Topic: Asbestos

In a recent survey, the American Pain Foundation, a non-profit organization dedicated to promoting research for effective pain management, found that a majority of cancer patients experience severe pain even when using pain medications.  As a result, the American Pain Foundation has turned its attention to raising awareness and research into what is known as “breakthrough cancer pain,” which is the sudden and unexpected flare-up of severe pain that can occur even if the patient is on pain relief medication.

The American Pain Foundation’s goal is to improve the quality of life for those in pain by providing information, raising awareness, and promoting research to increase effective pain management.  Breakthrough cancer pain can wake cancer patients from their sleep and affect their ability to do certain activities including routine everyday activities.  Many have also reported that breakthrough pain has raised their daily medical expenses and caused increased visits to the doctor.

In response to the results of its recent survey, the American Pain Foundation will feature papers on the topic in their quarterly news letter.  The organization will also host a web-based seminar, provide tips on pain management, have a roundtable discussion with leading medical experts, and have a dedicated online chat.

Galiher DeRobertis & Waxman Is Committed To Better Care For Cancer Patients

For over 30 years, Galiher DeRobertis & Waxman has represented clients with mesothelioma, lung cancer, asbestosis, and other illnesses that result from asbestos exposure.  We have worked with the families of our clients during difficult times, and as a result of our experience, we are very aware of the emotional, financial and physical impact of these diseases.   We have collaborated with world-renowned researchers, scientists and medical experts.  We have seen the evolution of cancer care over the years, and we are very encouraged by the progress we have made.

We are told by many of our clients’ families that the hardest part is seeing their loved one in pain.  Thankfully, further research continues in clinical trials, laboratories, and hospitals, and the focus on treatment continues to broaden into new areas that aim to provide patients with better comprehensive care.  The research by the American Pain Foundation is one important step toward helping patients better tolerate their medical treatments, thereby improving their quality of life.

The fact that asbestos exposure can cause malignant mesothelioma and other asbestos-related diseases is well established.  However, despite years of research, the actual mechanisms by which asbestos fibers cause disease on a cellular level remain unclear.  The International Mesothelioma Program (IMP) research team at the Brigham and Women’s Hospital in Boston continues to investigate the role of asbestos in the development of mesothelioma.  They hope these studies will improve mesothelioma patient treatment and recovery leading to the ultimate goal of finding a cure for this deadly tumor.

Focusing on Asbestos Fibers

Researchers such as John Godleski, M.D. at the International Mesothelioma Program want to answer three basic questions about asbestos in the body and its relationship to mesothelioma.  They want to know what kinds of asbestos fiber are present, how much is there and where those fibers are located.  Using various scientific equipment and innovative techniques including confocal microscopy, chemiluminescence on in vivo or live tissue, and scanning electron microscopy, they are able to answer some of these questions.

Confocal microscopy captures images that are cross-sections of tissue samples.  These two-dimensional slices can be combined to create a three-dimensional volume or model which helps researchers visualize the precise locations of the asbestos fibers in the tissue.  Knowing where the asbestos fibers are located is key to understanding the mechanism of translocation, which is the way asbestos fibers deposited in the lungs are transported to the pleura or lining in the lungs and abdomen.

The amount of reactive oxygenation species or ROS present in a tissue sample can be measured using in vivo chemiluminescence techniques.  High levels of ROS can damage DNA and may be linked to the development of cancers such as mesothelioma.  The IMP research team uses chemiluminescence to determine the timing and location of this important process.

Lastly, when asbestos fibers are identified accurately, the amount of asbestos fibers or fiber burden can be estimated with electron microscopes.  The type of fiber may be compared with the patient’s asbestos exposure history to correlate certain fiber types with the development of mesothelioma.

Possible Implications for Mesothelioma Treatment and Prognosis

One approach to prevent the development of mesothelioma is to try to block, disrupt or alter the process of translocation of asbestos fibers from the lungs to the pleura.  As noted earlier, in vivo chemiluminescence can identify susceptible regions like the lymphatic system involved in the translocation process.  This information could be used to slow down the movement or allow removal of the fibers before they are able to develop mesothelioma in the pleura.

