Category: Treatments

Mesothelioma Centers of Excellence are Open for Patients

• Lisa Hyde-Barrett
• Mesothelioma, Mesothelioma Diagnosis, Nurse's Corner, Treatments

We frequently suggest to patients and patient’s families to seek out a Mesothelioma Center of Excellence if diagnosed with this rare disease. For many, this includes traveling to get care at one of these centers. When the pandemic was first at its peak, a lot of travel was suspended and many just did not feel comfortable traveling away from home. For some who live locally to their Mesothelioma Center of Excellence they were able to have treatment but that was not the case for everyone.  

Each state has lifted some restrictions that were incorporated during the crisis of the pandemic, and the Mesothelioma Centers of Excellence are open. Many physicians have adapted to telehealth visits to accommodate patients during the pandemic. Thankfully, we are a world of technology and many test results, scans, and lab values can be expedited from your hometown medical center to an expert of mesothelioma, allowing a lot of preliminary work to be done prior to your arrival. 

If you are traveling to a Mesothelioma Center of Excellence, we have some suggestions:

• Inquire about their protocols for arrival of appointments. Do you need to call and announce your arrival prior to coming into the office?
• Can a family member or friend accompany for the visit? If not, can you call in and be placed on speaker phone while the consult is active with physician and patient?
• Are you required to bring hard copies of scans, reports, etc.?
• Will your visit require an overnight stay at local hospital? If so, can they help with accommodations?
• Asking what you should expect during this visit. The Mesothelioma Center consists of many medical professionals. Will you meet them in person?

These are a few suggestions to make your visit more streamlined. We urge you to get to a Mesothelioma Center of Excellence as soon as possible, as this is a very aggressive disease. The medical professionals realize this is a difficult situation coupled with the world’s current situation. We want you to know the centers are here for you. 

There have also been many volunteer opportunities that continue to be available to help you facilitate your treatment for your mesothelioma. For example, Angel Flights has been successful in transporting patients for treatments and returning them home. Please reach out to us or a Mesothelioma Center so we can assist you with making the connections that can help you with your disease.

Coronavirus & Mesothelioma Treatment: One Patient’s Story

• Lisa Hyde-Barrett
• Family, Mesothelioma, Nurse's Corner, Patients, Treatments

The COVID-19 pandemic upended our usual routine and impacted all of our lives. For people that needed medical treatment it became a different experience. Having treatment for anything but coronavirus related illness became the exception. No visitors were allowed in the hospitals for patients no matter what their diagnosis. Many people put off necessary treatment for a later time. Facing cancer at any time is frightening. Facing treatment for a rare cancer such as malignant mesothelioma, alone without your loved ones, can add another layer of stress.

Reading and hearing about people’s experiences you think would prepare you for seeing it in person. Whether it is physical or psychological the suffering is real.

Our patient was a middle aged man who has malignant pleural mesothelioma. His presenting symptom was a cough that would not go away. He was worked up for it and he was a surgical candidate which he opted to have. The time between his symptoms and being diagnosed was a few months. Things were on track for surgery, and he lived locally near his Mesothelioma Center. Things were lining up for him in a timely fashion, but then the pandemic came and things changed.

It is known that patients facing a cancer diagnosis do better with family support. Since most cancer treatment is on an outpatient basis that is where the majority of support happens.  However, the period in the hospital is unfamiliar and frightening – it can be terrifying. Our patient was dropped at the hospital and stayed in for greater than 30 days. He had a support system, but no visitors were allowed into the hospital. For his inpatient stay he remembers being confused, afraid, and convinced that he was dying. During this month-long stay he praised the staff of the hospital, but explained that not to see your loved ones when you are confused was too much. Frequent phone calls were no substitute for seeing someone who is supporting you through this stressful time. His hospital course was complicated and since discharge he has been experiencing many different emotions. Usually someone in control of his emotions, he finds himself crying frequently and unexpectedly. As he is processing this trauma he and his loved ones are realizing what an important part that support plays in a person’s physical and psychological recovery. 

Treatment for mesothelioma is difficult under the best of circumstances but during the pandemic it became harder. As people start to come for specialized treatment to a Mesothelioma Center of Excellence please know that their team is very tuned in to how vital support from their loved ones is during this time.

Top reasons to be seen at a Mesothelioma Center of Excellence

• Lisa Hyde-Barrett
• Mesothelioma, Treatments

We always recommend that patients diagnosed or suspected to have malignant mesothelioma be seen at a dedicated Mesothelioma Center of Excellence for diagnosis and treatment by an experienced medical team.

