In patients with advanced mesothelioma or elderly patients whose bodies are not strong enough to undergo aggressive, potentially curative treatments, palliative care is often the only available option. This type of treatment is designed to relieve pain caused by the disease and its accompanying symptoms. Palliative procedures may be used to slow the cancer’s growth and improve a patient’s quality of life. Palliative care can also be combined with curative treatment to provide relief from both the symptoms of mesothelioma and the side effects of treatment.
What’s the difference between curative and palliative care?
Curative treatment aims to remove as much of the cancer as possible and extend the patient’s life expectancy. Palliative care focuses on providing pain and symptom relief.
Factors Affecting Treatment
Treatment options vary on a case-by-case basis. Each patient will have unique driving factors that determine their course of treatment. The main factors affecting the treatment of mesothelioma are:
- Type of mesothelioma (pleural, peritoneal, or pericardial)
- Cell type present in mesothelial tumors (epithelioid, sarcomatoid, or biphasic)
- Stage or extent of the cancer’s spread (metastasis)
- Location and size of tumor(s)
- Patient age and overall health
Palliative Mesothelioma Treatments
The symptoms of mesothelioma can range from uncomfortable, to painful, to life-threatening. However, there are things you and your doctors can do to relieve pain and mitigate these symptoms. Some of these options include surgical procedures, chemotherapy, radiation, steroids, pain medicine, and complementary therapies.
Surgery can be used curatively or palliatively. When possible, surgery is performed in an effort to remove the cancer in its entirety. Unfortunately, by stage 3 or 4, eradication becomes nearly impossible due to extensive spreading. However, surgical procedures may still be performed as part of palliative care to help with pain management and symptom relief.
Palliative surgical options for pleural mesothelioma
Palliative treatment options for pleural mesothelioma help to decrease chest pain and make it easier for the patient to breathe. These options include thoracentesis (also known as a pleural tap), in which a doctor uses a needle to remove excess fluid from around the lungs, and pleurodesis, a procedure that seals up the space between the outer lining of the lung and chest wall to prevent future fluid buildup around the lungs.
Palliative surgical options for peritoneal mesothelioma
Similar to pleural mesothelioma, paracentesis — the equivalent of thoracentesis — can be performed as a palliative treatment to remove built-up fluid in the abdomen.
Shunts are an additional palliative option used to manage fluid buildup. This procedure uses a tube with a pump to allow the fluid to move into a different area of the body where it may be better absorbed. While often associated with peritoneal mesothelioma, shunts may also be used for treating patients with persistent fluid buildup in the lungs and chest cavity.
Palliative surgical options for pericardial mesothelioma
Because pericardial mesothelioma is so rare, there are few specialty treatments available. However, pericardiocentesis is the main palliative treatment option. This procedure uses a needle to remove fluid buildup around the heart. It can help relieve symptoms like chest pain and difficulty breathing. It may be followed by chemotherapy to provide further pain relief and management. Radiation is not typically used to treat pericardial mesothelioma, as it can cause damage to the heart.
Oncologists often use a combination of chemotherapy, or anti-cancer drugs, to treat mesothelioma. It can be used as a standalone treatment or in conjunction with other forms of curative and palliative care. Though chemotherapy may be used as a curative treatment, it can also help patients with advanced mesothelioma keep the tumor(s) from growing and causing additional pain. For instance, ALIMTA®, the trade name for pemetrexed, is often used along with cisplatin for treating unresectable mesothelioma tumors (those that cannot be removed with surgery).
Chemotherapy is given either in the form of pills or intravenously. In the case of mesothelioma, it can be administered through the chest (intrapleural) or the abdomen (intraperitoneal). Unlike radiation, chemotherapy attacks healthy cells as well as malignant cancer cells. This means that, though chemotherapy helps to keep the cancer and pain at bay, it takes a toll on the body. Common side effects include nausea, hair loss, weight loss, vomiting, and general fatigue. Doctors can usually work with patients to alleviate these additional symptoms.
Radiation, sometimes called radiotherapy, is often used as a palliative form of care for patients who are in poor health and cannot undergo more intrusive treatments. It can be used to shrink tumors and alleviate pain caused by pressure in the lung or abdominal cavities. It is administered in two ways: externally or internally. These are known as external beam radiation therapy (EBRT) and brachytherapy, respectfully.
Common side effects mesothelioma patients may experience with radiation include fatigue, sunburn-like skin irritation, and localized hair loss. Prolonged chest radiation can cause damage to the lungs, resulting in difficulty breathing. Conversely, abdominal radiation may induce nausea or vomiting, diarrhea, and loss of appetite. The side effects associated with radiotherapy tend to be milder than those experienced with chemotherapy.
Many mesothelioma patients experience fatigue, weakness, loss of appetite, and weight loss. Steroids can be administered as part of a palliative care plan to increase the patient’s energy and appetite, helping them maintain active lives for as long as possible. Steroids can also be effective to reduce inflammation, especially after surgery.
Your doctor may recommend over-the-counter pain medicine, such as acetaminophen or ibuprofen, for mild symptom relief. They may prescribe stronger pain relievers, such as morphine, Vicodin, OxyContin, or Percocet, to address worsening symptoms or the effects of treatment. Nerve blocks may also be used to target pain in specific areas of the body.
Complementary therapies such as acupuncture, massage, hypnosis, and ozone therapy can help with pain and symptom management, while practices like yoga, meditation and prayer can ease mental strain and emotional tension. Many mesothelioma patients (as well as friends and family members) also find it helpful to seek counseling or join a support group.
While a healthy lifestyle won’t cure your cancer, it can help strengthen your body, making it more receptive to treatment. Healthy changes that can significantly improve your well-being while living with mesothelioma include:
- Refraining from smoking
- Exercising regularly (without overexerting yourself)
- Eating a healthy diet
- Avoiding alcohol
- Getting plenty of rest