Each year, a disproportionate amount of U.S. military veterans are diagnosed with mesothelioma, a type of cancer caused by exposure to asbestos.
Abraham “Avi” Lebenthal, M.D., would like to see every one of them.
Lebenthal is a surgeon at the VA Boston Healthcare System who specializes in treating people with mesothelioma cancer. Patients with mesothelioma are a group he believes is often neglected by physicians nationally who don’t have the experience treating this rare and aggressive cancer.
Lebenthal is offering his expertise, which comes with the backing of respected but privately-owned Boston-area hospitals, to the entire VA system, hoping to attract and treat former servicemen from around the country.
“This not a knock on anyone, but mesothelioma is so complex, and its care so specialized, that a patient really needs, and these veterans deserve, the best care in the world,” he said. “We’re in a unique position to offer that here.”
Specialized Mesothelioma Care at the VA
The VA system includes more than 1,400 treatment facilities nationally. Once in the VA Health Care system, a patient can seek treatment in any of them, needing only a referral to receive specialized care at a different facility.
The Boston VA has a close relationship with Harvard University Medical School, along with the esteemed Brigham and Women’s Medical Center, the Dana Farber Cancer Institute and the International Mesothelioma Program, which is based nearby. Mesothelioma cases at the Boston VA receive the same scrutiny and committee reviews as they do at the private medical centers.
The mesothelioma program in Boston is so advanced that out-of-town patients often receive free housing and specialized therapy that is unavailable anywhere else. The only cost for veterans is the travel to reach the facility. Charitable organizations, though, like the Meso Foundation, have begun offering grants to help cover the costs of travel.
The Mesothelioma Center makes its experienced staff available to answer any questions about veterans benefits, making sure that they receive all the care to which they are entitled. They also can help navigate through an often complex system.
“We’re different from most all VA facilities in that we have the institutional depth and systems in place to handle very complex diseases like mesothelioma, which require a multi-disciplinary approach,” he said. “Surgery is just one aspect of it. There is depth in the department rarely seen outside the leading teaching hospitals. Kamal Itani (chief of surgery for the Boston VA) is a surgical leader who strives for excellence, utilizing the unique resources and affiliations at his disposal. Treating mesothelioma is a ‘team sport.’ When a veteran comes to Boston, he has access to the best anesthesiologists, nurses, surgical residents, physical therapists, social workers, the ICU, the whole team.”
Veterans Exposed to Asbestos Throughout Service
A disproportionate amount of mesothelioma cases has been traced to the military, where asbestos in hardware and structures once were prevalent because of its versatile fireproofing qualities and its affordability. Asbestos was used in every branch of the military. It was used in engines, boiler rooms, ships, airplanes, automobiles, mess halls and sleeping quarters.
It wasn’t until the mid-1970s that asbestos use was significantly reduced, leaving multiple generations of veterans seriously exposed. Once inside the body, asbestos fibers can take anywhere from 20 to 50 years to cause mesothelioma. Initial symptoms include shortness of breath and chest pain.
“There are very few diseases that actually are work-related like this. And I don’t think anyone in the military really knew asbestos was doing this to people,” Lebanthal said. “But now that it is, we should own up to it, and treat it as well as we possibly can. That’s what we want to do here.”
Lebenthal is lobbying to make the Boston VA the system where all service-related mesothelioma patients can come easily. He has the backing Itani, chief of surgery, and of his senior partner, Dr. Daniel Cohen, who has been the chief of thoracic surgery for the last five years. Dr Cohen is also experienced in treating mesothelioma patients.
Lebenthal and Cohen both trained with Dr. David Sugarbaker, who founded the IMP and still practices at Brigham and Women’s. They are both full- time faculty members in the Boston VA and in Dr Sugarbaker’s department at Brigham and Women’s. They often consult each other on mesothelioma cases, formulating a tailored and individualized therapy for each patient. When a Veteran comes to the Boston VA, he gets treated by a team of general thoracic surgeons trained by Sugarbaker.
“It’s a relatively rare cancer so a lot of doctors in the system may see only one or two cases a year. If you’re a patient, you don’t want to be on someone’s learning curve,” Lebenthal said. “Too many people, including doctors, take a fatalistic approach. ‘You’ve got mesothelioma, and you’re going to die. Just get a martini, and go sit on the beach.’
“God has blessed us with the ability to help our patients, we have great facilities and the best team in place. In a government setting, operating on mesothelioma patients only increases our workload. We just want to do what’s right for the veterans,” he said. “We’re here to do the right thing. That’s the only incentive. Ideally, I’d love to see mesothelioma treated regionally, with four or five places around the country, but that’s not realistic now. I really believe as it stands, we do it better than anyone else. That’s why I’d like to bring them all here. We’re ready to put on the gloves and go to work.”