“One-stop shop” for pleural disease an Australasian first

The first dedicated clinic in Australasia for “one-stop” diagnosis and treatment of people with pleural diseases has opened at Sir Charles Gairdner Hospital in Perth.

Patients with mesothelioma and other pleural diseases now receive streamlined care from pleural specialists who are breaking new ground in the latest therapies.

Clinic founder Professor Gary Lee said the service’s integrated care and state-of-the-art equipment had already made an impact, with patients now requiring fewer hospital days than previously.

“We are doing what we can to provide a speedy diagnosis and optimising the way we assess and treat,” he said. “Patients now have a special phone number to call if and when their symptoms recur. This puts them straight through to the clinic staff. In the old days, if they had a recurrence, they had to line up at Accident and Emergency. This meant they were at risk of perhaps undergoing repeated unnecessary procedures.”

The pleural clinic is also becoming an international training hub with doctors coming from as far afield as Egypt, the United Kingdom, the Netherlands and Hong Kong to learn pioneering therapies such as pleural ultrasound and pleuroscopy.

“These trainees are funded by their government to learn the latest therapies in pleural medicine with a view to returning to their home countries to establish specialist clinics,” Prof Lee said.

Patient numbers at the clinic have risen 300 per cent since Prof Lee was appointed Sir Charles Gairdner Hospital’s director of pleural services in 2009.

Since then, Prof Lee’s team has won two State Health Research Advisory Council best project awards, attracted about $2 million in collaborative funding and published between 10 and 12 papers a year in peer-reviewed journals.

The team is currently investigating the responses of mesothelial cells in in vivo models of the disease, as well as trialling new diagnostic tests and treatments.

A one-year study allowing patients to choose either the use of indwelling pleural catheters (IPC) – of which Prof Lee is a strong advocate – or the standard treatment in order to manage their condition was so successful that now all public pleural patients in Perth are offered IPC.

The past decade has seen a dramatic rise in pleural diseases as the incidence of pleural cancers, including mesothelioma, increases. Pleural effusions, or fluid in the lining of the lungs, can arise from more than 60 causes, making pleural disease an important sub-speciality within respiratory medicine.

Prof Lee said that mesothelioma, in particular, posed complex diagnostic and management challenges.

“Yet there are disproportionately few pleural specialists and dedicated pleural services,” he said. “Our clinic is the only active integrated centre in the Southern Hemisphere.”

A renowned chest physician, Prof Lee is on the panel of the British Thoracic Society Pleural Disease Guidelines. He wrote the Textbook of Pleural Diseases, which recently won the British Medical Association’s annual award for the best textbook. He has personally attracted more than $7 million in research funding and is a frequent invited speaker at international conferences.

By Catherine Madden.