how do you even find a good doctor for this stuff

That feeling you described, like the oncologist wasn't really invested. That matters. And like Frank said, trusting your gut here is valid.

For meso specifically you really want someone who sees it regularly, not just occasionally. A surgeon AND a medical oncologist working together is usually the standard at good centers. The National Mesothelioma Virtual Bank and MARF (Mesothelioma Applied Research Foundation) both have specialist finder tools on their sites that can help narrow this down.

Nashville has Vanderbilt which has solid oncology resources and isn't a brutal drive from Memphis. Worth calling and asking specifically how many meso cases they handle per year, a good center won't hesitate to answer that.

This is a lot to carry for your whole family. If you need to talk through the emotional side of all this searching and advocating, I'm here.

Your instinct about that first oncologist is worth paying attention to. Mesothelioma is rare enough that most general oncologists see maybe one or two cases in their career, and that really does make a difference in terms of knowing the current treatment landscape.

For pleural meso specifically, you want someone at a high-volume center that sees this regularly. The National Cancer Institute designates certain hospitals as Comprehensive Cancer Centers and they tend to have dedicated thoracic oncology programs. Vanderbilt in Nashville has a solid program and honestly that's not a terrible drive from Memphis. MD Anderson in Houston is probably the most well-known for meso volume in your region if you're willing to travel further.

The question of surgeon vs oncologist first is a good one. At stage 2, surgery may still be on the table (meaning potentially curative intent, not just palliative) so you want a thoracic surgeon who has done EPP (extrapleural pneumonectomy) or P/D (pleurectomy/decortication) procedures specifically, not just general chest surgery. The MARS and MARS2 trials have actually shifted thinking on which surgery is preferable so you want someone current on that. Ideally you'd see both an oncologist and a thoracic surgeon at the same institution because multidisciplinary tumor boards, where multiple specialists review the case together, really do lead to better treatment planning.

When you're evaluating a doctor, ask directly how many meso patients they see per year. Single digits and I'd keep looking. Ask if they have access to clinical trials, because there are active trials right now in second-line settings and even some first-line combinations beyond standard chemo plus immunotherapy.

Definitely have his current oncologist send all imaging and pathology records before any new appointment. And please, talk to the new oncologist about the full picture before making any treatment decisions.

Your instinct about that first oncologist is worth paying attention to. Mesothelioma is rare enough that a general oncologist who "treats meso" might see one or two cases a year, and that's genuinely not enough volume to stay sharp on the current treatment options.

What made the difference for my patients is finding someone at a center that tracks case volume specifically for mesothelioma. The Mesothelioma Applied Research Foundation keeps a list of specialized centers and you can look up who's doing meaningful numbers of cases. MD Anderson, Brigham and Women's in Boston, and the Thoracic Oncology Program at Vanderbilt in Nashville are all places worth a phone call. Nashville is a reasonable drive from Memphis and Vanderbilt's thoracic team sees enough volume that they're not guessing.

For stage 2 pleural, the sequencing question (surgeon first vs oncologist first) actually matters a lot. The 2022 MARS 2 trial data changed how a lot of us think about surgical timing, and you want someone who knows that literature and can have that conversation with your brother specifically, not just give a default answer.

When you're on the phone with a new office, asking "how many mesothelioma cases does this physician see per year" is a completely reasonable question. Any good specialist's office will answer it directly.

And yes, traveling to Nashville or even further for an initial consult is worth it even if ongoing treatment stays closer to home. Please make sure your brother's team knows this is an option. Talk to his oncologist about a referral.