Peritoneal mesothelioma may be a fairly rare disease, but Dr. Brian Loggie, a world-renowned cancer surgeon and malignant peritoneal mesothelioma specialist, regularly sees patients with the disease because they come from all over the U.S. to be treated by the surgical oncology team at Creighton University Medicine School.
Dr. Loggie has been treating patients, leading research teams and teaching at Creighton since 2002. He founded Creighton’s Division of Surgical Oncology and serves as Chief of the department. Dr. Loggie and his team specialize in treating patients with abdominal cavity diseases and cancers including tumors located in the colon, pancreas and appendix.
Peritoneal mesothelioma, sometimes called abdominal mesothelioma, affects the tissue in the abdomen. It is the second most common form of mesothelioma after pleural mesothelioma, representing 10-15% of all mesothelioma diagnoses. Approximately 250 new cases of peritoneal mesothelioma are diagnosed annually. Symptoms may include abdominal pain, unexplained weight loss and elevated white blood cell count. Like other forms of mesothelioma, peritoneal mesothelioma is most often linked to directly inhaling or ingesting asbestos fibers.
Dr. Loggie is also the Director of the Cancer Biology Program at Creighton, which is a full-service molecular biology and clinical research laboratory. As part of the Cancer Program, the Peritoneal Neoplastic Disease program is focused primarily on two fairly rare diseases: pseudomyxoma peritonei and malignant peritoneal mesothelioma, both cancerous diseases that occur in the abdominal cavity. According to Dr. Loggie, the research program is "focused on identifying biologic factors that would allow us to be able to treat mesothelioma better."
Dr. Loggie Pioneered Use of Heated Chemotherapy Perfusion During Surgery
Dr. Loggie pioneered the use of cytoreduction surgery (also called "debulking") in combination with hyperthermic intreperional chemotheraphy (HIPEC) perfusion for the treatment of malignant peritoneal mesothelioma. In layman’s terms, this means that heated chemotherapy drugs are circulated in the abdominal region during the surgical removal of the cancerous tumors. Dr. Loggie was the first to publish on this method, which has become the preferred modality for surgical oncology.
Unlike systemic chemotherapy, which is circulated throughout the body, HIPEC delivers heated, highly-concentrated doses of chemotherapy directly to cancer cells in the abdomen, which limits exposure to other areas of the body. Heating the solution is thought to improve the absorption of the drugs to destroy microscopic cancer cells that may remain in the abdomen after surgery.
For almost a decade, Dr. Loggie has favored the chemotherapy drug carboplatin, sometimes referred to as "carbo." Dr. Loggie has had highly favorable patient outcomes with carboplatin usage that have translated into shorter hospital stays after mesothelioma surgery as compared to using other chemotherapy drugs. While the average hospital stay after mesothelioma surgery is seven to eight days, many of Dr. Loggie’s patients only require approximately five days. He credits this to the lower toxicity of the drug, his “visceral sparing” approach to surgery (which is explained below), and the use of intravenous pain medications after surgery.
Dr. Loggie Continually Strives for Better Patient Outcomes
Although the major protocols for treating mesothelioma have not changed much for years, Dr. Loggie and his team continually refine their methods to try to obtain better outcomes. "We’re always trying to do better in terms of pain control, patient comfort, getting patients moving [after surgery], getting out of hospital faster and reducing any complications," says Dr. Loggie.
Dr. Loggie typically recommends two to three cycles of chemotherapy prior to surgery; whereas other practices tend to postpone chemotherapy until after surgery or do a full six cycles of chemotherapy before surgery. Dr. Loggie favors two to three cycles of chemo prior to surgery because it allows him to see the patient’s response to the chemo without going too far down one path. If a particular chemo drug works well, it can be continued after surgery and if it is not effective, he can pursue a different treatment path post-surgery.
In terms of pain control, Dr. Loggie and his team were early adopters of intravenous Tylenol, which became available in 2001. In the first twenty-four hours following surgery, Dr. Loggie’s team also administers spinal morphine. Intravenous anti-inflammatory medication and push-button narcotics may also be used for pain control.
To help with patient recovery and post-surgery quality of life, Dr. Loggie "emphasizes surgical treatment that preserves as much physiology as possible." If he can avoid removing the small bowel, colon or sigmoid during surgery, it leaves the patient open to more treatment options, can help speed surgical recovery and improves quality of life. Dr. Loggie also credits the use of carboplatin with speeding patient recovery.
In fact, Dr. Loggie’s patients have experienced a three-year increase in median life span with carboplatin versus mitomycin, which was the predominant chemotherapy drug he used previously.
Nurse Practitioner Dedicated to Patient Experience and Outcomes
Quality of life issues are a primary concern to Dr. Loggie and his cancer team, which includes Nurse Practitioner Holly Sennett. Holly’s role is to get to know the patients and their families to ensure that the patients get all of their questions answered and feel comfortable. Holly has been working with Dr. Loggie for more than six years. Previously, she was an ICU nurse.
When mesothelioma patients come to the practice, Holly is by their side from the beginning. The patient will typically have an MRI followed by a one to two hour discussion with Holly and Dr. Loggie to discuss the patient’s file and scan results and set up a treatment plan.
"It can get quite complex," says Holly, "so my job is to be the middleman and ensure the patient understands everything being said and that all questions are answered."
Patients are scheduled for surgery when the time is appropriate. Preparation for surgery is conducted the day prior to surgery and may include pre-operative testing, hydration, bowel preparation and radiology studies.
Only one patient is scheduled for surgery per day, so Dr. Loggie and Holly can focus exclusively on that patient. Typically, patients remain in the hospital for approximately five days following surgery. Patients visiting from out of town typically stay another day or two at a hotel in the area until they see Holly again for their final appointment before heading home.
If the patient is continuing chemotherapy at home, Dr. Loggie and the patient’s medical oncologist at home coordinate a treatment plan. Dr. Loggie’s office continues to stay in touch with their patients throughout the patient’s life to try to stay ahead of any recurrence or complications that could develop. Patients are scheduled to visit Dr. Loggie’s office three to four months after surgery, then every six months for the first two years, followed by ongoing annual visits.