The IMP investigators observed that pleural malignant mesothelioma patients with lower asbestos burdens have a higher survival rate than those patients with the highest burdens.  They discovered an association between asbestos fiber burden and degree of tumor suppressor gene silencing.  Higher asbestos burden corresponded to an increase in epigenetic silencing of tumor suppressor genes in mesothelioma.  This may explain why patients with lower asbestos fiber burden are predicted to have better clinical outcomes.

Need for Asbestos Research Remains

The use of asbestos through the 1980s and later in the United States and long latency means that mesothelioma will affect a significant number of exposed individuals for the foreseeable future.  Ilana Waxman, managing partner of Galiher DeRobertis & Waxman, a law firm that has represented mesothelioma patients for more than 30 years, agrees with the International Mesothelioma Program researchers that “additional studies of the role of asbestos in the development of mesothelioma are necessary and will help improve treatment and prognosis of this deadly cancer.”

Because mesothelioma is a relatively rare form of cancer, it is often difficult to diagnose and treat.  Fortunately, researchers all over the country are working hard to improve our understanding of the disease in order to develop better treatments, and ultimately a cure for this terrible disease.

At the Mesothelioma Program at M. D. Anderson Cancer Center at the University of Texas, a team of multidisciplinary scientists and physicians have made significant strides in developing more accurate methods of surgical staging for malignant pleural mesothelioma.  “Staging” is the medical term for the process of determining the extent to which a tumor has spread through the body.

Proper Staging of Mesothelioma Essential to Treatment

M. D. Anderson’s team of more than 30 physicians have worked together to develop an innovative surgical staging process that helps them properly assess and describe the extent of the disease.  This is crucially important, because mesothelioma must be properly staged before a patient begins treatment in order to provide the most effective therapy.  For example, surgical procedures such as extrapleural pneumonectomy (EPP) are can be very effective for a patient in the early stages, but are generally not recommended for patients in the later stages.

Initially, staging is usually done through radiographic imaging, such as a CT scan, an MRI, and/or a PET scan.  Doctors may also use serum mesothelin blood tests to measure certain proteins that are secreted by mesothelioma tumors.  These tests may also be confirmed by biopsy or thoracentesis.

Surgical Staging Also Required Before Surgery

However, these methods are not entirely accurate.  As a result, all patients who undergo surgery at M. D. Anderson also undergo a thorough surgical staging to ensure the mesothelioma has not spread to the lymph glands or abdomen.  This is done through a minimally invasive laparoscopic procedure, usually on an outpatient basis.

According to Dr. Anne Tsao, Director of the Mesothelioma Program, this surgical staging is crucially important to make sure that the patient is a viable candidate for surgery.  Dr. Tsao explained that, “the reason why it’s so hard to treat is often times people have more extensive disease than what we initially realize from the radiographic imaging.  So here at M. D. Anderson before we make the patient undergo a very large surgical procedure, we have to do a smaller surgery that stages the patient to be sure that they’re a correct candidate for that surgery.”

Attorneys Recognize Important Strides Toward Improved Treatment

Galiher DeRobertis & Waxman has a 30 year history of representing clients with mesothelioma.  Our attorneys and staff have seen firsthand the devastating effect of this disease on patients and their families.  Attorney Richard DeRobertis says, “We salute the physicians and researchers at M. D. Anderson who are making important strides toward improving the treatments for mesothelioma and giving patients real hope for a cure.”

The International Mesothelioma Interest Group (iMig) is an organization composed of  health professionals and researchers who have an interest in malignant mesothelioma.  From August 31, 2010 to September 3, 2010 iMig held its 10th International Conference at the Kyoto International Conference Center in Kyoto, Japan.  The conference was hosted by Hyogo College of Medicine, with Dr. Takashi Nagano serving as the conference chair.  There were 14 educational lectures and over 30 keynote lectures by doctors and researchers from around the world who specialize in mesothelioma.  Membership in iMig was not required to attend the conference, although certain workshops were not open for everyone’s participation.

