Purpose: To assess feasibility of open access and state-of-the-art in-network care for veterans diagnosed with malignant pleural mesothelioma (MPM) in the framework of the VA health care system and according to the patient-centered international mesothelioma program (IMP) care model.
Background: Malignant pleural mesothelioma is a rare disease that disproportionately affects veterans. According to the latest guidelines established by the International Mesothelioma Interest Group, maximal cytoreductive surgery has been shown to be superior to chemotherapy alone in patients with loco-regional MPM. Access to state-of-the-art mesothelioma care for veterans is limited to a handful of VA medical centers, and the West Roxbury VA Campus (WRVA) is uniquely positioned to routinely perform surgery for MPM.
Methods: We welcome all in-network, veteran referrals nationally. After initial phone triage or e-consult, qualified veterans are advised to register at the WRVA. A multidisciplinary team, including experienced MPM thoracic surgeons, pathologists, and radiologists, reviews each case and tailors an individual treatment plan. Controversial cases are further reviewed at the IMP. After thorough evaluation, veterans are advised by the surgeon to send additional documents if needed, come to Boston for an onsite consultation, or to continue local treatment.
Results: Between 2011 and 2015, we phone-triaged 55 veter-ans with suspected MPM. Forty-two patients had confirmed MPM, while 9 (4 unknown) had other thoracic pathology, including desmoplastic mesothelioma, sclerosing pleuritis, poorly differentiated non-small cell lung cancer, and peritoneal mesothelioma. We recommended surgical consultation at our VA for 46 veterans, of which 35 travelled to the WRVA from 21 states, with a median age of 63 years (all male), travelling an average distance of 961 miles. Seventeen veterans flew, 16 drove, and 2 came by train. Ultimately, 29 had MPM and 6 were found to have other diseases or the pathologic diagnosis is pending. The average time from initial contact to arrival at Boston was 15.4 days. Therapeutic recommendations were changed in 22 cases.
Conclusions: A national open-access program for suspected MPM is initially feasible at the WRVA. Treatment choices were altered in 63% of cases. This provides specialty in-network care, which is not locally available, regardless of distance traveled and cost required.
