VA Boston Healthcare System
VA Boston’s First IOHC Patient Recovering Well
Dr. Abraham Lebenthal, MD, Lead Thoracic Surgeon, VA Boston Health Care System
BOSTON - VA Boston Healthcare System became the first VA in the nation to successfully perform an intraoperative heated chemotherapy (IOHC) procedure on a patient with malignant pleural mesothelioma in 2015.
While the Los Angeles VA is the only other VA facility in the country to offer this innovative procedure, VA Boston is the only VA to offer both surgery and heated chemotherapy in one place and at one time.
Pleural Mesothelioma is a rare cancer often resulting from exposure to high levels of asbestos. In Pleural Mesothelioma, the pleura are affected, which is a thin membrane of lubricating mesothelial cells that line the lungs and chest cavity. Lead thoracic surgeon, Dr. Abraham Lebenthal, MD; surgical first assistant Dr. Jeff Siegert, MD, and their team have brought heated chemotherapy treatment to the VA from VA Boston’s affiliate hospital, Brigham and Women’s, where they have performed this innovative procedure for several years in the Division of Thoracic Surgery.
Intra-operative heated chemotherapy is used in addition to surgery and has significantly improved treatment for Mesothelioma and a patient’s long-term survival. During surgery, any visible tumors are removed. During the same operation, a liquid chemotherapy solution is heated, (approximately 107 degrees) pumped into the thoracic cavity, and then circulated for up to an hour before it is drained. Applying heated chemotherapy allows the surgeon to safely increase the dose of what is typically applied to standard chemotherapy treatment, permitting more precision and effectiveness for targeting any remaining cancer cells.
The operation is complex and is not successful without a team-based approach from many healthcare providers and administrators. Surgeons, anesthesiologists, radiologists, oncologists, nurses, pharmacists, social workers, physical and occupational therapists, and others all work together to make sure the patient goes through a successful surgery and has a healthy recovery. The necessary teamwork that is required makes the VA a great place for this kind of top quality care for mesothelioma patients.
Lebenthal has an open door policy for those patients who meet the criteria for surgery. Part of that criterion is a patient’s state of mind. “The patient needs to have a fighting attitude and not be willing to give up,” said Lebenthal. “This is a tough surgery with a lot of recovery and the patient with the right attitude will do the best.”
Dr. Lebenthal explains that a patient who is diagnosed with aggressive mesothelioma has an average prognosis of five to six months with no treatment. With standard chemotherapy alone, average survival can increase to approximately one year, and with surgery it can increase to a year and a half. However, when heated chemotherapy is added to surgery the average survival can expand to two years and beyond. “I expect this patient to do very well. We have seen patients living five to seven years, and in some cases longer,” said Lebenthal. “Unfortunately, many doctors still don’t know this procedure exists, but we are very excited to now be offering this treatment to Veterans.”
Since the surgery four months ago, VA Boston’s first IOHC patient is now recovering at his home in Colorado. When he first came to Lebenthal, he was on oxygen and in a wheelchair. He understands he has some healing to do, but tells us he is feeling great and immensely improved, now walking and breathing on his own.
“I can breathe so much more easily now and don’t feel as winded as I used to,” the patient told us. “I felt confident that Lebenthal had the knowledge and experience to take care of my problem, especially after meeting with him.”
Lebenthal’s patient will need to be seen every three to six months for follow-up care in order to monitor and ensure his full recovery, and with his VA insurance, he has the ability to be seen at any VA facility.
This was the first time Lebenthal’s patient received care at VA Boston and he had nothing but positive things to say about his experience, pointing out how he felt tremendous support from all phases of his care.
“I received care in all three hospitals: Testing at Jamaica Plain; surgery in West Roxbury; and rehab in Brockton,” the patient told us. “The service in all three facilities was outstanding: doctors and nurses followed up with me; listened to me; followed through with my meds; and made me feel comfortable the whole time.”
One-third of the 3,000 Americans who are diagnosed every year with mesothelioma are Veterans. It is due to mesothelioma’s long latency period (20-50 years) between asbestos exposure and diagnosis of the disease that those who served many years ago are now seeing effects.
After seeing the success of his first VA patient, Lebenthal plans to continue Intraoperative heated chemotherapy at VA Boston. Just last month he performed his second procedure.