Some of the Educational and Keynote Lectures

Dr. David Sugarbaker, thoracic surgeon at the International Mesothelioma Program (IMP) at Brigham and Women’s Hospital in Boston, Massachusetts, lectured on Extra Pleural Pneumonectomy (EPP) and Intraoperative Heated Chemotherapy.  His brother, Dr. Paul Sugarbaker, who is the director of Surgical Oncology at the Washington Cancer Institute in Washington, D.C., spoke on his specialty, Peritoneal Mesothelioma.  Another noteworthy United States surgeon, Dr. Harvey Pass, who is chief of Thoracic Surgery and Thoracic Oncology of the Department of Cardiovascular Surgery, New York University School of Medicine and Comprehensive Cancer Center, presented a lecture entitled Surgical Approach; Thoracoscopy and Video-Assisted Thoracoscopic Surgery (VATS).

International speakers included Dr. Luciano Mutti of Italy who lectured on New Pathways and Molecular Targeted Therapy.  Dr. Mutti has published papers on malignant mesothelioma with Dr. Giovanni Gaudino, a researcher at the Cancer Research Center of Hawai‘i (CRCH).  Dr. Takeharu Yamanaka of Japan presented a lecture on Biostatistics for Mesothelioma Clinical Trials.  Dr. Christopher Lee from Canada lectured on Maintenance Therapy; Transitioning From 1st-Line Cisplatin Plus Pemetrexed Treatment in Malignant Pleural Mesothelioma (MPM).

There were a number of other international lecturers who spoke on topics that ranged from the early detection to molecular oncogenesis to the most current treatment options of malignant mesothelioma.

On January 28-29, 2010, the ASTM (American Society for Testing and Materials) Committee D22 on Air Quality sponsored the Michael E. Beard Asbestos Conference 2010:  Laboratory Issues.  This year’s conference, held in San Antonio, Texas was named in honor of Michael E. Beard (1940-2008) who served as Chair of ASTM International Subcommittee on Sampling and Analysis of Asbestos for many years.  This committee is responsible for developing methods for monitoring asbestos  in different materials and has hosted six conferences on these issues at Johnson State College and the University of Vermont, beginning in 1986.  Mr. Beard was a long-time supporter and organizer of the ASTM International Johnson Conferences on asbestos.

Presentations at this conference focused on asbestos issues as they relate to people working in laboratories, users of analytical data, as well as those who interpret the results of laboratory investigations.  The conference showcased some of the most recent investigations and included discussions of new ideas and interpretation of the data.

Conference Highlights

The conference agenda highlighted four areas of interest for scientists and laboratories studying asbestos exposure, including:

1.    Analysis of soil and other media

2.    Quality assurance, training, and inter-laboratory studies

3.    Definitions of asbestos, cleavage fragments and NOA (naturally occurring asbestos) considerations

4.    Issues of laboratory interactions with NVLAP (National

Voluntary Laboratory Accreditation Program), assessors and government agencies

These issues are relevant not only to people diagnosed with asbestos-related diseases such as mesothelioma, lung cancer and asbestosis and the medical teams treating them, but to commercial interests and government regulators too.  Researchers from the Environmental Protection Agency (EPA), National Institute of Occupational Health and Safety (NIOSH), and New York State Department of Health were among the scheduled speakers.

Test for Detecting Asbestos in Vermiculite

A presentation on a possible new method for detecting asbestos in Vermiculite attic insulation could help homeowners who may have this material in their houses.  This asbestos-containing product was mined at W.R. Grace’s mines in Libby, Montana and distributed nationally.  Another presentation explains a technique to distinguish sepiolite from chrysotile used in industrial gasket materials.  Lastly, there was a presentation on a new ASTM draft method for fibers in floor tiles.

Three Presentations by James Millette, Ph.D.

