Lebenthal A

Objective: To assess feasibility and potential costs of transport and other barriers for new patients seeking specialized care for MPM at the Boston VA Healthcare System (VABHS).

Background: Malignant Pleural Mesothelioma (MPM) is a rare disease directly related to the exposure of asbestos fibers with a 20-50 year lag time from exposure to manifestation of symptoms. Veterans are disproportionately affected by MPM compared to the general population. Due to the lack of specialized care centers for MPM, Veterans must travel great distances from their homes to receive care. This travel burden manifests as a barrier to care for Veterans.

Methods: The Mesothelioma Program at VABHS was developed through a quality improvement initiative and pilot study of a national phone triage for specialized care within a centralized healthcare network. Patients with a diagnosis suspicious for MPM contacted a general thoracic surgeon at VABHS with specialty training in mesothelioma to review their medical history. After thorough evaluation Veterans are advised by the surgeon to travel to Boston for an on-site consultation or to continue local treatment if deemed appropriate.

Results: Between 2011 and May 2016, 93 patients contacted the VABHS Mesothelioma Program, of which 73 were actually Veterans. Of these Veterans, 43 (58.9%) eventually travelled an average of 1031 miles for further workup. For the Veterans that travelled: 20 came by plane, 20 by car, 2 by train and 1 by unknown mode of transportation. Veterans stay at government housing called Huntington House (HH) an average of 7 days. The average one-way plane fare in 2015 was $377 based on Department of Transportation data. Thus a roundtrip for 2 people would average $1,508 if coming by air. For Veterans that drove to VABHS, the average distance from the West Roxbury campus was 217 miles. Using this average, it costs an average of $41.00 round trip to Boston based on current gas prices. The hotel most often used for patients costs $89.00 per night for the least expensive room. Over 7 days, this would cost the Veteran with MPM $623.00.

Conclusion: Veterans are potentially able to deflect many costs of specialized surgical care for MPM. Further improvements in the travel offices need to be pursued in order to improve efficiency.

Objective: To assess feasibility and potential costs of transport and other barriers for new patients seeking specialized care for MPM at the Boston VA Healthcare System (VABHS).

Background: Malignant Pleural Mesothelioma (MPM) is a rare disease directly related to the exposure of asbestos fibers with a 20-50 year lag time from exposure to manifestation of symptoms. Veterans are disproportionately affected by MPM compared to the general population. Due to the lack of specialized care centers for MPM, Veterans must travel great distances from their homes to receive care. This travel burden manifests as a barrier to care for Veterans.

Methods: The Mesothelioma Program at VABHS was developed through a quality improvement initiative and pilot study of a national phone triage for specialized care within a centralized healthcare network. Patients with a diagnosis suspicious for MPM contacted a general thoracic surgeon at VABHS with specialty training in mesothelioma to review their medical history. After thorough evaluation Veterans are advised by the surgeon to travel to Boston for an on-site consultation or to continue local treatment if deemed appropriate.

Results: Between 2011 and May 2016, 93 patients contacted the VABHS Mesothelioma Program, of which 73 were actually Veterans. Of these Veterans, 43 (58.9%) eventually travelled an average of 1031 miles for further workup. For the Veterans that travelled: 20 came by plane, 20 by car, 2 by train and 1 by unknown mode of transportation. Veterans stay at government housing called Huntington House (HH) an average of 7 days. The average one-way plane fare in 2015 was $377 based on Department of Transportation data. Thus a roundtrip for 2 people would average $1,508 if coming by air. For Veterans that drove to VABHS, the average distance from the West Roxbury campus was 217 miles. Using this average, it costs an average of $41.00 round trip to Boston based on current gas prices. The hotel most often used for patients costs $89.00 per night for the least expensive room. Over 7 days, this would cost the Veteran with MPM $623.00.

Conclusion: Veterans are potentially able to deflect many costs of specialized surgical care for MPM. Further improvements in the travel offices need to be pursued in order to improve efficiency.

