Only ~20 mesothelioma specialists exist in the U.S., most in coastal cities

Mesothelioma is so rare that fewer than two dozen oncologists and thoracic surgeons in the United States have deep experience treating it. These specialists are concentrated at major academic medical centers in the Northeast (Memorial Sloan Kettering, Brigham and Women's), Texas (MD Anderson), and a few other urban hubs. So what? A veteran in rural West Virginia or a retired factory worker in Montana who is diagnosed with mesothelioma faces a 500+ mile trip to see a specialist. So what? Mesothelioma patients are typically elderly (median age at diagnosis is 72), often physically weakened by the disease, and on fixed incomes -- making repeated long-distance travel for multi-modal treatment (surgery + chemo + radiation over months) financially and physically devastating. So what? Many patients default to local general oncologists who may see one mesothelioma case in their entire career, leading to suboptimal treatment plans that miss emerging options like immunotherapy combinations or tumor treating fields (Optune Lua). The structural reason this persists: rare diseases cannot sustain specialist practices in smaller markets, medical training produces generalists by default, and telemedicine -- while helpful for second opinions -- cannot replace the hands-on surgical and interventional procedures that mesothelioma treatment requires.