Peritoneal mesothelioma is a rare but complex cancer that makes it incredibly important for a patient to find a facility where they have both the know-how, and the experience, to treat it effectively.
It’s a big reason why patients come to the Gayle and Tom Benson Cancer Center at the Ochsner Medical Center in New Orleans. Louisiana is one of the top two or three states in the country in terms of the number of mesothelioma cases, and there is a tremendous need for a place to find real help. We provide it here.
If you’re in the Gulf South region today, you don’t have to go to Boston or one of the bigger centers to get help. We want to be one of the regional centers where patients are funneled.
Experience is paramount. We’ve had success with a combination of cytoreductive surgery and intraperitoneal chemotherapy (HIPEC) that has become the standard in treating peritoneal mesothelioma today. You want a surgeon who is in the abdomen, doing complex operations, all the time. We do that a lot here, and we do it safely and as well as anyone.
We have a team — including Dr. Rodney Landreneau — that is experienced in all types of mesothelioma. The more you see it, the better equipped you are. It’s extremely important because most surgeons are not going to want anything to do with this because it’s a long, difficult operation. And the post-operative care is difficult, too.
The program we have here works because we have so many people working closely together with the same goal of the best possible care for our patients. We have clinical nurses, hospital nurses, anesthesia and other specialty physicians (interventional radiology, critical care, etc.) and home health experts.
As a team, we meet twice each month to discuss performance improvement initiatives in patient care. We figure out ways to get patients through complex operations, like those done for peritoneal mesothelioma, as safely as possible.
If you’re somewhere that doesn’t see a lot of this disease, you might be told surgery is not an option — when it very well may be an option — just because they don’t want to be involved with it. You should make sure you’re really, truly considered for the procedure, and not just told some information that isn’t quite right about your candidacy (for surgery). I’ve seen that happen many times.
A lot of people in the medical community have a pessimistic view about the treatment of mesothelioma. It’s important to go where they do it regularly, and not just dabble in it, because the outcomes there will not be as good.
We do a lot of big, complex surgeries like this. We have really good medical oncologists, and a nursing staff that is comfortable managing the post-operative care.
The overall survival rate for pleural mesothelioma is not great. And it’s not the greatest, either, with peritoneal mesothelioma. Some of the larger studies, though, are now quoting five-year survival at 40-50 percent when cytoreductive surgery and HIPEC are used. And that’s pretty darn good. Without those treatments, long-term survival is virtually zero.
If we do a good cytoreduction and follow with heated chemotherapy in the abdomen, you can stay ahead of the disease sometimes. There is good rational behind the HIPEC. If you just do the cytoreductive surgery, it’s ridiculous to think you’ll get every single cell. You are going to have some (cancer) cells left in the peritoneal cavity, so you want something else to get rid of the microscopic stuff you can’t see and is left behind.
The intraperitoneal chemo makes sense. You can use a higher concentration of chemo, and get it where it needs to be, because it doesn’t get the systemic absorption.
We try to be honest with these patients facing a diagnosis like this. There is so much gloom and doom out there with mesothelioma. All they’ve heard is that nobody survives, but that’s just not the case anymore.
We do a lot of education with the patients, especially the ones moving forward to surgery. We have an extensive pre-operative education program that the nurses do. We try and get rid of the unknown and alleviate the anxiety for patients. We have a psychologist who works with our cancer patients, and they can get help there if they need it.
A big, big part of this is making sure each patient has a plan, to understand what will be happening as they move forward, and what to do next. To not have a plan and just be out there languishing, that’s the worst. That doesn’t happen here. You have to come up with something, a plan, to give a patient real hope.
Peritoneal mesothelioma can be difficult to diagnose sometimes. It often is not diagnosed right away, and a patient can have symptoms for awhile before they figure out what it is. A lot of times, the changes on a CT scan are too subtle. You can go down the road of testing, testing, testing, then all of a sudden, people are shocked at the diagnosis.
It’s another reason to find a center with experience in this disease. The way it grows, it can involve a lot of the organs. They may need part of the pancreas out, part of the liver out, the colon, so you need experience. We are a high-volume center for complex abdominal operations, where the outcomes are good. Mortality and complication rates are low.
There has been progress made with the cytoreductive surgery and HIPEC, and it’s reasonable to say the results have been pretty good. With what we’re doing, we think we can help a lot of these patients now.