Treatment is often not equal amongst all patients with cancer, and for those with mesothelioma, this can prove deadly, highlighting the need to understand why and where these disparities exist to determine treatment plans.
At the 2019 World Conference on Lung Cancer (WCLC) in Barcelona, Spain, OncLive®, a sister publication to Oncology Nursing News®, had the chance to sit down with Emauela Taioli, MD, director of the Institute for Translational Epidemiology and the Center for the Study of Thoracic Diseases Outcomes, to discuss her research presented on survival among surgically treated patients with malignant pleural mesothelioma and the need for real-time assessment of disparities in the clinic.
OncLive: Can you explain the need for surgical intervention along with chemotherapy or radiotherapy in patients with mesothelioma?
Taioli: The first thing to say is that mesothelioma has very few treatment options and survival is very short, so there's very little that can be done for the utility of these patients. Having said that, the treatment of choice it's usually chemotherapy, which is based on cisplatin and/or radiotherapy and surgery. We have looked at the patients who underwent surgery and that's the base of our abstract and we compared different racial groups according to surgical types.
What are outcomes like when chemotherapy or radiotherapy is not supplemented with surgery?
The chemo and radiotherapy, first of all, they are reserved mainly to patients who have a lot of comorbidities or other issues that prevent surgery. So, these are patients who cannot undergo surgery and are usually less healthy, so survival is very short. 20%-30% of these patients develop resistance to cisplatin so eventually, they have to interrupt chemotherapy because it's not useful. There are a lot of problems with that therapy alone and usually, there are multiple therapies, so they do chemo, radiation, and surgery.
What are the key takeaways from your presentation on racial disparities related to mesothelioma treatment?
The 1 study we did a year or so ago was to compare surgery between black and white patients in the U.S. and we found that black patients undergo surgery less frequently for mesothelioma. Now, this year we looked at the type of surgery, and we found out there is a difference between black and white patients in the type of surgery they undergo. Black patients undergo less invasive surgery than white patients. So, the less likelihood of surgery and the less invasive surgery is something we've observed less frequently in black patients and we don't really know the reasons for that.
However, access to surgery may be 1 reason for that. Black patients don't have access to surgery as frequently as white patients. It could be an insurance issue, so maybe they don't have coverage that allows for surgery. The extent of surgery, which is usually less extensive in black patients than in white patients, could be due to the fact that they have more comorbidities and therefore they could not go for very extensive surgery, or it could also be a request of the patients’ that don't want to have a massive surgery.
What challenges still exist with getting all patients with mesothelioma the treatment they need and how can these challenges be addressed?
The disparities in treatment are present across all cancer sites and mesothelioma is behaving the same as the others, so black patients will get treated less. We did a study in which we observed black patients refused surgery more frequently than white patients, so that could be a cultural component, maybe black patients are less likely to allow surgery to happen for personal or cultural reasons.
One clear challenge is to have a real-time capture of cases so these cases can be sent to the appropriate treatment right away, including clinical trials. One of the problems is that survival after mesothelioma is so short patients don't have the physical time to undergo appropriate treatment and there are so many delays because of insurance reasons, or distance from the center that treats mesothelioma, so those are all things that need to be addressed. We are trying to develop a real-time registry on mesothelioma, so cases are registered right away at diagnosis and sent to the appropriate treatment center as soon as possible.
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