So I've been through this twice now with my dad. First center we looked at in March when he got diagnosed, then we switched to Northwestern in June because the first place was basically just doing standard chemo and calling it a day. That switch probably added months to his life, honestly.
Here's what I learned that's actually useful instead of just looking at rankings or how many meso cases they claim to do.
First, ask them point blank what their multimodal protocol looks like. Not what they say it looks like on the website. Call and ask to talk to their surgical oncologist directly if you can. My dad's surgeon at Northwestern, Dr. Kashani, actually walked me through exactly what the pre-op imaging would be, what markers they'd check, what the pleurectomy would involve. The first center kept deflecting to "we customize for each patient" which sounds good until you realize they don't actually have a standardized approach.
Second, find out if they do neoadjuvant chemo before surgery or if they're doing it backwards. The data actually supports chemo first then surgery, and if a center is doing it the other way they're behind. Ask how many patients they've enrolled in clinical trials in the last year. If it's zero, that tells you something.
Third and this is weirdly specific but matters, ask what their follow-up imaging schedule is after treatment ends. My dad's team does chest CTs every 8 weeks for the first year, then every 3 months. Some places space them out way too far and you miss recurrence early when you might actually catch it.
Also check if they have a dedicated meso tumor board. Not just "we discuss complicated cases." An actual board where pulmonologists, thoracic surgeons, oncologists, and sometimes interventional radiologists meet weekly to go through meso cases specifically. Northwestern does this every Tuesday morning and Dr. Kashani presents my dad's scans and talks about what's happening.
One more thing nobody mentions: ask about their complication rates and what they do if something goes wrong post-op. Not the shiny "success" numbers but the actual data on how many patients developed post-op infections, how many needed re-intubation, how long average hospital stay is. The first center couldn't even tell me their average LOS.
Dad's palliative now since October so the aggressive multimodal window is closed for him, but if we'd caught this earlier or if I had known what questions to ask initially, I think we would have gotten him to Northwestern sooner. The difference between a center that just treats meso and a center that's actually invested in it is huge and it's not always obvious from the outside.