comcare Research Team by email at firstname.lastname@example.org.