P2.06-33 Heterogeneity in Care Pathways for Patients with Malignant Pleural Mesothelioma Presenting at a Quaternary Thoracic Oncology Center in Quebec

Abstract

Malignant pleural mesothelioma (MPM) is a rare disease for which diagnostic and therapeutic trajectories are ill-defined. We hypothesize that MPM patients experience delays during their diagnostic and therapeutic trajectory with significant heterogeneity in care pathways. Thus, we evaluated management practices at the MUHC over the past 10 years to address the need for a centralized program and dedicated care team. We conducted a retrospective chart review of MPM cases diagnosed at our center from 2006 to 2016. Clinical, pathologic, and treatment variables were collected. We assessed time from first abnormal imaging to definitive diagnosis, time from definitive diagnosis to first treatment and time from definitive diagnosis to palliative care consult. Overall survival was analyzed by Kaplan Meir method. We identified 145 patients over a 10-year period and report outcomes on 92 cases with complete data. Demographic data are presented in Table 1. Overall survival was 1.4% at 5-years for all patients, with a median survival of 1 year following a definitive diagnosis. Forty-five percent of patients underwent an investigational PET/CT scan, 89% of patients had M0 status prior to treatment, of whom 20% developed extra-thoracic metastases. Sixty-three percent of patients received some form of treatment. Eight treatment combinations were identified, irrespective of intent, lymph node involvement, and metastatic status. With regards to delays in care pathway, median time from first abnormal imaging to definitive diagnosis was 34 days (IQR 20.5 to 55), definitive diagnosis to first therapeutic intervention was65 days (IQR 35.8 to 163.8), and definitive diagnosis to palliative consult was 289 days (IQR 3 to 1651).Table 1Demographics and treatment characteristics of patients diagnosed with MPM at the McGill University Health Center over a 10-year period.CharacteristicsOverallSample size92AgeNumber (%)Median (IQR)72 (62-79.5)Female Gender, n (%)19 (20.7)Previous or current smoker, n (%)36 (39.1)Asbestos ExposureNo20 (21.7)Yes36 (39.1)Unknown36 (39.1)Type of MPMBiphasic9 (9.8)Desmoplastic3 (3.3)Epitheliod67 (72.8)Sarcomatoid3 (3.3)Not otherwise specified10 (10.9)TreatmentNo28 (30.4)Yes58 (63.0)Unknown6 (6.5)Treatment CourseChemotherapy only8 (13.8)Chemo and Radiotherapy5 (8.6)Radiotherapy only15 (25.9)Surgery only10 (17.2)Trimodality therapy7 (12.1)Surgery and Chemo7 (12.1)Surgery and Radiotherapy4 (6.9)Concurrent therapy2 (3.4)Intent at first treatmentCurative31 (53.4)Palliative24 (41.4)Unknown3 (5.2) Open table in a new tab