Mesothelioma Outcomes Better at High Volume Facilities

A new study provides more evidence that malignant pleural mesothelioma patients considering surgery would do well to seek out a facility that does a lot of them.

Researchers found that mesothelioma patients tend to have fewer complications and shorter hospital stays when they are treated at high volume facilities.

The new study is based on data from the National Cancer Database and is published in the latest issue of the journal Lung Cancer.

It defines a “high volume facility” as a medical facility that falls into the 90th percentile in terms of the number of pleural mesothelioma surgeries done there. All other facilities were classified as lower volume facilities (LVFs).

HVFs vs LVFs for Mesothelioma Treatment

Of the 1307 mesothelioma patients included in the new study, 621 (48%) had their surgery at an LVF while 686 (52%) had surgery at an HVF.

The researchers found that HVFs tended to be concentrated in the Mid/South Atlantic region in the US and were less likely to be found in New England, the South and the Midwest.

 

While both types of facilities tend to use lung sparing pleurectomy/decortication surgery most often for their mesothelioma patients, the more radical and complex procedure called extrapleural pneumonectomy was more common at HVFs than LVFs (25% versus 16%).

Regardless of which procedure was used, mesothelioma surgery patients stayed in the hospital longer, were more likely to be readmitted to the hospital within 30 days, and were less likely to live longer than three months after surgery if they were treated at an LVF.

What About Mesothelioma Survival?

Despite the higher complication rates at LVFs, there was one important measurement that did not differ significantly between the LVFs and the HVFs: mesothelioma survival. The median overall survival for both sets of patients was between 15 and 18 months.

“On multivariable analysis, facility volume did not independently predict for overall survival,” writes first author Vivek Verma with the radiation oncology department at Allegheny General Hospital in Pittsburgh. “These findings have implications for postoperative management, patient counseling, referring providers, and cost-effectiveness.”

The new study is the largest investigation to date comparing facility volume with postsurgical pleural mesothelioma outcomes.

In a separate recent study also headed by Dr. Verma and published in the Annals of Surgical Oncology, researchers found that peritoneal mesothelioma patients (mesothelioma in the abdomen) who were treated at “academic centers” were more likely to receive cytoreductive surgery (CRS), the gold standard for peritoneal mesothelioma treatment.

That study supported the findings of previous studies showing that overall peritoneal mesothelioma survival is highest in patients who undergo both CRS and heated intraperitoneal chemotherapy (HIPEC).

Sources:

Verma, V, “Facility volume and postoperative outcomes for malignant pleural mesothelioma: A National Cancer Data Base analysis”, June 2018, Lung Cancer, pp. 7-13

Verma, V, “Malignant Peritoneal Mesothelioma: National Practice Patterns, Outcomes, and Predictors of Survival”, May 2, 2018, Annals of Surgical Oncology, Epub ahead of print