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International Mesothelioma Program

Patient Resources:

This section includes useful information and helpful resources for patients and their families and caregivers who plan their treatment at the Brigham and Women’s Hospital Thoracic Surgery Department.

Make an Appointment
Your First Appointment
What You Need for Your First Appointment
Scheduling Your Surgery
What Happens After Surgery?
Important LInks for Patients and Families

Make an Appointment

The first step in initiating your care is making your first appointment. When you make your first appointment, you will speak to our New Patient Coordinators. At this time, you will be asked to provide some information about yourself and any insurance coverage you may have. You will also be asked for the address and phone number of any referring physicians and the nature of your illness. You will then be given the date and time of your appointment and the name of the surgeon you will be meeting with as well as instructions on what to bring with you at the time of your appointment. The New Patient Coordinator will be able to answer any questions you may have or will put you in contact with the appropriate person. You may call our New Patient Coordinators directly at (617) 732-5922.

Your First Appointment

Please arrive 60 minutes ahead of your Thoracic Surgery appointment and register at Ambulatory Services Registration, located at 45 Francis Street. Do not make additional obligations that day, as your visit in the Thoracic office will last for several hours. Although you will see several practitioners during your visit, you will also experience a considerable amount of waiting. Please note that as a surgical practice, emergencies can arise that may take the surgeon out of the office during your appointment time. If this should occur, our office staff will notify you of the delay.

At Ambulatory Services Registration, you will receive a Brigham and Women's Hospital Blue Card with your BWH medical ID number. You will also verify your personal demographic and insurance information with the Ambulatory Services Registration staff. Do not make any co-payments at this desk.

You will then proceed to the Thoracic Surgery Clinical Offices, located in the lobby at 15 Francis Street, where you will check in at the front desk. The front desk staff will request your hospital blue card, your insurance cards, any co-payment necessary, insurance referral, your completed forms and radiology films and reports. They will give you some additional forms to review while you register in the clinic.

Our certified medical assistant staff will then take a complete set of vital signs and perform a series of Pulmonary Function Tests (PFTs) on you. Once this is complete, a physician assistant will review your medical history and interview you. We encourage you to have a family member present during the interview. This helps us get the most accurate information possible.

Once the physician assistant has completed your medical history, the information will be presented to the surgeon. After the surgeon has reviewed your history and radiology studies, he/she will discuss your condition with you. You may be asked to have additional tests on the day of your first visit or even the next day. Please plan accordingly. Once again, we recommend bringing a family member into the meeting with your surgeon. If the surgeon believes you are eligible, you may be offered the chance to participate in one of our clinical research trials.

If surgery has been deemed appropriate, the surgeon will discuss the type of surgery, the risks and benefits of the surgery, and the recuperation process. Once surgery has been agreed upon you will meet with the surgical coordinators in order to schedule your surgery and pre-operative testing. The surgical coordinator will give you verbal and detailed written information about your surgery.

If surgery is not an option at this time, you may be referred to the Thoracic Oncology Program (TOP) located at The Dana Farber Cancer Institute. You will be given information about the program offered at TOP and the phone number of the TOP New Patient Coordinator. Our office will set up an initial appointment for you.

What You Need for Your First Appointment:

Prior to your first visit, it would be very helpful to have the following tests completed and reports faxed to our office (617-264-5252). Films should be brought to the office at the time of the first visit. These would include:

Chest CT Scan
Chest MRI scan, specifically to look for invasion through the diaphragm and invasion through the pericardium. Include sagittal cuts to R/O contralateral involvement, chest wall or diaphragm involvement, growth in the pulmonary artery and aorta and R/O cardiac involvement
A cardiac echo to assess cardiac function, as well as invasion through the pericardium and to R/O Pericardial effusion. Please include Pulmonary Artery pressures.
Blood Chemistry that includes a Metabolic Panel and Hepatic Function. This test must be no more than one-week old at the time of the consultation visit.
Hematology should include a CBC with platelet count and differential, which should be no more than one-week old.
One or two representative blocks of the tumor tissue used to determine diagnosis. If this is not possible, please provide 12 unstained sections on positively charged slides suitable for immunohistochemistry. This would greatly reduce the time required for pathologic confirmation of the diagnosis.
It would be helpful to have an English translation of all reports.
We would also request that any physician notes, including notes from any previous operation and a written list of medications, be faxed to our office. You will receive a packet from the Thoracic Surgery office, detailing the tests above that must be completed and instructions on how to obtain the reports if the tests were done previously.

Please feel free to call the New Patient Coordinators at 617-732-5922.

Scheduling Your Surgery

If after your evaluation by and consultation with the Thoracic Surgeon it has been decided that surgery is necessary, you will meet with our Surgical Scheduling Coordinators. They will schedule you for any pre-operative testing you may require. These may include chest x-ray, CT scan, bone scan, bronchoscopy, ventilation/perfusion studies, biopsies, and blood work. You will be given an appointment at the Pre-Admitting Testing Center (PATC) as well as a time and date for your thoracic surgery. You will be informed as to anything you must do prior to your surgery and will be told what time you need to arrive at the hospital the day of your surgery. They will give you an information packet that will contain any information you need to know regarding your hospital stay. They are also available by phone to answer any questions you may have after you leave the clinic.

What Happens After Your Surgery

ICU). Most patients are not required to be on a respirator and are awake immediately after surgery. You will receive an epidural for pain control and a chest drainage tube will remain in place. If all goes as expected, you will leave the surgical ICU within a few days and be transferred to the Thoracic Intermediate Care Unit. The hospital stay is usually from 7 to 14 days.

Some patients undergoing pleurectomy will stay on the respirator overnight after surgery.

Before you are discharged from the hospital, your surgeon will tell you when you should schedule your first follow-up visit. Generally, the doctor will ask you to come back about one week after your surgery. If you are coming from a long distance, it is expected that you stay in the area until your first follow-up visit is completed.

Chemotherapy and Radiation
About 4 to 6 weeks after your surgery, you will undergo chemotherapy and radiation. You may elect to go to your own oncologist, or we can refer you to the Thoracic Oncology Program at the Dana-Farber Cancer Institute. Recommendations for chemotherapy will be made to your oncologist; however, the exact treatment will be left up to him/her.

Recovery
Overall, recovery tends to be slow for most patients. Even at six months after surgery, about 60 percent of pneumonectomy patients find that their exercise tolerance is still significantly limited by shortness of breath. Complete recovery time is one year.