Abstract
BackgroundMalignant pleural mesothelioma (MPM) is a rare cancer with a poor prognosis. Centralization of rare cancer in dedicated centers is recommended to ensure expertise, multidisciplinarity and access to innovation. In Italy, expert centers for MPM have not been identified in all regions. We aimed to describe the treatment patterns among MPM patients across different Italian regions and to identify factors associated with the treatment patterns across the regions.MethodsWe performed an observational study on a random sample of 2026 MPM patients diagnosed in 2003–2008. We included 26 population‐based registries covering 70% of the Italian population. To identify factors associated with treatment patterns, across the different regions, we fitted a multinomial logistic regression model adjusted by age, sex, stage, histology and hospital with thoracic surgical department.ResultsMPM patients mostly received chemotherapy alone (41%) or no cancer‐directed therapy (36%) especially the older patients. The first course of treatment for MPM patients differed across regions. Patients from Piedmont, Liguria and Campania were more likely to receive no cancer‐directed therapy; those living in Tuscany and Sicily were more likely to get surgery; patients from Marche and Lazio were more likely to receive chemotherapy. These differences were not explained by age, sex, stage, histology and availability of a thoracic surgery department.ConclusionsThere is limited expertise available and lack of a network able to maximize the expertise available may contribute to explaining the results of our study. Our findings support the need to ensure the appropriate care of all MPM patients in reorganizing the health care services.Key pointsSignificant findings of the study:MPM patients mostly received chemotherapy alone or no cancer‐directed therapy especially the older patients. The first course of treatment for MPM patients differed across Italian regions.What this study adds:Differences in MPM clinical management are not explained by the age, stage, histology nor by the availability of a thoracic surgery department. Limited expertise for MPM contribute to explaining the unequal access to appropriate care for MPM patients in Italy.
Highlights
Malignant pleural mesothelioma (MPM) is a rare tumour[1] strongly associated with asbestos exposure
MPM patients with stage I–II and III were more likely to be treated with SRG as compared to those diagnosed with stage IV
No major differences were confirmed across the other geographical areas. This is the first population-based study to provide a description of the treatment patterns up to 2008 for MPM patients in Italy and across different Italian geographical areas
Summary
Malignant pleural mesothelioma (MPM) is a rare tumour[1] strongly associated with asbestos exposure. MPM has a poor prognosis (five-year survival 9%)[6] and no survival progresses have been observed at population level during the last decades.[6] Traditionally, the centralization of rare cancer in dedicated centers has been recommended to ensure expertise, multidisciplinarity and access to innovation.[7] this process requires health migration, rationing of resources and a potential failure in routine care since the limited expert resources may be overwhelmed, determining waiting lists.[7] By ensuring appropriate care of all patients regardless of the point of access, networking seems to be the most appropriate answer to rare cancers such as MPM.[7] In Italy, specialized centers for MPM patients have not been identified in all regions and, up to 2017, only an informal professional network on rare cancers, focused mainly on sarcoma tumors, was created to provide second opinion and clinical advice on rare cancers.[8]. Malignant pleural mesothelioma (MPM) is a rare cancer with a poor prognosis.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
