When I returned to Loyola University Health System as director of thoracic surgery in January 2016, my intent was to build a mesothelioma specialty center that was second to none.
We are well on our way. We have place together a multidisciplinary staff with the interest and expertise in treating pleural mesothelioma cancer.
One of the first things we talked about early in the process was having a mesothelioma tumor board that met regularly to discuss each case, and how best to individualize the treatment.
This has worked exceptionally well, providing a huge benefit for our patients, and ensuring they are getting the best care possible.
The Mesothelioma Tumor Board Process
Every two weeks, we bring together a multidisciplinary group of mesothelioma cancer specialists to discuss each case individually. This week, we discussed three mesothelioma patients.
In the meeting room are medical oncologists, thoracic surgeons, pathologists, radiologists, physician assistants, nurses, researchers and anyone involved in taking care of these patients — either upfront or behind the scenes.
Each case is presented individually, all imaging and pathology reviewed, and everyone provides input, offering different levels of experience and from different perspectives.
All the bases are covered. We talk about why we’re doing certain things, and why we’re not doing other things, what’s working and what’s not working.
Key to Individualized Treatment
The philosophy is that this is not a one-size-fits-all disease. You can’t paint it with a broad brush. You have to individualize the treatment. You find the ideal treatment for that particular patient. You do that through collaboration, by thinking outside the box a small in some cases. That’s what the tumor board is about.
Doctors will challenge each other in these tumor board meetings. Why this surgery, and why not that surgery or medical treatment? It’s a very collaborative group without a lot of egos involved. At least I hope the egos aren’t involved. The exchange of thoughts and opinions is a excellent thing.
Part of the meeting, we also talk about research, and what we can do. Why does this work? Why does this not work? What can we do to improve it? Everybody comes away with something. I reckon the patient benefits the most.
This tumor board meeting is specifically dedicated to patients with mesothelioma, and it’s unique to Loyola University Medical Center at the Cardinal Bernadine Cancer Center, where the motto is: “We also treat the human spirit.”
Without it, at other places, the patients often are just being selected to fit into certain protocols. There is no individualization. It’s not always what’s best for the patient.
Sometimes, we’re discussing data on a patient before we even see him or her. We have this discussion usually before we start treatment. In many centers, just the treatment is based on one opinion. An oncologist starts the patient on chemotherapy, and then decides on a biopsy or surgery because the treatment is not working.
With our tumor board, we look through all the information first — as a group — before we start with a treatment plot.
Patients will typically come on Tuesday or Thursday when they can be seen by everyone involved. We meet to discuss the case before or after to determine what’s best for the patient.
We have the expertise here. It’s absolutely imperative for a patient to find that. It’s incredible sometimes how small a lot of people, even in the medical profession, know about mesothelioma.
Importance of a Mesothelioma Specialist
People will advertise that they treat mesothelioma — everyone thinks they are an expert in the field — but that is not necessarily right. That’s a real problem.
I’ve performed more than 200 surgeries for mesothelioma patients. Unless you’re doing this regularly, you probably shouldn’t be doing these complex surgeries.
For mesothelioma, you have to be properly trained and develop the expertise to do it well, and the opportunity to train well in this field is limited, unlike lung cancer.
We’re proud of what we’re accomplishing here. The tumor board is part of that.
Dr. Wickii Vigneswaran is director of thoracic surgery at Loyola University Health System and an internationally recognized expert in the surgical management of diseases affecting the lungs, mediastinum and pleura. He is the former director of the Lung and Lung-Heart Transplantation team at the University of Chicago Medical Center and still an active member of the transplant team at Loyola.
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