A new study suggests that some patients are missing out on chemotherapy for mesothelioma because their doctors do not believe it will work.
Doctor “nihilism” – the idea that life is meaningless anyway – was the top reason that 20+ percent of pleural mesothelioma patients did not get the care that might have helped them.
In other cases, patients were simply never referred to a cancer doctor who could prescribe chemotherapy for mesothelioma.
Doctor Attitudes and Chemotherapy for Mesothelioma
The Australian study is based on surveys with 107 doctors and 19 nurses. Most respondents were either lung specialists or cancer doctors. They completed the surveys in 2014.
The surveys show that most of the doctors (90%) think at least one in ten eligible patients is not getting chemotherapy for mesothelioma.
A smaller percentage (43%) put the number at more than two out of ten.
When they were asked why they thought more patients did not get chemotherapy for mesothelioma 70% cited doctor nihilism. Half thought that non-referral to a cancer doctor played a role.
Another 44% said the lack of mesothelioma specialists in the rural areas kept some patients from getting chemotherapy for mesothelioma.
Nurses Have Different Ideas
The surveyed nurses saw things a little differently.
According to the nurses, delay on the doctor’s part was the main reason more patients did not get chemotherapy for mesothelioma.
Seventy-four percent said delayed mesothelioma diagnosis was the biggest reason. Another 63% thought it was because pleural mesothelioma patients never got referred to a cancer specialist.
More than half of the nurses cited “lack of clinician knowledge” for the lower rates of chemotherapy for mesothelioma.
Chemotherapy for Mesothelioma Improves Survival
Most patients diagnosed with pleural mesothelioma will receive chemotherapy.
Chemotherapy is the primary treatment for asbestos cancer around the world. Study after study shows that mesothelioma patients who get chemotherapy live longer than those who do not.
The biggest survival advantage is in people who have both chemotherapy and surgery. Sometimes an added treatment like radiotherapy or immunotherapy can improve mesothelioma survival, too.
The new study does not address how to improve the odds that eligible patients will get chemotherapy for mesothelioma.
But it does highlight why mesothelioma patients and their families need to be good advocates for themselves.
“Caring for patients with malignant pleural mesothelioma is challenging and complex,” writes lead author Anne Warby with the University of Sydney. “Health care professionals believe under-utilisation of chemotherapy is occurring, primarily due to clinician nihilism and lack of medical oncology referral.”
Warby, A, et al, “Managing malignant pleural mesothelioma: experience and perceptions of health care professionals caring for people with mesothelioma”, January 25, 2019, Supportive Care in Cancer, Epub ahead of print, https://link.springer.com/article/10.1007%2Fs00520-019-4648-0