Mesothelioma Surgery as a Viable Option

Dr. Krug in his presentation discussed surgery as an option for treating malignant pleural mesothelioma.  There are two types of surgeries; one is the decortication or pleurectomy and the other is the more aggressive approach which is the extrapleural pneumonectomy (EPP).  The extrapleural pneumonectomy involves resecting the pleura, the lung and the diaphragm.  This is a major surgery and should be performed by skilled surgeons, he remarked.  Dr. Krug indicated that the extrapleural pneumonectomy should be considered for patients with early stage mesothelioma.  He indicated there is a fair amount of controversy in the medical community about its use.

At the International Mesothelioma Program (IMP) at Brigham and Women’s Hospital, one of the member institutions of the NCCN, Dr. David Sugarbaker regularly and skillfully performs both surgeries with some remarkable results.

Chemotherapy and Radiation Therapy Necessary for Mesothelioma

The guidelines indicate that the first line chemotherapy regimen is pemetrexed (Alimta) combined with Cisplatin.  Even with surgery, both chemotherapy and radiation therapy are recommended.  Carboplatin can also be used in place of Cisplatin.  Use of other drugs such as Gemcitabine and Vinorelbine can be prescribed as well.  Chemotherapy and radiation are necessary to prevent relapse and to treat the cancer cells that are microscopic and are present even after surgery.

Mesothelioma Guidelines Will Improve Treatment

The oncology practice guidelines are a result of evidence based research and are the consensus of the malignant mesothelioma panel of NCCN.  Thirty-five oncologists, surgical oncologists, radiation oncologists, pathologists and hematology oncologists participated on the panel and worked on the guidelines.  The guidelines are now available for practicing physicians, but of course each physician will use his or her best independent medical judgment to decide how to treat and care for a mesothelioma patient.

These unprecedented malignant pleural mesothelioma guidelines take medical care a big step forward in standardizing and improving the treatment, prognosis and quality of life for a person being diagnosed with mesothelioma today.  Attorney Gary Galiher, who has represented mesothelioma clients for over 30 years, applauds and commends the work of the many physicians and scientists in their clinics, hospitals and laboratories, “It is their hard work and years of experience that enabled the NCCN to develop these new clinical practice guidelines for malignant pleural mesothelioma.”

Multi-Disciplinary Team Serves Mesothelioma Patients

If you decide to contact Sloan-Kettering, you may want to consider the option of entering one of several mesothelioma clinical trials for treatment and care.  This consideration will be carefully discussed with a physician or nurse clinician at Sloan-Kettering who is part of a multi-disciplinary team.  This team of specialists will be there to serve you and meet your medical needs, as well as your emotional and other needs, as you go forward with your treatment and care for mesothelioma.

Consider Entering A Mesothelioma Clinical Trial

Under Dr. Krug’s leadership, there are presently at least three open mesothelioma clinical trials being conducted at Sloan-Kettering.  One trial utilizes an investigational drug known an CBP 501, a stable peptide, which is an enzyme that works on cancer cell division.  Along with CBP 501, the standard mesothelioma therapy of Alimta and Cisplatin is used.  In order to participate in this particular study, the mesothelioma tumor must be unresectable and untreated.  The mesothelioma patient must also be able to be up and about for half of his waking hours.

Another clinical trial involves the use of Everolimus (RAD 001).  Everolimus inhibits the molecule mTOR which helps cancer cells grow.  Even if a mesothelioma patient has had prior chemotherapy treatment, he or she can still participate in this study.  The patient will need to have adequate pulmonary function however.

Finally, another trial is a toxicity study utilizing chemotherapy followed by Intensity Modulated Radiation Therapy (IMRT), which is targeted radiation.  To participate, the mesothelioma patient must have an unresectable tumor and not have had any prior chemotherapy or radiation treatment.  Usually standard radiation therapy does not work well for mesothelioma patients.  Some radiation oncologists liken it to attempting radiation on the apple peel without radiating the apple itself.  IMRT obviates this problem of standard radiation therapy.

Of course eligibility for any of these mesothelioma clinical trials will be decided in close consultation with the multi-disciplinary team who will review each individual mesothelioma patient’s medical records, test results and situation very carefully.

Be Proactive – Explore Sloan-Kettering’s Mesothelioma Program

As you can see, if you intend to explore the possibility of participating in any of these mesothelioma clinical trials, the sooner you contact the Sloan-Kettering Mesothelioma Program, the better it is for you.  More options may be available.

