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Lower-Volume Centers Less Likely to Follow Mesothelioma Treatment Guidelines

mesothelioma treatment guidelines

Mesothelioma patients need to beware of low-volume centers that are less likely to follow mesothelioma treatment guidelines. That is the message from a new study based on data from the National Cancer Institute.

The study was run by doctors at Cedars-Sinai Medical Center in Los Angeles. It shows that treatment centers that do not see a lot of mesothelioma cases are less likely to follow the life-saving mesothelioma treatment guidelines.

As a result, patients treated in these lower-volume facilities tend to have shorter mesothelioma survival.

What are the Mesothelioma Treatment Guidelines?

Malignant pleural mesothelioma is a cancer that occurs on the membrane that surrounds the lungs. It is extremely rare and difficult to treat. Many hospitals and doctors never see more than a handful of cases.

Mesothelioma treatment guidelines are meant to help cancer doctors offer the best treatment options to their patients, even if they rarely treat mesothelioma.

The current guidelines say epithelioid mesothelioma patients should be offered a combination of surgery and chemotherapy. Adding a third treatment modality like radiation or immunotherapy improves survival even more.

Mesothelioma patients with sarcomatoid or biphasic mesothelioma should have chemotherapy.

But the new study suggests that too many smaller, non-academic hospitals are not following these mesothelioma treatment guidelines. Their patients may be paying the price.

Lower Compliance = Shorter Survival

The study is based on the cases of more than 3,400 mesothelioma patients. The patients received a mesothelioma diagnosis between 2004 and 2014.

Mesothelioma patients who have no treatment have a median survival estimate of 10.2 months. Those who have chemotherapy alone live for an estimated 15.4 months.

But those who receive combination treatment according to the mesothelioma treatment guidelines have a median survival of more than 21 months.

Researchers say the two top predictors of whether a center was following these guidelines were insurance status and facility type.

“In epithelial malignant pleural mesothelioma, a significant increase in overall survival was observed in surgery plus chemotherapy and trimodality,” observes lead researcher Fernando Espinoza-Mercado, MD.

Finding the RIght Mesothelioma Treatment Center

The bottom line for mesothelioma patients is to seek treatment in a larger, academic center, if at all possible. These centers have more experience with this rare cancer and are more likely to follow the current mesothelioma treatment guidelines.

“There is a suboptimal compliance with national guidelines for the treatment of MPM, particularly in low-volume non-academic settings,” concludes the new report. “Adherence to recommended surgery-based multimodal therapy is associated with an overall survival improvement.”

When it is not possible to travel to a higher-volume center, have a discussion with your physician about current mesothelioma treatment guidelines. This list of 7 questions for your oncologist can help you choose the best mesothelioma doctor for you.


Espinoza-Mercado, F, et al, “Disparities in Compliance with National Guidelines for the Treatment of Malignant Pleural Mesothelioma”, April 17, 2019, Annals of THoracic Surgery, Epub ahead of print, https://www.annalsthoracicsurgery.org/article/S0003-4975(19)30559-4/pdf

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