Quebec has the grim distinction of having North America's highest rate of malignant pleural mesothelioma (MPM), a deadly cancer directly linked to asbestos exposure. And yet, the province is without a comprehensive diagnostic and treatment approach for the disease. With the help of their research grant from the Rossy Cancer Network's (RCN) CQI Fund, a team led by thoracic surgeon Dr. Jonathan Spicer, is creating a multidisciplinary program called the Integrated Program for Pleural Mesothelioma, which will establish a centre of excellence in the care of MPM patients. The program is based out of McGill’s hospitals and extends its reach provincially. A website explaining the program to patients and physicians will be available shortly.
"This is a very rare disease — about 180 patients are diagnosed in Quebec per year — but the number of patients with mesothelioma is increasing," explains Dr. Spicer, who performs thoracic surgery at the Montreal General Hospital of the McGill University Health Centre (MUHC) and Jewish General Hospital (JGH), and is Assistant Professor in the Department of Surgery at McGill. This is because symptoms often take as long as 40 years to appear, and asbestos mining and its widespread use as a fire retardant in construction continued until the 1990s. "Given the years it was used in the construction industry we expect peak incidence to be from now to 2030," says Dr. Spicer.
Mesothelioma patients presenting with symptoms are often misdiagnosed or left undiagnosed; this is because symptoms are vague and/or similar to other respiratory illnesses in the early stages. MPM has a five-year survival rate of just 5% and this, combined with its rarity and the difficulty in diagnosing it, can make it seem like a bit of a lost cause in the eyes of physicians. "There is a sense of nihilism about this disease – that there's nothing we can do but give patients their diagnosis and tell them to get their affairs in order," says Dr. Spicer.
"Sometimes, not offering treatment is the right thing to do for the patient" adds Dr. Spicer. "One of the goals of the program is to help direct patients to the appropriate supportive care as early as possible." His team found that this isn't always being done.
The team plans to begin by raising awareness among caregivers all over Quebec. "We want to make it known across the province that this is the place to refer patients," says Dr. Spicer. "We want to get them seen by our team and make sure we get the appropriate treatment started."
The first stop for most MPM patients is a visit to a thoracic surgeon like Dr. Spicer, who can help reduce fluid build-up around the lungs and ease some of their symptoms. The MPM team will then judge if it is appropriate to start treatment, to enroll patients in a clinical trial, or to arrange tailored to palliative and supportive care. For patients from outside of Montreal, this will mean extending the team’s outreach efforts to regional partners. "It doesn't make sense for the MUHC or the Jewish General Hospital to be offering the palliative care for those patients," says Dr. Spicer. "We'll be working with local hospital palliative care departments to advise them on how to help patients."
The team will maintain contact with MPM patients who had been seen at the clinic, and eventually assess how the Program impacts their outcomes. Because of the small number of patients diagnosed, this promises to be a long-term endeavour. "We're very thankful to the RCN for recognizing this orphan disease," says Dr. Spicer. "Now it will get a bit of attention. The patients feel relieved to meet with a team of experts who are familiar with this rare and complicated disease."