Attorney Gary Galiher, who has represented many mesothelioma clients over the last 32 years, remarks that, “from a scientific point of view, what is happening at Memorial Sloan-Kettering is exciting and encouraging.  But more importantly, from seeing what my clients and their families have gone through over the years, I encourage anyone who has been diagnosed with mesothelioma to be proactive and explore what is available at leading cancer centers such as Sloan-Kettering.”

International Mesothelioma Program Shares Tissue Samples to Advance Research

The International Mesothelioma Program, under the leadership of Dr. David Sugarbaker, sees approximately 300 mesothelioma patients for consultation each year.  Last year, over 160 of these patients also underwent surgery.  The IMP maintains a patient data registry as well as a tumor bank of all patients who are seen at Brigham and Women’s Hospital for mesothelioma treatment.  Because the International Mesothelioma Program works collaboratively with the Dana-Farber Cancer Institute, mesothelioma patients treated at any of these facilities become part of this important patient data registry.  If surgery is performed, their pathology material is preserved in the International Mesothelioma Program’s tumor bank as well.

There is significant research underway at the International Mesothelioma Program using the tissue samples and the data from the patient registry.  However, the IMP also recognizes the importance of advancing  mesothelioma research in other hospitals and cancer institutes.  Accordingly, the IMP readily shares the information in the patient data registry and the tissue samples from the mesothelioma tumor bank with researchers at other cancer centers to advance the study of the development of mesothelioma and how to treat this disease.

One such researcher is Dr. V. Courtney Broaddus, a professor of medicine at the University of California at San Francisco.  Dr. Broaddus is studying the role played by other cells such as immune cells around the mesothelioma cells.  She studies macrophages to understand the role they play in assisting the mesothelioma tumor’s growth.  To do this research, the IMP sends tumor tissue to Dr. Broaddus via Federal Express from tumors that are resected from patients.  After the overnight flight from Boston to San Francisco, the tumor cells are still alive when they arrive.  Dr. Broaddus commented that this just shows how tough and hardy these mesothelioma cells are.  She grows these cells in vitro to observe the growth of the macrophages.  Growing these cell lines also enables her to test various treatments on mesothelioma cells.

Research Comparing Surgical Results Based On Patient Age

Although the International Mesothelioma Program was officially formed in 2002,  a patient data registry has been maintained for many years because patients have been treated at the Brigham and Women’s Hospital for mesothelioma since the 1980s.  The database has 400 fields, so all kinds of information has been captured and recorded for 2,000 patients.

One example of the type of research that has been conducted involves a study done by Dr. Andrea Wolfe of the IMP and Brigham and Women’s Hospital.  Dr. Wolfe compared the outcomes for mesothelioma patients having either an extrapleural pneumonectomy or a pleurectomy with decortication and were 65 years old and older.  She found that older patients fared less well immediately after the extrapleural pneumonectomy, but in terms of longer term outcomes of those who survived the surgery, both surgeries produced similar results.  She was able to do this research retrospectively looking back at 227 patients who were in the patient data registry.

Attorneys Recognize Valuable Resource for Mesothelioma Research

Attorney Gary Galiher, who has successfully represented hundreds of mesothelioma clients, remarked that the IMP’s patient data registry and tumor bank are, “an incredibly valuable resource for scientists so they can do cutting edge research that will eventually lead to a cure for this devastating disease.”   While Galiher and his law firm Galiher DeRobertis Ono have been able to obtain fair compensation for their mesothelioma clients and their families, the untold suffering caused by mesothelioma can only be addressed by medical research being done by Dr. Sugarbaker, the IMP and other scientists.

Misconceptions About Clinical Trials Dispelled

Having never made such a monumental decision, many are concerned about enrolling in a clinical trial.  Some worry that the patient will be treated like a guinea pig or will receive the placebo or sugar pills.  Worse yet, some think that clinical trials should be considered only when there is no hope.  These misconceptions about clinical trials are dispelled at the International Mesothelioma Program (IMP) at Brigham and Women’s Hospital in Boston, Massachusetts.