Objective: To assess feasibility and potential costs of transport and other barriers for new patients seeking specialized care for MPM at the Boston VA Healthcare System (VABHS).

Background: Malignant Pleural Mesothelioma (MPM) is a rare disease directly related to the exposure of asbestos fibers with a 20-50 year lag time from exposure to manifestation of symptoms. Veterans are disproportionately affected by MPM compared to the general population. Due to the lack of specialized care centers for MPM, Veterans must travel great distances from their homes to receive care. This travel burden manifests as a barrier to care for Veterans.

Methods: The Mesothelioma Program at VABHS was developed through a quality improvement initiative and pilot study of a national phone triage for specialized care within a centralized healthcare network. Patients with a diagnosis suspicious for MPM contacted a general thoracic surgeon at VABHS with specialty training in mesothelioma to review their medical history. After thorough evaluation Veterans are advised by the surgeon to travel to Boston for an on-site consultation or to continue local treatment if deemed appropriate.

Results: Between 2011 and May 2016, 93 patients contacted the VABHS Mesothelioma Program, of which 73 were actually Veterans. Of these Veterans, 43 (58.9%) eventually travelled an average of 1031 miles for further workup. For the Veterans that travelled: 20 came by plane, 20 by car, 2 by train and 1 by unknown mode of transportation. Veterans stay at government housing called Huntington House (HH) an average of 7 days. The average one-way plane fare in 2015 was $377 based on Department of Transportation data. Thus a roundtrip for 2 people would average $1,508 if coming by air. For Veterans that drove to VABHS, the average distance from the West Roxbury campus was 217 miles. Using this average, it costs an average of $41.00 round trip to Boston based on current gas prices. The hotel most often used for patients costs $89.00 per night for the least expensive room. Over 7 days, this would cost the Veteran with MPM $623.00.

Conclusion: Veterans are potentially able to deflect many costs of specialized surgical care for MPM. Further improvements in the travel offices need to be pursued in order to improve efficiency.

Objective: Retrospective review of Veterans diagnosed with MPM looking at history of exposure to asbestos, military occupation, active duty service branch, and compensation for disability or ‘service connection’ (SC).

Background: Malignant Pleural Mesothelioma (MPM) is a rare disease that disproportionately affects Veterans. Untreated, this is a rapidly fatal disease with a 6 month median survival. Traditionally, an association between Navy service and MPM in veterans is well established. The Veterans Healthcare Administration (VHA) rewards a full, 100%, compensatory benefit known as SC disability for pleural neoplasms in the setting of asbestos exposure during military service. In 2012, Kuschner et al. from the Palo Alto VA reported that 6% (1/16) of MPM patients at their VA were even told about the possibility of compensation.

Methods: We offer open access, in-network, advice and therapy for Veterans within VHA nationally. After initial phone triage or e-consult, qualified Veterans register at the VABHS. A multidisciplinary team, including experienced MPM thoracic surgeons, pathologists and radiologists, reviews each case and tailor individual treatment plans.

Results: Between 2011 and 2016, we phone-triaged 73 Veterans with suspected MPM. 56 had confirmed MPM and half (50%) served in the U.S. Navy. 39% (16 Army, 3 Marines, 3 Air Force) served in ground or air combat units. There were 2 Veterans from the Coast Guard (4%) and 4 Veterans with unknown service branches (7%). 43 Veterans travelled an average of 1,031 miles to VABHS. 38 of these Veterans have biopsy-proven MPM, which the VHA defines as a disease rewarded 100% SC disability compensation. 3 Veterans are currently being processed by the VHA. There are still significant numbers of Veterans with MPM without SC (see Table 1.)

Conclusion: The majority of Veterans evaluated at the VABHS served in the Navy or Coast Guard, however 39% served in branches not traditionally associated with MPM. Surprisingly, many did not serve in traditional military occupations associated with asbestos exposure. There is an opportunity for improvement in recognizing a ‘service connection’ for veterans with MPM.

