C. J. Siegert1,2, J. Lally1,4, M. Shoni1,2, P. M. Fisichella4, A. Lebenthal1,2,3 1VA Boston Healthcare System,Section Of General Thoracic Surgery,West Roxbury, MA, USA 2Brigham And Women’s Hospital,Division Of General Thoracic Surgery,Boston, MA, USA 3Brigham And Women’s Hospital,International Mesothelioma Program,Boston, MA, USA 4VA Boston Healthcare System,Department Of Surgery,West Roxbury, MA, USA
Introduction:
The Boston VA Healthcare System (VABHS) is one of a handful of VA hospitals throughout the country offering specialized care for MPM. Thus an increasing number of patients with suspected mesothelioma call to inquire about specialized, multi-modality care. Malignant Pleural Mesothelioma (MPM) is a rare disease affecting approximately 3000 Americans annually. A disproportionate amount of new patients are veterans, accounting for an estimated 1/3. The majority have distant history of asbestos exposure during military service. A latency period of decades is common, and the disease is difficult to diagnose. The treatment options include supportive care, chemotherapy and maximal cytoreductive surgery. Guidelines support multidisciplinary care, with evaluation by surgeons with expertise treating MPM.
Methods:
In 2011 we began to offer open access phone triage to Veterans with newly diagnosed MPM by a general thoracic surgeon and a member of the International Mesothelioma Program (IMP), VABHS. The patients were referred by primary care providers, oncologists, surgeons, veteran advocates or self-referred using online media. A total of 69 patients were triaged world-wide. Further documentation was requested and analyzed including records, diagnostics labs, radiology tests and pathology slides from an initial biopsy. Patients that were reasonable candidates for cytoreductive surgery were encouraged to travel to the WXVA for further assessment.
Results:
Out of 69 callers, 57 were Veterans, and we encouraged 46 to be seen by a surgeon with expertise in the field. 32 veterans were surgically staged at VABHS. 13 of these patients eventually underwent definitive surgery at VABHS, while 16 patients transferred their care to another hospital. 9 veterans opted out of surgery or had a contraindication to surgery. All service branches were represented for veterans with mesothelioma: Army (13), Navy (23), USMC (4), Coast Guard (2), Air Force (4) and unknown (11)
Conclusion:
Open access Phone triage for veterans with findings suspicious of MPM, by a surgeon with expertise in the treating MPM, provides guideline supported care for patients across the nation. Veterans who served in branches other than the Navy have significant representation.