Dr. David Sugarbaker, the founder and director of the International Mesothelioma Program and the Chief of Thoracic Surgery at Brigham and Women’s Hospital, has been treating mesothelioma patients along with his colleagues at the Dana-Farber Cancer Institute since the 1980s.  In fact, the clinical trials being conducted at the IMP are at the forefront of state-of-the-art mesothelioma treatment and care in the United States.  Each year approximately 160 mesothelioma patients are treated at the International Mesothelioma Program by Dr. Sugarbaker and his team of medical experts.  Twice that number of patients are seen for consultation.

Surgical Clinical Trials Leading to Increased Survivability

In a lecture given in late 2009, Dr. Sugarbaker noted that through his surgical clinical trials, the IMP is seeing a 17 percent survival rate for patients who are four years post-surgery.  This is remarkable when you consider these patients’ original prognosis, which was a mere six to nine months to live.  Dr. Sugarbaker is seeing survivors who are eight to ten years post-surgery and a few others who are living as long as 13 years with no recurrence.

Attorney Gary Galiher, who has represented mesothelioma clients for 32 years, is very hopeful when he see the results Dr. Sugarbaker has had from his clinical trials.

“I have seen my clients suffer and die from this devastating cancer.  Dr. Sugarbaker’s clinical trials portend much hope and promise that one day in the not so distant future mesothelioma will be a curable disease.”

Clinical Trials at the International Mesothelioma Program

One important mesothelioma clinical trial is Protocol 07-091 for patients with resectable pleural malignant mesothelioma; that is, a tumor that can be removed surgically.  The surgery is followed by heated chemotherapy drugs applied directly into the chest cavity during the surgical procedure.  The drug combination used is Cisplatin along with Gemcitabine.  Amifostine is also used to protect the normal cells.  The patient is then followed weekly.

Of 304 patients screened, Dr. Sugarbaker says 64 were enrolled in this clinical trial.  The study is still open and accepting patients.  The clinical trial requires that certain criteria are met in order for a patient to qualify for enrollment in Protocol 07-091.  Since time is of the essence, it is important that patients discuss this and other possible courses of treatment with their physician right away.   They may also consider calling the IMP directly at phone:  617-732-5922 to get immediate information.

It is clear that through a number of clinical trials, medical advances are taking place at the International Mesothelioma Program under Dr. Sugarbaker’s leadership.  Virtually all advances in cancer treatment involve clinical trials.  These advances translate to hope and a prolonged and enhanced quality of life for mesothelioma patients.

New Clinical Trial Underway

The International Mesothelioma Program will be conducting a new clinical trial for patients with advanced stage mesothelioma.  This new Phase I trial would use the neoadjuvant mTOR inhibitor followed by administering Cisplatin in combination with pemetrexed or Alimta.  After the chemotherapy regimen, depending on the patient’s response, an extrapleural pneumonectomy could then be performed.

Over the years through the clinical trials, the IMP has been able to increase the dose of chemotherapy drugs to the maximum tolerable amount.  Additionally, because of Dr. Sugarbaker’s experience treating so many mesothelioma patients, he and the IMP have learned the site of recurrence of the cancer is usually in the chest or abdomen where the original tumor appeared.  Dr. Sugarbaker explained that he and his medical team have observed over the last 15 years that, even after surgery, microscopic cells are present and thus he developed the in vivo model, as he calls it, of administering the heated chemotherapy in the maximum tolerable dose into the open chest cavity.

His patients have words of praise and gratitude as they speak of Dr. Sugarbaker being a hero and a pioneer in mesothelioma research with the clinical trials which the International Mesothelioma Program is conducting.

As one of our clients, who is also her husband’s caregiver, told her friends, everything leading up to his surgery was a whirlwind, leaving her little time to think about the extent of the care that would ultimately be required.  Her strong recommendation to other caregivers is to take some time for yourself while the patient is hospitalized.  Upon discharge, you will have medications to pick up and all the needs of the patient to tend to, along with the regular chores of daily living such as laundry and meals.

Family Support Groups at the International Mesothelioma Program

The International Mesothelioma Program supports the patients’ families and caregivers with regular Family Support Group meetings so that families can get together and share their stories.  No one feels alone.  IMP social worker, Charlene Haouiliya, says it is very important for the families to learn from and support each other emotionally.  Being treated at the International Mesothelioma Program is much more than a surgical or clinical procedure.  A mesothelioma patient’s caregivers often feel like their own circle of family and friends don’t really understand what they’re going through.  The weekly support group meetings allow families to connect with other families who do understand and who have similar experiences.

