Palliative Care Specialist

Mesothelioma Palliative Care – Options for Pain and Symptoms

Pain is a burden that shouldn’t have to result in quiet suffering and discomfort. People diagnosed with mesothelioma can face severe side effects and pain from the disease, which can be mitigated with the help of palliative care. Palliative care is a multidisciplinary form of caretaking where the main purpose is to manage pain and improve quality of life, whereas curative care is working to cure or eradicate someone from their disease or diagnosis.

Implementing mesothelioma palliative care early is important since there currently isn’t a cure for this disease, and patients should have the option to manage their pain and comfort levels rather than continue painful curative treatments. Patients in palliative treatment can hope to receive support for managing their symptoms with treatments and medications, but it should also support in areas of mental health, dietary counseling, spiritual care, and more.

What are the Stages of Mesothelioma Palliative Care?

Doctors will take into account what stage of mesothelioma you are in when considering starting a patient on palliative care. What type of care you get depends on your stage since some treatments aren’t effective if tumors progress too far. In stage 1, you have the most treatment options available since the cancer is localized to one area and easier to target. Some people may have no symptoms or may show signs of a persistent cough, body aches, chest pain, fatigue, and shortness of breath. Treatment options can include a mix of chemotherapy, radiation, and immunotherapy.

In stage 2, treatment options are still relatively open as cancer can still be pinpointed in one localized area. Doctors may recommend the same treatments as stage 1, but in addition, there is the option for surgery. Surgery for palliative care is done for the purpose of managing a patient’s symptoms. Removing the tumor mass to be cancer free isn’t the goal, but stage 2 surgery to reduce fluid built up in the chest and abdomen can help a patient’s breathing.

Late Stage Mesothelioma Palliative Care

By stage 3, you are more than likely feeling the effects of cancer. The need for managing symptoms starts to grow as the quality of life begins to suffer when patients are experiencing more discomfort than not. Symptoms in stage 3 mesothelioma can include any of the previously listed and also dry cough, anemia, blood clots, fever, fluid build-up in lungs or abdomen, difficulty breathing, and more. The same treatments can be applied as in stage 1 and stage 2, but the options decrease as the body becomes weaker from the cancer growing.

Your cancer has progressed and spread to multiple organs when diagnosed with stage 4 mesothelioma. Pain and symptoms are at an ultimate high, and you may struggle to have the energy to complete once-daily tasks. If you or someone you know has reached this stage, their prognosis isn’t good as the mortality rate increases vastly. At this stage, seeking palliative treatments and medicine to ensure quality of life is imperative. Your doctor may only be able to put you on one treatment instead of multiple since the human body can’t handle rigorous treatments during later stages.

Pain Treatments and Medications for Mesothelioma 

Mesothelioma is an aggressive cancer that spreads fast. Palliative treatments and medication can help keep the tumors from growing and spreading, even though they won’t completely eliminate cancer. Patients can live longer and more enjoyable lives by using certain treatments, including pleurodesis, shunt placement, and catheter placements, combined with medications, such as chemotherapy. Most of the mesothelioma palliative treatments are centered around releasing lung fluid built up over time, whereas the medications help manage symptoms and pain from cancer. Please refer to your doctor or primary care physician before implementing these therapies.

Surgery to Remove Fluid Buildup

Those with pleural mesothelioma probably deal with fluid buildup in their body, which may also be known as pleural effusion. It occurs in almost all cases of pleural mesothelioma and can significantly affect one’s breathing. Fluid can build up in either the chest, belly, or heart. Thoracentesis, paracentesis, and pericardiocentesis are all surgical procedures that remove the fluid buildup by extracting it through a needle. Doctors choose which procedure to use based on where the buildup is occurring in the body. These methods can also be used for those who are in the process of getting diagnosed with mesothelioma, as the fluid can be tested after extraction. This is not a permanent fix. Surgery to remove fluid buildup will need to be done consistently, and how often varies from person to person.

Pleurodesis is another method for removing fluid buildup, but its results are more long-term and invasive. The procedure starts with a small cut around the chest cavity and inserting a chest tube so the fluid can drain for one to two days. Then either a talc slurry, an antibiotic, or a chemotherapy drug is added through the tube where it reacts with the lining of the lungs and chest wall, causing them to stick together. This process prevents fluid from building up again. The space where fluid once was pooling is eradicated during pleurodesis and can provide people with mesothelioma relief so they can breathe easier.

