Researchers at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine have shown that patients with the rare lung cancer mesothelioma can have better outcomes — if they receive the right care. The study was published in the journal JAMA Network Open.
“We found that mesothelioma patients who receive treatment in a timely fashion, and have access to specialized care, do much better,” said oncologic surgeon Estelamari Rodriguez, M.D., M.P.H., associate director of community outreach in thoracic oncology and senior author on the paper. “Unfortunately, many patients have poor access.”
Because mesothelioma it is a rare cancer, many physicians have little or no experience treating it. In addition, mesothelioma treatments require surgeons and oncologists with specialized training. These clinicians often work at major medical centers in the Northeast, West Coast and South, leaving large parts of the U.S. underserved.
In this retrospective study, Dr. Rodriguez and colleagues investigated 1,389 patients from the National Cancer Database who had operable mesothelioma. They found that surgery improved overall survival by 30%. However, many people were never referred for surgery.
“If a patient gets diagnosed with non-cell lung cancer, they will probably have access to surgeons near them who feel comfortable performing that surgery,” said Dr. Rodriguez. “But oncologists in most communities have little experience with mesothelioma. This study shows us that people can benefit from surgery and early, multimodal treatment, but the resources in the United States are not equally distributed.”
Reducing Disparities in Mesothelioma Outcomes
For many patients, poor access to expert care can have dire consequences. Diagnoses can be delayed, and once the diagnosis is made, clinicians may not fully understand the treatment options, biasing them toward palliative care.
In addition, social determinants of health, such as age, gender, race and income, may play a role in how these patients are treated. Black patients in particular are at higher risk of dying from mesothelioma.
“This is where social determinants of health can really explain some of these outcomes,” said Dr. Rodriguez. “There is no clear link between ethnicity and the risk of mesothelioma, but there are many things about living in communities with limited access to high-level care that can explain these differences.”
The study group included a multidisciplinary team of researchers and clinicians. First author Ahmed Alnajar, M.D., is a quality management analyst. Nestor Villamizar, M.D.; Dao Nguyen, M.D.; and Syed Shahzad Razi, M.D., are cardiothoracic surgeons. Gilberto De Lima Lopes, M.D., and Samuel A. Kareff, M.D., are medical oncologists. J. Sunil Rao, Ph.D., directs the Division of Biostatistics and is interim chair of the Department of Public Health Sciences.
Sylvester is working to reduce the disparities in outcome among mesothelioma patients. In November 2021, the team held the First Miami International Mesothelioma Symposium, a virtual conference that educated both providers and patients about the disease. There will be a second conference in November 2023. The team is also reaching out to South Florida communities to educate them about Sylvester’s mesothelioma program, including its clinical trials and immunotherapy options.
“We need to get past the point where physicians tell their mesothelioma patients there’s nothing they can do for them,” said Dr. Rodriguez. “We know that patients who receive comprehensive care have better outcomes. It’s our job to make sure everybody has access.”