The IMP has two chaplains, who both agree that the Family Support Group helps to reduce the isolation often felt when a family is faced with a devastating diagnosis like mesothelioma.  Some important pointers come from those who have participated in the International Mesothelioma Program’s Family Support Groups, who remind other caregivers to take care of themselves too.  Key to this is having some respite or time off from caregiving.  If a relative is in town to see the patient, the caregiver could take a few hours to do something relaxing.

Dr. Sugarbaker also tells all the patients who are treated at this program that they are not alone.  They have friends and family to support them, as well as the excellent support systems that come with the IMP. Dr. Sugarbaker sums it up very well when he says:

“You have the support of other patients and families…you have the support of a clinical team that is focusing on you and your particular circumstances…you have a research team helping to improve the care and treatment we can provide…and you have yourselves and your inner strengths, your survival skills.”

Helpful Suggestions for the Mesothelioma Caregiver

Another strong suggestion for caregivers is to be sure to ask your questions of the medical team or the social worker.  Keeping a journal may be a good way to be able to recall later what was said, especially since so much is happening very quickly.  Your loved one may ask you later what happened, and the journal would be a good way of accurately recalling.

While it is helpful to talk with others whose loved ones are facing mesothelioma, it is also of critical importance to always remember that each patient is different from the next and that each person will react differently to seemingly similar procedures and medications.  In charting this course, the Family Support Group and the professionals from the IMP associated with it are a valuable and uplifting resource for the family and caregivers whose loved one is being treated for mesothelioma.

Mesothelioma is aggressive and a multimodality approach (meaning surgery, chemotherapy and radiation) is often recommended as the course of treatment.  As a result, a patient necessarily has appointments with an oncologist, a radiation oncologist, a surgeon, a cardiologist, a pulmonologist, at imaging, at nuclear medicine and with other specialists and departments.

In order to find one’s way through this seemingly complex medical maze, forward thinking medical centers today have on staff patient navigators to assist mesothelioma patients and others facing a cancer diagnosis.  A patient navigator is a professional with medical training, sometimes as a nurse or a medical assistant.

First and foremost, the patient navigator will meet with the patient and be there to help.  She will help schedule appointments.  She will try to set appointments as conveniently as possible, perhaps limiting the number of days that a mesothelioma patient has to go to the medical center or the hospital.  The navigator also meets with the patient’s team to discuss the plan for care and treatment, as well as progress and difficulties that may develop along the way.

If there seems to be a conflict between prescriptions or if instructions are unclear, the navigator will help to straighten out the situation and provide clarity for the patient.  The patient navigator’s job is to alleviate much of the stress and concern that a patient and his family may feel when trying to navigate the system themselves. The navigator helps to ensure that the patient does not feel alone in this process.

A mesothelioma patient’s needs go beyond medical tests and treatment.  An effective patient navigator will assist with issues involving medical insurance, financial assistance, nutrition and with psychosocial problems.  When the need arises, palliative care suggestions can be provided.  Sometimes the navigator will suggest an appropriate support group.

One example of a state of the art patient navigation system is available at Queen’s Cancer Center in Honolulu, Hawaii.  An award winning and innovative program, the Queen’s Patient Navigation Program helps patients wind their way through their medical treatment, and transition from inpatient to outpatient care when necessary.  The result for the patient is improved medical care, more focus on quality of life and an overall better experience for the patient at an incredibly difficult time.

Welcoming each guest with a fresh orchid lei, attorneys Gary Galiher, L. Richard DeRobertis, Jeffrey Ono, Diane Ono and Ilana Waxman were on hand to meet the event organizers.  Dr. Christine Fukui, formerly of Kaiser Permanente, has treated many mesothelioma patients throughout her medical career as an internist, and Ms. Jean Evans, is the Executive Director of the American Lung Association in Hawaii.  Gary Galiher and the attorneys from the Galiher DeRobertis Ono team were privileged to be introduced to the faculty and symposium attendees during the elegant open air reception.  Attorney Gary Galiher commented that, “It was most interesting and enlightening to meet physicians so intimately involved in the study of pulmonary medicine who work directly and indirectly to help our mesothelioma and other clients who have asbestos conditions such as lung cancer and asbestosis.”

