Objective: To assess feasibility and potential costs of transport and other barriers for new patients seeking specialized care for MPM at the Boston VA Healthcare System (VABHS).
Background: Malignant Pleural Mesothelioma (MPM) is a rare disease directly related to the exposure of asbestos fibers with a 20-50 year lag time from exposure to manifestation of symptoms. Veterans are disproportionately affected by MPM compared to the general population. Due to the lack of specialized care centers for MPM, Veterans must travel great distances from their homes to receive care. This travel burden manifests as a barrier to care for Veterans.
Methods: The Mesothelioma Program at VABHS was developed through a quality improvement initiative and pilot study of a national phone triage for specialized care within a centralized healthcare network. Patients with a diagnosis suspicious for MPM contacted a general thoracic surgeon at VABHS with specialty training in mesothelioma to review their medical history. After thorough evaluation Veterans are advised by the surgeon to travel to Boston for an on-site consultation or to continue local treatment if deemed appropriate.
Results: Between 2011 and May 2016, 93 patients contacted the VABHS Mesothelioma Program, of which 73 were actually Veterans. Of these Veterans, 43 (58.9%) eventually travelled an average of 1031 miles for further workup. For the Veterans that travelled: 20 came by plane, 20 by car, 2 by train and 1 by unknown mode of transportation. Veterans stay at government housing called Huntington House (HH) an average of 7 days. The average one-way plane fare in 2015 was $377 based on Department of Transportation data. Thus a roundtrip for 2 people would average $1,508 if coming by air. For Veterans that drove to VABHS, the average distance from the West Roxbury campus was 217 miles. Using this average, it costs an average of $41.00 round trip to Boston based on current gas prices. The hotel most often used for patients costs $89.00 per night for the least expensive room. Over 7 days, this would cost the Veteran with MPM $623.00.
Conclusion: Veterans are potentially able to deflect many costs of specialized surgical care for MPM. Further improvements in the travel offices need to be pursued in order to improve efficiency.