The pandemic we are currently in has made it difficult and sometimes impossible to do this. As people all over the country follow distancing guidelines, we are realizing in our own worlds that we cannot be teachers, hairdressers, cook like chefs, do DYI projects like on TV, and we cannot treat ourselves for medical issues.

One of the perspectives we are gaining out of this pandemic is the one to respect experience. There are skill sets involved in being an expert. With experience comes relationships – respect what experience can bring to your situation.

The pandemic has allowed us to re-examine our relationships with each other and what is important to us. Caring for patients with malignant mesothelioma is complex. Everyone is different and their expectations are different. 

When we slowly get back to our lives before the pandemic and start looking to our experts for care, what should that care look like?

In 2017, The John A. Hartford Foundation and the Institute of Healthcare Improvement along with the American Hospital Association and the Catholic Health Association of the United States came up with the “4Ms.” These are four evidence-based elements of high-quality care. The guidelines are aimed at treatment of the older adult, but really apply to all.

• What Matters – what are the persons goals, what do they want?
• Medication – what medications are necessary? How do these medications affect the person’s mobility or cognition? Is that what they want?
• Mentation – is the person depressed? Are they suffering from delirium? Has their  dementia been identified?
• Mobility – is the person safely able to move around? Are they falling? Are they safe?

In the Mesothelioma Center that we are very familiar with, these are standards of care. When you come to a Mesothelioma Center of Excellence you will be treated by experienced professionals that have incorporated these evidence-based practices into your care – before and after the pandemic.

Combination of Electric Fields and Chemotherapy May Be A New Treatment Option for Pleural Mesothelioma Patients

• Lisa Hyde-Barrett
• Featured News, Research, Treatments

The key to increasing  survival for mesothelioma patients is to kill the cancer cells before they can spread to other organs. Treatment options, including surgery, chemotherapy and radiation, all contribute to a patient’s survival, but many times the prognosis remains unchanged. Now, one company has turned to experimenting with delivering electromagnetic waves to the chest of pleural mesothelioma patients and reports improvements in overall survival when combined with chemotherapy.

Novocure, a UK-based medical device company that develops and markets Tumor Treating Fields delivery systems,  developed the novel devices as an alternative way to destroy tumor cells while sparing healthy tissue. Already approved by the U.S. Food and Drug Administration for the treatment of brain cancer, the  device is now in a Phase II clinical trial for pleural mesothelioma patients.

In April, researchers gave an interim review of the STELLAR clinical trial reporting that the first 42 pleural mesothelioma patients treated with the combination of Tumor Treating Fields (TTF) and pemetrexed and cisplatin or carboplatin had a one-year survival rate of 80 percent, compared to 50 percent in the chemotherapy only patients. Median progression free survival was 7.3 months versus just 5.7 months in the chemotherapy controlled group.

“We are extremely pleased with these top-line results, which bring us one step closer to realizing the potential for a new treatment for mesothelioma patients in desperate need,” said Dr. Eilon Kirson, Novocure’s Chief Science Officer and Head of Research and Development, in an April 17 press release.

The NovoTTF-100L device used in the clinical trial provides mesothelioma patients with a round-the-clock treatment option that allows them to maintain an active lifestyle without interference to activities such as walking outdoors, shopping, and cleaning. Connected to the patient via insulated electrode arrays placed on the upper torso, the device delivers low-intensity alternating electric fields to the region near the mesothelioma tumors. The TTF is inconspicuous and  light enough to carry to most functions and activities. The device needs to be active approximately 18 hours a day. According to the company’s website there are no limiting side effects.

“Mesothelioma is the first torso indication for which Novocure will pursue FDA approval,” said Dr. Kirson.

Novocure previously received a Humanitarian Use Device (HUD) designation for the use of TTF  for pleural mesothelioma. The next step is to submit a Humanitarian Device Exemption (HDE) application to the FDA. For medical devices, an HDE exempts the businesses from proving effectiveness of the device. However, the company must show that the HUD “will not expose patients to an unreasonable or significant risk of illness or injury and the probable benefit to health from use of the device outweighs the risk of injury or illness from its use, ” according to the HDE application requirements.

