Improving Mesothelioma Outcomes in California Bay Area
I’ve spent a good portion of my life in California. Since moving to Kaiser Permanente’s Oakland Medical Center in 2014, I’ve made it a goal to improve the current standard of mesothelioma treatment for patients on the West Coast.
I see about 30 to 45 mesothelioma cases every year at Kaiser, surpassing any other hospital in the Bay Area. With aggressive and nuanced surgical treatment, along with multimodality therapy for mesothelioma, I believe we can set a new standard for patient outcomes.
Regionalized Care Improves Survival
In the past three years, my colleagues and I have published a series of papers showing that surgical patients who receive treatment in a regional Center of Excellence have better survival rates.
Historically, patients with rare diseases such as mesothelioma would need to travel long distances across several medical systems to receive care. These patients would get one referral after another until they found a specialist to perform the appropriate procedure.
The constant traveling and poor communication between hospitals meant patients were receiving substandard care. In 2019, we examined how regionalizing thoracic surgeries and integrating care within one hospital system improved short-term outcomes and overall survival for patients with esophageal cancer.
Regionalization meant patients were more likely to have their surgery at a designated Center of Excellence. Their surgery times decreased by two hours, and the length of stay decreased by 2.3 days. The rate of complication 30 days post-surgery fell significantly.
We repeated these studies in 2020 and 2021, focusing on regionalizing lung cancer and other thoracic surgeries for patients in the Bay Area. Results showed a significant decrease in patient morbidity and mortality and an increase in pulmonary resection volume.
My team and I are currently publishing a similar study in the Journal of Thoracic Oncology examining mesothelioma patient outcomes. The results have similarly shown an increase in median patient survival from 19 to 23 months.
Since regionalizing its thoracic surgical care in 2014, Kaiser Permanente has seen more patients treated with curative intent rather than mesothelioma palliative treatment or hospice. This success also comes from our willingness to treat patients aggressively and reexamine how we prescribe surgery for mesothelioma.
Building on Dr. Sugarbaker’s Legacy
After finishing medical school at George Washington University School of Medicine, I completed my general surgery residency at the University of California Los Angeles Medical Center. During my residency years, I also gained invaluable experience as a postdoctoral research fellow for two years in the Department of Cardiothoracic Surgery at Stanford University.
I then completed my residency training in cardiothoracic surgery at the Brigham and Women’s Hospital, Harvard Medical School in Boston. My mentor, Dr. David Sugarbaker, was the pioneer of mesothelioma treatment and paved the way for future specialists at Brigham and Women’s.
After he died, his specialized training persisted in the doctors who worked with him. In my training with Dr. Sugarbaker, I learned the importance of determining the best surgical option for each patient.
The primary surgical options for mesothelioma are either a pleurectomy with decortication (lung-sparing) or an extrapleural pneumonectomy, which includes removing the affected lung.
Knowing how and when to perform both provides the best patient benefit. Another alumnus of Dr. Sugarbaker’s methods, Dr. Marcelo DaSilva at AdventHealth Orlando, also employs a similar approach.
Early Diagnosis Key to Mesothelioma Survival
The future of mesothelioma care lies in early diagnosis and treatment. More patients receive earlier-stage mesothelioma diagnoses than 20 years ago, thanks to better and more frequent screenings and imaging exams.
Unless a patient has mediastinal lymph node disease upon presentation, they should undergo a pleurectomy and decortication immediately after diagnosis.
Combined with an adjuvant multimodal approach of mesothelioma chemotherapy and radiation, these treatments offer the best survival rates. In the future, Tumor Treating Fields for mesothelioma along with adjuvant immunotherapy could improve life expectancy.
I hope to continue Dr. Sugarbaker’s legacy and set the standard of excellence for mesothelioma care on the West Coast. At Kaiser Permanente Northern California, we’re encouraging all mesothelioma patients along the West Coast to experience the benefits of a regionalized and specialized medical system.