Malignant pleural mesothelioma (MPM) represents a relatively rare histologic tumor type both in the US and globally. It accounts for less than 0.17% (approximately 3000 total) of all US tumor diagnoses as of 2018, and this proportion is expected to continue decreasing given greater awareness of causality linked to asbestos exposure. 1. Guidelines suggest that multimodality therapy, including surgery, chemotherapy, and possible radiation therapy, can lead to the best possible outcomes for this rare tumor type. 2. Unfortunately, outcomes of localized MPM remain poor despite multimodality therapy.
Nonclinical factors may play a role in these findings; however, data are limited regarding the impact of disparities in access to care and patients’ social determinants of health (SDOHs) in disease-related outcomes for patients with potentially operable MPM. A recent review3 demonstrated that lower income and lack of insurance are associated with worse survival within the US and globally; however, there is no unifying definition of income level on which to define this observation. Similar findings related to median zip code income have been reported for surgical treatment in early-stage lung cancer.4 Moreover, additional SDOHs, such as level of education, have yet to be evaluated systematically in MPM, although they have been identified in other thoracic tumor types, such as tracheal cancer.5 Furthermore, although the distance to treatment is associated with survival rates in multiple reports, access to treatment for patients with MPM should be studied. Our objective was to examine factors associated with patterns of care as well as overall survival (OS) among patients with operable MPM by treatment access and patients’ SDOHs. (author introduction)