Continue to Live Your Life to the Fullest

Many clients and their families tell us that their feelings range from shock to anger and denial, many finally come to a sense of acceptance and finding a “new normal.”  Today, some doctors believe that living with mesothelioma or any form of cancer should be viewed as living with a chronic illness, just as some people live with diabetes, arthritis or other chronic conditions.  Mrs. G-T, a client living with mesothelioma, shared her attitude with us:

“I have to live my life and I won’t let [the mesothelioma] take over me.  I have my grandchildren and my children.  They all count on me.  If you let it get you down, you won’t live a good life.  I feel I’ve been dealt this and I live with it.”

Mrs. G-T went on to tell us that her greatest joy was taking all eight of her grandchildren on a trip to Disneyland.  She recounted how much fun both she and her husband had with them.

Coordinate the Scheduling of Your Treatments

Undergoing chemotherapy, radiation and possibly surgery are not easy.  Scheduling appointments may seem like a simple task but with multiple physicians and facilities involved, that task may become overwhelming.  If you have someone who can help make the appointments for you and coordinate them to limit the number of trips back and forth to the medical center, that may help to ease some of the burden.

Some cancer centers have a patient navigator whose job is to coordinate your appointments and to see that things like medical insurance issues are handled.  One wife of a mesothelioma client told us that she made her husband’s appointments so that they could make one trip to the medical center.  They planned to stay for much of the day, and her husband took his reading material.  She got him his gourmet coffee to enjoy to begin his day.  Seemingly small things can make a big difference in a patient’s outlook and attitude.

Focus on Everyday Activities

During this time, it is important to focus on the things you like to do.  Some have found normalcy in going to work, even for shortened hours.  If you have a hobby like gardening or if you play a sport like golf, by all means, partake in the activity whenever you feel you can.  Many take trips to see friends or relatives or go to places they’ve always wanted to go to.  Another wife said her husband visited his relatives who he had seen occasionally over the years.  Her husband’s hobby was cooking, and he continued to make wonderful dishes.

We have observed many living with mesothelioma have an amazingly strong human spirit.  Carrying on with your every day routine in as usual a fashion as possible is helpful.  It is important to celebrate and enjoy the good days.  Be present in the moment.  Above all else, a positive, fighting spirit of living life intensely is key.

“Given the difficulty of medical research in this day and age, very few important medical breakthroughs can be accomplished by an individual researcher, no matter how smart.  Those days are gone.  Current medical research requires a team approach and I believe that assembling the best team of scientists I can bring together at the CRCH to work on the difficult issues of malignant mesothelioma is the best way to proceed.”

Dr. Michele Carbone

Dr. Carbone is also the Chair of the Department of Pathology at the John A. Burns School of Medicine at the University of Hawaii.  Dr. Carbone was recruited to the cancer center in 2006 from Chicago and brought with him approximately $12 million in funding from grants and other sources.  As such, he is the most highly funded mesothelioma researcher in our country.

Mesothelioma is a cancer caused by breathing asbestos fibers.  It is a latent disease occurring 10 to 50 years after exposure and at present is incurable.  Dr. Carbone’s life commitment is to understand how mesothelioma cells develop and why and what measures can be taken to stop their growth.  He is one of the editors of a book entitled, “Malignant Mesothelioma: Advances in Pathogenesis, Diagnosis and Translational Therapies”.

Speaking with a charming Italian accent, Dr. Carbone originates from Rome and Calabria, a region located in the toe of the boot-shaped peninsula of Italy.  After graduating from medical school at Universita Degli Studi Di Roma La Sapienza in Rome, Carbone worked as a fellow at the National Institutes of Health in Bethesda, Maryland for eight years.  He then did his residency at the University of Chicago Hospitals in Anatomic and Clinical Pathology.  Prior to coming to CRCH, Carbone was at Loyola University Medical Center in Chicago, Illinois.

Dr. Carbone and Gary Galiher listening to a presentation on the latest mesothelioma research at the CRCH

With his experience, talent and commitment, Carbone dreams of greatly expanding his mesothelioma research at the cancer center, especially in the area of therapeutic care for mesothelioma patients.  As a vital part of this effort, Carbone collaborates with researchers around the world who are working with new mesothelioma treatment drug therapies as well as with clinicians in hospitals.  Dr. Carbone, a leading mesothelioma researcher in the U.S., and Gary Galiher, a leading attorney who has represented mesothelioma clients for over 30 years, are working together to give Hawaii the first center for excellence on asbestos and mesothelioma in the country.

