Study: Treatment at Academic Facilities Extends Mesothelioma Survival,- More than half of patients with peritoneal mesothelioma cancer in the United States are being treated at community hospitals, sacrificing the chance to extend survival at an academic/research facility.

    Too many die sooner than they should.

    A medical research team at Brigham and Women’s Hospital, a teaching affiliate of Harvard Medical School, has shown that median survival is more than twice as long for patients treated at an academic facility compared to those at a community hospital.

    “Malignant peritoneal mesothelioma patients may be better served at experienced, academic centers,” the authors concluded in the study. “Community facility was an independent predictor of higher risk of death.”

    The Journal of Gastrointestinal Surgery published the Brigham and Women’s study in July. The work also was presented earlier this year at the Society of Surgical Oncology’s International Conference on Surgical Cancer Care.

    Dr. Vanessa M. Welten, lead author of the study, did not respond to requests to provide additional insight or perspective on the findings.

    The retrospective study using the National Cancer Database reemphasized the importance of finding a highly skilled specialty center when it comes to treating mesothelioma, a rare cancer with no definitive cure.

    National Treatment Guidelines Lacking

    There is no substitute for experience, and this research only emphasizes the point.

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    Of the 2,682 patients with peritoneal mesothelioma identified in the study’s 12-year period, 47.4% were treated at an academic facility and 52.6% at a community facility, which includes community cancer programs, comprehensive community cancer programs or integrated network cancer programs.

    Here are some of the findings:

    Community Hospital
    Median Overall Survival 24.8 months 11.6 months
    1-Year Survival 66.2% 48.9%
    5-Year Survival 29.7% 18.3%

    One of the problems facing the nonacademic centers is that the National Comprehensive Cancer Network still has no specific guidelines for treating peritoneal mesothelioma, even though it is recognized as different from the more commonly seen pleural mesothelioma. Specific guidelines do exist for pleural mesothelioma.

    While the novel combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, or HIPEC, has become the gold standard for treatment – and has shown incredible results – it is used considerably less at nonacademic centers.

    Surgery Has Survival Benefits

    At community hospital centers, only 38.2% of the patients underwent any type of surgery compared to 62.4% at academic centers. And only 10.4% of patients received chemotherapy on the same day as surgery, which is interpreted as HIPEC, while 28.8% received that combination at academic centers.

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    All categories of surgery demonstrated a survival benefit compared to no surgery.

    “The survival differences observed may in part be explained by the lower rates of surgery and chemotherapy among patients treated at community hospitals,” the authors wrote. “These treatment discrepancies may themselves result from a lack of standardized guidelines, as well as a lack of expertise at community centers.”

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    Median overall survival of just under one year at community hospital centers compares to the survival rates everywhere before the cytoreductive surgery/HIPEC combination rose to prominence more than a decade ago.

    Other Studies Show Similar Results

    One earlier report cited in this latest study found an overall median survival of 79 months, along with one- and-five-year survival rates of 84% and 50%, respectively.

    Another one with the combination therapy reported one- and five-year survival rates of 77% and 39%, respectively.

    Dr. Paul Sugarbaker, a surgical oncologist in Washington, D.C., who has pioneered many of the mesothelioma treatment advances worldwide over the past two decades, has reported a 75% five-year survival rate, with many patients still alive after 10 years.

    Sugarbaker’s protocol starts with the surgery and HIPEC, but continues with early postoperative intraperitoneal chemotherapy, known as EPIC, and a long-term regional treatment.

    One portion of the Brigham & Women’s study separated the patients into three subgroups: Those treated just with chemotherapy, those treated with surgery and those treated with chemotherapy and surgery.

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    The survival difference between those treated in academic vs. community hospitals was noticeable in all three but was the widest in the subgroup receiving both chemotherapy and surgery, according to the authors.

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    Finding Mesothelioma Expertise Is Imperative

    “It is important to note that academic facilities do not all necessarily have greater expertise in mesothelioma with a higher volume of CRS and HIPEC than all community facilities, with a couple single-institution studies reporting their success at a community center,” the authors wrote. “It has been estimated that between 140 and 220 cases are needed to reach technical proficiency.”

    With no NCCN guidelines to follow, most experts stress the importance of patients being evaluated at a specialty center with experience in peritoneal mesothelioma, which typically is an academic center.

    Unfortunately, that doesn’t always happen.

    “There are significant gaps in treatment guidelines,” the authors conclude. “Patients with this disease may therefore be better served at an experienced academic center.”

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