One of the symposium’s co-chairs, James Millette, Ph.D., made three presentations.  The first topic covered the analysis of soil and other media, the second was an overview of a method to analyze talc for asbestos, and the third discussed the practical aspects of cleavage fragment and asbestos determination.  The law firm of Galiher DeRobertis & Waxman has worked with Dr. Millette and many other distinguished experts to investigate claims of people injured by exposure to asbestos and asbestos-containing products

Dr. David Sugarbaker, the founder and director of the International Mesothelioma Program (IMP), exudes confidence and optimism as he talks about his state-of-the-art treatment for mesothelioma patients.  His attitude and his team’s groundbreaking work in the treatment of malignant mesothelioma have changed the outlook and lives of many patients.  Last year Dr. Sugarbaker and his team at the IMP operated on more than 160 patients, yet Dr. Sugarbaker still takes the time to share his surgical techniques with both lawyers and doctors.

Sharing With Lawyers

Last November Dr Sugarbaker was in Miami at the “Asbestos Medicine” conference sponsored by the Defense Research Institute sharing his enthusiasm and latest surgical techniques with over 1200 lawyers.  Dr. Sugarbaker is the Chief of Thoracic Surgery at Brigham & Women’s Hospital in Boston and the Director of the IMP.  At this asbestos medicine seminar, he talked about the history of the IMP with attorneys from Galiher DeRobertis & Waxman, which has represented hundreds of mesothelioma families for over 30 years.

According to Dr. Sugarbaker, the project began in 2002 to deal with the ever increasing number of mesothelioma cases occurring worldwide.  It is designed to function at three levels.  First and foremost, the IMP provides patient care and treatment.  Hand in hand with that comes support for patients and their families.  Last but far from least, the IMP focuses on mesothelioma research that will ultimately lead to a cure for this devastating disease.

Although there presently is no cure for mesothelioma, the vision of the IMP is to provide state-of-the-art treatments that extend the lives of mesothelioma patients.  As Dr. Sugarbaker told our attorneys, “The purpose of the IMP can be summed up in seven words: ‘Quality life extension leading to a cure.’”

During his presentation, Dr Sugarbaker used graphic slides to illustrate his cutting edge surgical techniques designed to extend the quality of the patient’s life.  Since 1988 when Dr. Sugarbaker established a Thoracic Division at Brigham & Women’s Hospital, the surgical treatment options for mesothelioma have improved and expanded.  Today Dr. Sugarbaker’s multimodality approach offers patient’s a better chance for prolonged survival.  Dr. Sugarbaker’s technique includes surgery in which he removes either the diseased pleura or the lung and the pleural.  After the surgery, Dr. Sugarbaker injects heated chemotherapy solutions directly in to the chest.  Research has shown that this increases the effectiveness of the chemotherapy drugs.  This solution kills the residual tumor at the surgical margins and any malignant cells that may have been shed during the surgery.  For many patients, this surgical procedure has lead to a longer life.

Presentation for Doctors at International Conference

Dr. Sugarbaker is also spreading his word internationally.  He will be making a presentation in Kyoto, Japan in August about the surgical techniques at a conference sponsored by the Intentional Mesothelioma Interest Group.  This presentation will include a description of an extrapleural pneumonectomy (EPP) operation that is followed by intra-operative heated chemotherapy.

Dr. Sugarbaker will explain how he has assembled at the International Mesothelioma Program as impressive team of health professionals, including surgeons, oncologists, epidemiologists, pathologists, statisticians, and clinicians, all focused on finding the best treatments and ultimately a cure for mesothelioma.

Spreading the Word Even Further

After hearing about Dr. Sugarbaker’s groundbreaking surgical techniques, Attorney Ilana Waxman, managing partner of Galiher DeRobertis & Waxman, is anxious to spread the word about the treatment options offered by Dr. Sugarbaker to his clients who suffer from mesothelioma and the doctors who treat them.  In Waxman’s words, “Dr. Sugarbaker offers a degree of optimism to the families who face the devastating effects of this disease.  I wish these treatment options had been available to all of the mesothelioma patients we have represented over the past 30 years.”

Dr. Sugarbaker’s dedication to his work is obvious and his optimism is infectious. It was all reflected in his parting words, “One thing I can guarantee any patient who sees me is hope.”