My husband Gary Galiher and I also have a very personal experience with cancer treatment and clinical trials.  In 1997, sixteen years after I began working with mesothelioma clients, our daughter was diagnosed with acute lymphocytic leukemia at the age of four.

Like you, I was shell shocked and devastated when the oncologist explained our daughter’s diagnosis.  It was hard to believe the words coming out of his mouth.  After that initial shock, however, I decided that I would follow every aspect of her treatment each step along the way to ensure her remission and cure.

As you face your or your loved one’s diagnosis of mesothelioma, I would like to share some important lessons our family learned from our daughter’s diagnosis and the 2 1/2 years of treatment that followed.

Clinical Trials Are the Best Hope for a Mesothelioma Cure

Many call it a medical miracle that childhood leukemia, which was almost always fatal only 30 or 40 years ago, now has a cure rate of 85% or more.  These phenomenal cure rates were accomplished through clinical trials.

Unlike adults, the majority of children with cancer participate in a clinical trial for their treatment.  Today, participation in a clinical trial is the standard of care for a child with cancer.  Among adult cancer patients, however, only 3% participate in clinical trials.

Curing childhood leukemia is the story of many committed scientists, including researchers in the laboratory together with physicians treating young patients, working collaboratively by involving the sick and dying children in clinical trials over many years.  A cure for malignant mesothelioma will be found by patients like you participating in clinical trials.

You Must Be Your Own Best Advocate

The first lesson we learned was that you must be your own best advocate.  Because clinical trials have certain criteria for participation, you need to ask your oncologist what is available.  Be proactive.

Ask your doctor to explain to you which study or studies he thinks you might be able to qualify for.  Ask which one he would recommend for you and why.  If there is a cancer research center or a university medical school in your area, they may have information about what is available.

The Protocol and Roadmap

Participation in a clinical trial will mean that a medical professional, sometimes a nurse clinician, will explain to you the treatment protocol, as well as the Roadmap and all of the informed consent forms that require your signature.  The Roadmap is a detailed schedule of when each drug must be administered, in what dosage and which tests and procedures must be done along the way.

All of the paperwork and very technical medical language may seem overwhelming.  It is a good idea to have someone from your family there with you to listen and ask questions as well.  If you don’t understand something, do not be afraid to ask.

Your physician or the nurse clinician will be able to explain things in lay terms that will be easier to understand.  This is about you and your loved ones.  You want to take every possible measure to fight your cancer, so don’t be afraid to ask that things be repeated or re-explained.  There is no such thing as a dumb question.

Have a way to organize all of the papers being given to you.  I used a three ring binder with dividers.  I marked on the Roadmap the date the treatment was actually administered.  Sometimes treatment has to be postponed due to infection or other problems.  By staying organized, you will know that you received all of the treatment set forth for your study.

Higher Standard of Care

Participating in a clinical trial will mean that you will have a higher quality standard of care than the average patient.  This is because the study you are on will require very close monitoring of your condition.  You will have certain tests such as blood tests, x-rays or other procedures that must be administered according to schedule.

Your doctor who is participating with you in the study will be providing information to the principal investigator of the study or somehow forwarding your data so that it can be compared with other study participants. You are essentially taking part in a well-controlled human experiment.

You may wonder why you couldn’t just get the medications being used in a study without the bother of the paperwork and formality of actually participating in a trial.

In fact, many doctors around the country may be administering the very same medications being studied and some are probably experiencing certain successes in helping their patients.  However, if everyone in their own locality acts separately, there is no way for doctors to share their experiences and analyze the scientific data.  Unless this data is collected through a clinical trial, researchers will be unable to identify the most promising treatments, and the cure for mesothelioma will be even further away in the future.

Participation in a clinical trial may not only help to extend your life and boost your quality of life, but will also help medical research to find the best possible treatment and eventual cure for this devastating disease.

A Fighting Spirit and Hope Are Strong Medicine

Lastly (and this is not medical or legal advice) have a fighting spirit!  Having hope and the will to make every day count helps you maintain a healthy, strong mind to face adverse circumstances.

I encourage you to ask your doctor today to tell you about the clinical trials available to you.  Our daughter is now 17 years old and is a senior in high school.  I am still helping mesothelioma clients, and I hope our personal perspective will assist you as you go forward in your treatment.