A new study shows a person’s insurance status and where they live often impact their access to multi-modality mesothelioma treatment. This can have an impact on their survival.
Researchers at the University of Miami Sylvester Comprehensive Cancer Center conducted the new study. They shared their findings at the recent virtual world conference of the International Association for the Study of Lung Cancer.
The study found that access to multi-modality mesothelioma treatment was more common in patients with private insurance or Medicare. It was also more common among those who lived closer to larger medical centers.
People who lived further out or who did not have insurance often did not receive the treatments that offer the best odds of mesothelioma survival.
Disparities in Access to Multi-modality Mesothelioma Treatment
Malignant pleural mesothelioma is a lung-related cancer caused by exposure to asbestos. When people inhale asbestos dust, the fibers stay in the tissue indefinitely. Decades later, these people can develop tumors on the pleural membrane around the lungs.
There is no single effective treatment for pleural mesothelioma. Patients who tend to have the best outcomes are those with access to multi-modality mesothelioma treatment. This usually means some combination of surgery, chemotherapy, immunotherapy, and/or radiation.
Multiple studies show that surgery nearly always improves the odds of surviving mesothelioma. This is true regardless of what other mesothelioma therapies a person has.
But mesothelioma is rare and mesothelioma surgery is complex. Many small-town hospitals never see a single case, let alone offer mesothelioma surgery. The Miami research shows this is causing a disparity in access to multi-modality mesothelioma treatment between rural residents and city-dwellers.
Mesothelioma Options Greater in Cities
Previous studies show that up to 40 percent of pleural mesothelioma patients do not receive standard-of-care treatment. This is especially true for elderly patients.
Oncologist Estelmari Rodriguez and her University of Miami colleagues wanted to know why. Is it a function of socioeconomic status, education, location, or something else?
They used the National Cancer Database to identify 2,804 patients with pleural mesothelioma. Patients received treatment between 2004 and 2017.
Half of the patients had access to multi-modality mesothelioma treatment including surgery. More than half (57.3%) of these procedures took place at academic centers. These centers were mostly in urban areas where they have a higher volume of mesothelioma patients.
“The majority of patients who had surgery were white, with private/Medicare insurance, and had access to multidisciplinary care in high-volume, academic facilities,” Dr. Rodriguez reported. “Very few patients who had surgery were uninsured or came from rural areas.”
Location and insurance status had a greater influence on access than income, race, other health problems, or education. But survival had more to do with the type of care they received. Patients who had access to multi-modality mesothelioma treatment with surgery had “significantly improved survival” over those who only had chemotherapy.
“The findings of this study suggest that patients without access to expert multidisciplinary care at high-volume, academic facilities are being inappropriately undertreated for their disease due to lack of access,” Dr. Rodriguez concluded.
Rodriguez E. “Socioeconomic disparities in access to treatment and survival in operable malignant pleural mesothelioma in the United States”. Presented at: IASLC 2021 World Conference on Lung Cancer hosted by the International Association for the Study of Lung Cancer; September 8-14, 2021. Abstract OA13.02. https://library.iaslc.org/conference-program?product_id=24&author=&category=&date=&session_type=&session=&presentation=&keyword=Socioeconomic%20Disparities%20in%20Access%20to%20Treatment%20&cme=undefined&