Kaiser Study Shows Benefits of Mesothelioma Specialty Centers

Treatment & Doctors

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Patients diagnosed with pleural mesothelioma are better managed and survive longer when treated at an integrated specialty center, according to a study by Kaiser Permanente that compared its own performance before and after making the transition to specialty care.

Doctors at the Kaiser Permanente Northern California health care system found a dramatic improvement once more specialized and standardized treatment was established for mesothelioma patients.

The Journal of Thoracic Disease published the results of the findings in August.

Mesothelioma patients at Kaiser were three times more likely to receive treatment for this cancer than before the transition. The rate of aggressive mesothelioma surgery went from 6% of patients to 22%.

After the mesothelioma specialty center was established, patients were evaluated and diagnosed more accurately, understood more clearly and treated more aggressively, according to the study.

Median overall survival rates of those undergoing multidisciplinary therapy increased by an average of 12 months, compared to the majority of patients who opted for a more hands-off, hospice approach before the changes were made.

“The takeaway from this study is that mesothelioma patients today really need to get a medical opinion at a center that has expertise in handling this cancer,” study co-author and thoracic surgeon Dr. Jeffrey Velotta told The Mesothelioma Center at Asbestos.com. “Too many don’t. Too many patients today are just not getting the appropriate treatment, and in this day and age, that’s crazy. It is happening too often.”

Mesothelioma Study Makes Before/After Comparisons

Kaiser’s study involved 368 adult mesothelioma patients from Jan. 1, 2009, to Dec. 31, 2020, some before and some after the regionalization of Kaiser Permanente that involved specialized surgical teams and multidisciplinary reviews of treatment options.

The first group included 171 mesothelioma patients from 2009 to 2014, a period in which a low volume of surgeries were performed at two different sites by two different surgeons.

A second group had 197 mesothelioma patients from 2015 through 2020, which was after the move to one thoracic surgeon, a mesotheliomas specialist, at one site. It included a team of multidisciplinary specialists and a tumor board that met weekly to review cases.

In the first group, just 43.9% of the patients received any treatment at all. Only 10 of the 171 patients underwent surgery.

In the second group, 63% of the patients opted for treatment and 44 of the 197 underwent aggressive surgery.

Median survival of the patients opting for surgery went from 16.7 months to 22.6 months, respectively, in the two groups.

“One of the highlights of our regionalization program was that significantly more eligible patients for multimodality treatment did indeed undergo optimal treatment, compared to preregionalization,” the authors wrote.

Many Mesothelioma Patients Go Without Treatment 

Mesothelioma, which is caused by exposure to asbestos, is a rare cancer with no cure that is often only diagnosed in its later stages. Oncologists rarely see it and generally deliver a grim prognosis without many treatment options. Too often, patients are told that mesothelioma treatment side effects are not worth the little difference they would make.

“That ‘do-nothing’ attitude is all too common. When I came here in 2014, I was shocked. You still see it at a lot of centers today,” Velotta said. “People need to get treatment. You can do well with mesothelioma. You just have to go to a place that knows how to treat it.”

In recent years, Velotta has built a reputation as one of America’s top mesothelioma surgeons. Kaiser Permanente also has become a West Coast leader in the field of mesothelioma, particularly with the specialty center Velotta has helped build at Oakland Medical Center, the flagship hospital.

His success has come as no surprise, having trained at  Brigham and Women’s Hospital in Boston under legendary thoracic surgeon Dr. David Sugarbaker, a mesothelioma treatment pioneer.

“Treatment is not going to be easy, but nothing about mesothelioma is easy. Even if you don’t have surgery, there are other good options today,” Velotta said. “The majority do well with surgery. We’ve had success here. That’s why I still find it hard to believe how many people are still going undertreated.”

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