Why Doctors Should Refer Veterans With Mesothelioma to Specialists

There are few surgeons and oncologists with experience treating mesothelioma. The rarity of this cancer means few medical experts have ever seen it on an imaging scan, much less in the operating room.

This fact can leave many patients with more questions than answers—and physicians unable to help. Unfortunately, this reality affects United States military veterans most of all. This demographic has alarming rates of mesothelioma, accounting for around 33% of cases in the country. That equals around 1000 new cases of veterans with mesothelioma every year.

More alarming is how many go to their local oncologist or general physician for help, only to be told there are no chances of survival or given incorrect information about treatment. Some veterans even go to their Veterans Affairs (VA) medical center but do not find anyone with the expertise to treat this cancer.

Here is what physicians should understand about mesothelioma—and what they can do to help their patients who are veterans.

What Physicians Should Know About Mesothelioma

Mesothelioma is a cancer of the mesothelial linings, usually either the pleura or peritoneum. The proximity of these linings to organs—the pleura near the lungs and the peritoneum near the abdominal organs—means early action is the best way to save the patient’s life.

Early action requires early diagnosis. Unfortunately, this is a challenge.

Mesothelioma is caused by asbestos exposure, and it usually takes 20 years to develop. Most people do not realize they have mesothelioma until they are retired and brushing off symptoms as signs of old age. When they relay the signs to their physician, they usually do not get diagnosed right away. The lack of knowledge and exposure to mesothelioma cases often causes a misdiagnosis.

The common signs of mesothelioma are:

• Chest or abdominal pain
• Pleural effusions
• Shortness of breath
• Loss of appetite
• Weight changes
• Ascites

If a patient expresses multiple of these, it might be good to order an imaging scan just to be safe. If they are a veteran, the risk of having mesothelioma is even higher.

Treatment Options Available for Mesothelioma

Systemic chemotherapy is the first treatment approved by the US Food and Drug Administration for mesothelioma. However, this option only improves the prognosis by a few months.

Mesothelioma is a fast-spreading cancer, and it grows resistant to chemotherapy rather quickly. Most studies suggest chemotherapy only leads to survival of around one year following diagnosis.

So what other options are there?

This is why a specialist and surgeon are so important. There are aggressive surgeries to improve the life expectancy by multiple years. These operations are challenging, though, and they require consideration between extending life and avoiding mortality.

Extrapleural pneumonectomy removes one of the lungs. Since mesothelioma often forms near the lungs, this surgery can resect many of the tumors spreading through the lung cavity. An alternative is a pleurectomy with decortication, which leaves both lungs in place while peeling the pleural cavity out of the chest.

For patients with abdominal mesothelioma, debulking surgery with hyperthermic intraperitoneal chemotherapy (HIPEC) is the best option. HIPEC sends heated chemotherapy into the abdominal cavity. It is a meticulous surgery and requires an experienced hand to perform safely.

Referring a patient to a specialist also means they will get added resources from a prestigious cancer center. Some of these resources are experimental therapies, such as radiation, photodynamic therapy, and ongoing clinical trials. Most cancer centers also offer immunotherapy and chemotherapy before and after surgery, which helps avoid recurrence.

Where to Send Veterans With Mesothelioma for Treatment

Veterans make up such a large portion of mesothelioma cases due to the abundance of asbestos in the military. Navy ships, Air Force planes and Army barracks were filled with the substance, mostly to prevent fires.

However, veterans with mesothelioma cannot go to any VA medical center for treatment. Even a local hospital does not have the capability to perform aggressive surgery. This requires a specialized surgical hand and oncologist mind to improve life expectancy.

Fortunately, three VA medical centers have mesothelioma treatment programs. They are staffed by local cancer centers with specialist surgeons and oncologists.

The three centers with known mesothelioma programs for veterans are:

• Boston VA (West Roxbury campus)
• Los Angeles VA
• Houston VA

If you have a patient who is a veteran with mesothelioma, they can get help through Mesothelioma Guide. This is a patient advocacy organization with a veteran on staff to assist with VA claims and VA health care.

Carl Jewett is a 24-year Navy veteran. He can simplify the process of scheduling consultations with a specialist and investigating whether surgery is an option. If a veteran does not have VA health insurance yet, he can help them sign up before beginning treatment at a VA medical center. Email him at cjewett@mesotheliomaguide.com.