It may be harder this year for patients who need it to get surgery for peritoneal mesothelioma.
An international group called RENAPE keeps track of peritoneal cancers like mesothelioma. The group advises doctors on the best treatment practices. The group is advising hospitals to tighten the criteria for who can get surgery for peritoneal mesothelioma during the pandemic.
“The Covid-19 pandemic is profoundly changing the organization of healthcare access,” say French doctors writing about the RENAPE recommendations. “This is particularly so for peritoneal neoplastic diseases, for which curative treatment mobilizes substantial personnel, operating room and intensive care resources.”
Mesothelioma Treatment Options
Mesothelioma is a rare cancer associated with asbestos exposure. About a fifth of all mesothelioma cases are the peritoneal variety. There is no cure for peritoneal mesothelioma and it is often fatal within two years.
Malignant mesothelioma is a fast-growing cancer with few good treatment options. Survival is highest for patients who have surgery for peritoneal mesothelioma as soon as possible.
This cytoreductive surgery is often followed by a rinse of heated chemotherapy called HIPEC. Cytoreductive surgery with HIPEC is a large and complex surgery. But it can improve peritoneal mesothelioma survival for the right patients.
Prioritizing Surgery for Peritoneal Mesothelioma
Surgery for peritoneal mesothelioma is considered the gold standard treatment. The good news for mesothelioma patients is that RENAPE says surgery should be reserved for cancers like this one where there are no other good options.
But even before the pandemic, not every mesothelioma patient was a candidate for surgery. People who are very old or have many other health problems may not be strong enough for this major operation. In addition, some tumors are too extensive to remove.
During the COVID-19 pandemic, the RENAPE group says cytoreductive surgery for should be reserved for:
- Younger patients
- People with few or no other health problems
- Patients with the smallest peritoneal tumors
- People for whom chemotherapy “cannot be a temporary or long-term alternative”
The addition of HIPEC adds another layer of complexity to surgery for peritoneal mesothelioma. The French team says hospitals have to make the decision based on their own resources.
“Addition of HIPEC must be discussed case by case in an expert center,” the French team writes. “The prioritization of indications must consider local conditions and the phase of the epidemic to allow optimal perioperative care.”
Glehen, O, et al, “Treatment of Primary and Metastatic Peritoneal Tumors in the Covid-19 Pandemic. Proposals for Prioritization From the RENAPE and BIG-RENAPE Groups”, April 23, 2020, Journal of Visceral Surgery, Epub ahead of print, https://www.sciencedirect.com/science/article/pii/S1878788620301181?via%3Dihub