Objective: Retrospective review of Veterans diagnosed with MPM looking at history of exposure to asbestos, military occupation, active duty service branch, and compensation for disability or ‘service connection’ (SC).

Background: Malignant Pleural Mesothelioma (MPM) is a rare disease that disproportionately affects Veterans. Untreated, this is a rapidly fatal disease with a 6 month median survival. Traditionally, an association between Navy service and MPM in veterans is well established. The Veterans Healthcare Administration (VHA) rewards a full, 100%, compensatory benefit known as SC disability for pleural neoplasms in the setting of asbestos exposure during military service. In 2012, Kuschner et al. from the Palo Alto VA reported that 6% (1/16) of MPM patients at their VA were even told about the possibility of compensation.

Methods: We offer open access, in-network, advice and therapy for Veterans within VHA nationally. After initial phone triage or e-consult, qualified Veterans register at the VABHS. A multidisciplinary team, including experienced MPM thoracic surgeons, pathologists and radiologists, reviews each case and tailor individual treatment plans.

Results: Between 2011 and 2016, we phone-triaged 73 Veterans with suspected MPM. 56 had confirmed MPM and half (50%) served in the U.S. Navy. 39% (16 Army, 3 Marines, 3 Air Force) served in ground or air combat units. There were 2 Veterans from the Coast Guard (4%) and 4 Veterans with unknown service branches (7%). 43 Veterans travelled an average of 1,031 miles to VABHS. 38 of these Veterans have biopsy-proven MPM, which the VHA defines as a disease rewarded 100% SC disability compensation. 3 Veterans are currently being processed by the VHA. There are still significant numbers of Veterans with MPM without SC (see Table 1.)

Conclusion: The majority of Veterans evaluated at the VABHS served in the Navy or Coast Guard, however 39% served in branches not traditionally associated with MPM. Surprisingly, many did not serve in traditional military occupations associated with asbestos exposure. There is an opportunity for improvement in recognizing a ‘service connection’ for veterans with MPM.

Objective: Retrospective review of Veterans diagnosed with MPM looking at history of exposure to asbestos, military occupation, active duty service branch, and compensation for disability or ‘service connection’ (SC).

Background: Malignant Pleural Mesothelioma (MPM) is a rare disease that disproportionately affects Veterans. Untreated, this is a rapidly fatal disease with a 6 month median survival. Traditionally, an association between Navy service and MPM in veterans is well established. The Veterans Healthcare Administration (VHA) rewards a full, 100%, compensatory benefit known as SC disability for pleural neoplasms in the setting of asbestos exposure during military service. In 2012, Kuschner et al. from the Palo Alto VA reported that 6% (1/16) of MPM patients at their VA were even told about the possibility of compensation.

Methods: We offer open access, in-network, advice and therapy for Veterans within VHA nationally. After initial phone triage or e-consult, qualified Veterans register at the VABHS. A multidisciplinary team, including experienced MPM thoracic surgeons, pathologists and radiologists, reviews each case and tailor individual treatment plans.

Results: Between 2011 and 2016, we phone-triaged 73 Veterans with suspected MPM. 56 had confirmed MPM and half (50%) served in the U.S. Navy. 39% (16 Army, 3 Marines, 3 Air Force) served in ground or air combat units. There were 2 Veterans from the Coast Guard (4%) and 4 Veterans with unknown service branches (7%). 43 Veterans travelled an average of 1,031 miles to VABHS. 38 of these Veterans have biopsy-proven MPM, which the VHA defines as a disease rewarded 100% SC disability compensation. 3 Veterans are currently being processed by the VHA. There are still significant numbers of Veterans with MPM without SC (see Table 1.)

Conclusion: The majority of Veterans evaluated at the VABHS served in the Navy or Coast Guard, however 39% served in branches not traditionally associated with MPM. Surprisingly, many did not serve in traditional military occupations associated with asbestos exposure. There is an opportunity for improvement in recognizing a ‘service connection’ for veterans with MPM.