Shunt and Catheter Placements

Adding a shunt or catheter as a mesothelioma treatment can help move fluid to another part of the body or control the amount that gets built up. A shunt is a small device that is placed within the body to move fluids from one area to another. This is done to help with fluid absorption since some areas of the body don’t take in fluid; they instead accumulate, which is when mesothelioma patients may start to feel side effects. Part of the shunt has a pump within, and the patient should pump multiple times a day to help move the fluid from one area to another.

A catheter’s job is similar to the process of pleurodesis. An incision is made around the chest where the catheter is placed to have one end inside the patient and the other hanging outside. The part outside of the body can be attached to a bag or bottle where fluid can be drained out regularly. The catheter can be kept in for as long as a doctor sees fit, but it isn’t very conducive to everyday life since a patient would be constantly hooked to the device.

Palliative Chemotherapy Treatment

Chemotherapy is a widely used drug in the cancer world. For mesothelioma, it’s no different. The drug can either works by itself or with a combination of other chemotherapy drugs to kill cancer cells. Chemotherapy for curative care can be used during active treatment efforts of mesothelioma in combination with surgery and other therapies. For chemotherapy palliative care, the treatment cycle can last between 3 to 4 weeks with pain management goals, ensuring higher quality of life and reducing the effects of symptoms. The drug can be administered systemic, injected into the blood through a needle, or intrapleural, injected straight into the lungs or where the cancer is. In some cases, chemotherapy can be heated to help the body react and start killing cancer cells. Common chemotherapy drugs for mesothelioma include:

• Pemetrexed
• Cisplatin
• Carboplatin
• Gemcitabine
• Vinorelbine

Palliative Radiation Treatment

Another widely used cancer treatment is radiation therapy. High radiation doses are known to kill or significantly shrink the size of cancer cells. Though this treatment is also used during the active treatment of mesothelioma, it can be used during palliative care to manage symptoms. Symptoms of advanced mesothelioma can be debilitating and palliative radiation care aims to lower their effects on patients so they can live peacefully. Radiation oncologists can suggest treatment internally or externally. External beam radiation therapy (EBRT) is when the patient lies in a machine and the radiation is beamed through the infected part of the body. Brachytherapy is considered internal radiation therapy since it targets the exact spot where the cancer is by inserting a radiation pouch into the location.

What is Palliative Immunotherapy?

Immunotherapy is the use of drugs to jump-start a person’s immune system and then the body will learn how to defend itself better. To keep the body safe and from attacking itself, the body has created checkpoints which are produced from proteins in the cells that are turned on and off when an immune response is needed. Cancer cells have adapted to hop on these checkpoints and avoid being noticed and attacked by the immune system. In palliative immunotherapy, checkpoint inhibitor drugs can be taken to attack cancer cells that are hiding at the checkpoints. The drugs have to target a specific protein to be successful, and two proteins that are targeted often are PD-1 and CTLA-4.

The PD-1 inhibitor drugs are pembrolizumab and nivolumab. PD-1 role in the body is to keep a body’s cells from attacking one another. Both drugs work similarly to block the PD-1 protein and allow the body to go after any cancer cells, which is known to shrink tumors or slow their growth. The CTLA-4 inhibitor drug is ipilimumab and it is also working to boost the immune system’s response to cancer cells in the body. Some doctors may prescribe both drugs for you to use together. All three drugs are given through IV infusion and can be given every 2-6 weeks.

The use of palliative immunotherapy benefits a person with mesothelioma in their fight against cancer, but with all good things, there is the bad as well. The side effects of using PD-1 and CTLA-4 inhibitors may not be worth it for some. While on these medicines, people may experience cough, nausea, headache, decreased appetite, rashes, and joint pain. You may also experience issues with your infusion or develop an autoimmune reaction. With both, you may experience an allergic reaction to the medication, which could cause some organs in the body to take a beating from the drugs and begin to shut down.

How Long Do Patients Survive in Palliative Care?

Patients who are actively engaged with palliative care treatments and medicines have a one year prognosis after initial diagnosis. The main goal of palliative care is to ensure the quality of life after diagnosis. There are some anomalies in people who have lived several years with mesothelioma, but those cases are rare. Currently, no treatments have successfully rid of cancer for people with mesothelioma. This is why the role of palliative care at an early stage is important.

A patient’s quality and quantity of life can be managed as best as possible by starting a palliative treatment plan. There are many options for mesothelioma palliative care, and a lot of them have been highlighted on this page. There are forms of care for patients looking to stay as painless as possible and treatments that will help keep tumors from growing, so patients can live longer. If you are unsure how to approach palliative care for yourself or a loved one with mesothelioma, contact our experienced patient advocate team.  They are dedicated to help you learn more about your diagnosis, treatment options, medical centers you can visit, and any other questions you may have.