Selecting Your Specialist
Although not all Appendix Cancer patients will require CRS/HIPEC, it is still recommended that all Appendix Cancer and PMP patients consult with one of these specialists before undergoing treatment because they are the most familiar with the disease and are the only physicians who treat it on a regular basis.
Currently, no objective criteria exist to determine what constitutes a “specialist” in the treatment of pseudomyxoma peritonei, appendix cancer and other peritoneal surface malignancies. Therefore, the ACPMP Research Foundation does not recommend any particular specialists nor have we created a list of recommended specialists. However, we have provided some suggestions and resources below to assist you in your search.
When searching for a specialist to treat PMP/Appendix Cancer, patients should be aware that research studies have concluded that the learning curve for the CRS/HIPEC procedure, the "standard of care" for these diseases, reaches its peak only after the completion of 130, 140, 180, or even over 200 of these procedures. A patient searching for a specialist to treat PMP, Appendix Cancer or a related disease may want to inquire as to how many CRS/HIPEC procedures a surgeon under consideration has performed, as well as the number of CRS/HIPEC procedures or other complex surgical procedures that the surgeon's center has performed.
In addition to these questions, a patient may also want to consider the other questions listed below.
Resources for Selecting a Specialist
Many resources exist to assist patients in finding a physician with experience in treating PMP, Appendix Cancer and PSMs.
Several of the recognized leaders in the field present at and attend the biannual International Congress on Peritoneal Surface Malignancies established by Dr. Paul Sugarbaker. The 12th International Congress on Peritoneal Surface Malignancies will take place in Beijing, China on September 18 – 20, 2020. Many experts also attended the 10th International Congress on Peritoneal Surface Malignancies in Washington, DC on November 17 – 19, 2016.
Many recognized experts in the field also organize, attend and present at the annual Advanced Cancer Therapies symposium, presented by the Society of Surgical Oncology, formerly organized by the Koch Center at the University of Pittsburgh Medical Center.
The ACPMP Research Foundation Professional Advisory Board consists of recognized experts in the treatment of pseudomyxoma peritonei, appendix cancer and peritoneal surface malignancies as determined by a review of each PAB member’s membership application and curriculum vitae by the PMPRF Board of Directors.
Nearly all of the ACPMP Research Foundation grant recipients have established clinical programs at their respective institutions with extensive experience treating PMP and Appendix Cancer.
Several websites listed on our Helpful Links page contain their own specialist lists. When reviewing these lists please keep in mind that there are no uniform criteria used to determine what constitutes a “specialist”. Our “Considerations when Selecting a Specialist” section (above) provides some suggestions on how to conduct your search.
Considerations when Selecting a Specialist
- Read his/her resume: is his/her training, areas of interest and experience in line with what you are looking for?
- Is the facility respected, especially for specialty cancers?
- Has the center under consideration performed a significant number of cytoreductive surgeries (at least 130+) related to the treatment of PMP/Appendix Cancer/PSMs?
- Are outcome reports available telling prospective patients how prior patients are doing?
- How does the treatment recommendation from the specialist compare with that of other specialists? A patient may want to consider consultations with at least 2 or 3 recognized specialists in the field before selecting a physician for treatment.
Here are some important questions to ask your Specialists
- How many cytoreductive surgeries have you performed (studies have shown that the peak of the learning curve for CRS/HIPEC is 130, 140, 180, or even over 200 procedures)?
- What percentage of these CRS surgeries performed were done specifically to treat PMP/Appendix Cancer?
- How many years of experience do you have performing these surgeries?
- In approximately what percentage of surgeries do you use hyperthermic intraperitoneal chemotherapy (HIPEC)?
- What chemo agents do you use for HIPEC, and why?
- Do you perform HIPEC using the open or closed technique? Why do you believe this method is superior?
- Do you perform HIPEC only during surgery, or do you continue early post-operative intraperitoneal chemotherapy (EPIC) for some days after surgery?
- How many days do you estimate for a post-surgical hospital stay? Do you have a set timeframe, or is it based solely on post-op milestones? What are those milestones?
- What is a typical operating time for cytoreductive surgery?
- What are your current outcome statistics for disease-free survival for LAMN (DPAM), HAMN (PMCA), PMCA-I (intermediate), appendiceal adenocarcinoma (with and without signet ring cells), and goblet cell carcinoid tumors?
- What is your philosophy about using systemic chemo before and/or after surgery?
- What chemotherapy agents (including systemic “cocktails”) do you use/recommend and why?
- Are there any special therapies you provide? If any, can you provide research on which they are based? Are you pursuing this therapy in a research context?
- What is your average (or typical) patient age and gender?
- Do you recommend chemo sensitivity assays? Why or why not? If yes, what lab(s) do you use?
- Do you recommend molecular assays of tumor samples? Why or why not? If yes, what lab(s) do you use?
- What is the typical waiting time for a patient to be scheduled for surgery?
- Please describe your surgical selection criteria (for LAMN (DPAM), HAMN (PMCA), PMCA-I (intermediate), appendiceal adenocarcinoma [with and without signet ring cells], and goblet cell carcinoid tumors).
- Do you recommend molecular and genetic testing of tumor tissue or circulating tumor DNA testing to identify targetable mutations for immunotherapy or other precision medicine therapies?