Pleural mesothelioma, a rare form of cancer affecting the lining of the lungs, is highly aggressive and is resistant to many cancer treatments. Most often diagnoses are not made until symptoms appear and the disease has progressed to an advanced stage leaving the patient with life-threatening complications. 3,000 Americans are diagnosed with mesothelioma each year.

Sources :

• STELLAR clinical trial
  https://clinicaltrials.gov/ct2/show/NCT02397928
• Novocure’s Chief Science Officer and Head of Research and Development
  https://www.novocure.com/novocure-reports-positive-top-line-results-from-stellar-phase-2-pilot-trial-in-mesothelioma/
• NovoTTF-100L
  https://www.novocuretrial.com/stellar-mesothelioma/living-with-ttfields/
• Humanitarian Device Exemption
  https://www.fda.gov/medicaldevices/deviceregulationandguidance/howtomarketyourdevice/premarketsubmissions/humanitariandeviceexemption/default.htm
• HDE application requirements
  https://www.fda.gov/MedicalDevices/DeviceRegulationandGuidance/HowtoMarketYourDevice/PremarketSubmissions/HumanitarianDeviceExemption/ucm563286.htm

ASCO Offers Malignant Pleural Mesothelioma Treatment Guidelines

• Nancy Meredith
• Pleural Mesothelioma, Treatments

The American Society of Clinical Oncology (ASCO) is the world’s leading professional organization for medical professionals caring for cancer patients. The Society has a goal to improve the quality of care in the field of oncology.  Now, to assist medical professionals managing patients with malignant pleural mesothelioma, the organization has just released new evidence-based recommendations.

In their newly released clinical practice guidelines, ASCO offers guidelines for diagnosis, staging, chemotherapy, surgical cytoreduction, radiation therapy, and multimodality therapy in malignant pleural mesothelioma (MPM) patients. According to the panel of experts, including Hedy L. Kindler, MD, of the University of Chicago, and Mary Hesdorffer, formerly the Executive Director of the Mesothelioma Applied Research Foundation, the recommendation addresses five “overarching clinical questions.”

• What is the optimal approach to obtain an accurate diagnosis of mesothelioma?
• What initial assessment is recommended before initiating any therapy for mesothelioma?
• What is the appropriate first- and second-line systemic treatment of patients with mesothelioma?
• What is the appropriate role of surgical cytoreduction in the management of mesothelioma?
• When should radiation be recommended for mesothelioma?

Pleural mesothelioma is a rare, painful cancer caused by exposure to airborne asbestos fibers. Treatments manage the symptoms to hold the cancer at bay, but there is no known cure for this deadly disease. Patients have a poor prognosis, and the median overall survival of patients with advanced surgically unresectable disease is about 12 months, according to ASCO. About 3,000 new cases are diagnosed each year in the U.S.

The ASCO team noted that “Given the rarity of this malignancy, there have been few large randomized trials, especially for surgical management of this disease.” Seeing a critical need to find and compile this information, ASCO convened a panel of experts, including thoracic, oncology and advocacy experts, to review medical literature published from 1990 through 2017 that included references to pertinent trials and studies.

Through the search of the literature, the team identified 222 relevant studies. After assessing the key areas of interest, including survival and quality of life, using evidence and informal consensus the team developed the evidence-based guideline recommendations.

The guidelines, published in the Journal of Clinical Oncology, include offering chemotherapy as a means for improving survival and quality of life for mesothelioma patients. The recommended first-line chemotherapy is pemetrexed plus platinum. However, the team recommends offering patients the option of enrolling in a clinical trial. Other chemotherapy recommendations include the addition of bevacizumab to pemetrexed-based chemotherapy for  select patients, as well as pointing out risks for the use in some patients.

The panel “strongly recommends” a maximal surgical cytoreduction surgery for certain patients with early-stage disease. The recommendations note, however, that surgery is just one modality and chemotherapy and/or radiation should also be administered.

See the Journal of Clinical Oncology for all of the mesothelioma recommendations.

ASCO states that “clinical practice guidelines are intended to improve the quality of cancer care by helping oncologists make choices about treatment, prevention, supportive care, or follow-up in line with the best available evidence from oncology research.” ASCO notes that the guidelines are voluntary and do not account for variation among patients or the most recent evidence.

Sources:

• ASCO
  https://www.asco.org/practice-guidelines/quality-guidelines/guidelines/thoracic-cancer#/29376
• Journal of Clinical Oncology
  http://jco.ascopubs.org/content/early/2012/12/13/JCO.2012.44.6443.abstract