ABSTRACT: Pleural mesothelioma (PM) is a rare, aggressive tumor strongly linked to occupational asbestos exposure, with a complex presentation that often delays diagnosis. Effective management requires a structured, multidisciplinary approach integrating diagnostic, therapeutic, psychological, and supportive care across the healthcare system.
Conducted within the PNC-SINTESIproject – funded by the Italian Ministry of Health under the PNC/PNRR for environment-health surveillance in Sites of National Interest – this study analyzed diagnostic and therapeutic care pathways (PDTAs) for PM developed by eight Italian regions (Emilia-Romagna, Piemonte, Sicilia, Puglia, Toscana, Campania, Marche and Sardegna). Regional documents were compared across eleven key dimensions, including healthcare professionals involved, access criteria, hub-and-spoke center definitions, and process indicators, to identify shared components and propose a harmonized national model. The analysis identified a core multidisciplinary team – medical oncologist, radiation oncologist, thoracic surgeon, pulmonologist, radiologist, pathologist, and palliative care specialist – alongside a standardized hub-and-spoke framework and six key process indicators for quality monitoring.
Early, concurrent integration of palliative care and psychological support emerged as critical, consistent with evidence that timely psychosocial involvement improves patients’ and families’ quality of life. Given the established asbestos link, the framework also recommends occupational disease notification and medico-legal counselling to protect patients’ rights and support epidemiological surveillance. This reproducible model aims to reduce regional variability in PM care and may serve as a reference for international standardization.

Impact statement: A harmonized hub-and-spoke PDTA model for pleural mesothelioma may standardize multidisciplinary care and reduce interregional variability in Italy.

Key words: Pleural mesothelioma; care pathway; multidisciplinary team; palliative care; hub-and-spoke model.