Palliative Care for Mesothelioma
Palliative care includes types of treatment whose primary goal is reducing painful or immobilizing symptoms and side effects of the disease. Surgery, radiation, and chemotherapy can be used as palliative care to remove or shrink tumors as well as to prevent them from spreading. Steroids, pain medicine, and some lifestyle changes can also increase patients’ comfort and physical independence during end-of-life treatment.
Medically Reviewed by: Dr. Emma Hegwood, D.O | July 29th, 2024
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What Is Palliative Care?
In patients with advanced mesothelioma or patients whose bodies are not strong enough to undergo invasive treatments, palliative care is often the only available treatment option. This type of treatment is designed to relieve pain caused by the disease and its accompanying symptoms, such as tumors that make it hard to breathe for lung cancer and mesothelioma patients. 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 Is the Difference Between Curative and Palliative Care?
Mesothelioma is a rare and aggressive cancer caused by asbestos exposure, and it is a terminal illness with no known cure. While this is a daunting diagnosis, understanding the available treatments can help patients make informed decisions about their care. Curative treatments aim to remove as much of the cancer as possible and extend life expectancy, though a complete cure is not guaranteed. Palliative care focuses on managing pain, symptoms, and emotional distress to improve quality of life and can be used alongside curative treatments or as the primary focus, depending on the disease stage. As treatments continue to improve, it is important to seek personalized support from a mesothelioma specialist to explore your options and receive tailored care.
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. While mesothelioma is a daunting diagnosis, understanding the available treatments can help patients make informed decisions about their care. Palliative treatments aim to remove as much of the cancer as possible and extend life expectancy, though a complete cure is not guaranteed. Palliative care focuses on managing pain, symptoms, and emotional distress to improve quality of life and can be used alongside curative treatments or as the primary focus, depending on the disease stage. 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
Mesothelioma Palliative Care Options
The symptoms of mesothelioma can range from uncomfortable to painful to life-threatening. However, there are various options available to relieve pain and mitigate these symptoms, including surgical procedures, chemotherapy, radiation, steroids, pain medicine, and complementary therapies.
Surgery
Surgery can be used both curatively and palliatively. Curative surgery aims to remove as much of the cancer as possible, but by stages 3 or 4, complete eradication becomes nearly impossible due to extensive spreading. However, palliative surgery may still be performed to help manage pain and provide symptom relief. This involves cutting and debulking physical tumors to improve the patient’s quality of life. It’s important to consider that surgery carries higher risks due to the need for different anesthesia and the invasiveness of the procedures.
Interventional Procedures (Non-Surgical)
Interventional procedures are less invasive than surgery and can also be used to increase quality of life and decrease pain. These procedures include thoracentesis and pericardiocentesis, which involve draining excess fluid from the chest or pericardial area to alleviate discomfort and improve breathing. While these procedures are invasive, they do not involve the extensive cutting and debulking associated with surgery, and they carry different risks and benefits. Decisions on whether to pursue surgery or interventional procedures depend on various factors, including the patient’s overall health, the stage of the disease, and the specific symptoms being addressed. Understanding the differences between these options is crucial for making informed decisions about your care. Consulting with a mesothelioma specialist can provide personalized guidance tailored to your unique situation.
Palliative Surgical Options for Pleural Mesothelioma
Palliative treatment options for pleural mesothelioma help 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 surgery, 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 to a different area of the body where it may be better absorbed. While often associated with peritoneal mesothelioma, shunts may also be used to treat 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.
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Chemotherapy as a Palliative Treatment
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 mesothelioma 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 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.
Palliative Radiation Treatment
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 chest wall or abdominal cavities. It is administered in two ways: externally or internally. These are known as external beam radiation therapy (EBRT) and brachytherapy, respectively.
Common side effects mesothelioma patients may experience with radiation include fatigue, sunburn-like skin irritation, dehydration, 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.
Steroids and Pain Medicine
Many mesothelioma patients experience fatigue, weakness, loss of appetite, and weight loss, both as symptoms of the disease itself and as side effects of treatment. Steroids can help increase energy and appetite, helping patients maintain active lives before, during, and after treatment. Steroids can also be effective to reduce inflammation, especially after surgery. Steroids have short and long term side effects and your doctor will decide if steroids should be used or not.
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, hydrocodone, or oxycodone, 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 and Lifestyle Changes
Complementary therapies such as acupuncture, massage, and hypnosis are just some options that can help with pain and symptom management. 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 mesothelimoa 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
Emotional Support and Counseling After Prognosis Update
Coping with a mesothelioma diagnosis can be challenging, making emotional support even more essential. Counseling and therapy can provide invaluable guidance as you navigate the complexities of the disease. A mental health professional can help you process your emotions, make difficult decisions, and develop effective coping strategies. They can also offer crucial support to your family and caregivers, ensuring everyone involved receives the care they need. If you’re struggling emotionally, don’t hesitate to seek help. Your mental well-being is just as important as your physical health and professional support can make a significant difference in your overall quality of life.
Hospice Care for Mesothelioma Prognosis
Hospice care is a specialized type of palliative care focused on providing comfort and support for individuals with a terminal illness, typically when a life expectancy of six months or less is anticipated. Unlike palliative care, which can be provided at any stage of illness, hospice care is specifically designed to address the unique needs of patients nearing the end of life. The emphasis is on pain management, symptom relief, emotional support, and spiritual care. Hospice care can be provided in a patient’s home, a hospice facility, or a hospital. A hospice care team includes doctors, nurses, social workers, chaplains, and trained volunteers who work together to provide comprehensive care and support for the patient and their family.
Affording Palliative and/or Hospice Care
Despite not being curative, mesothelioma palliative care can still be expensive, especially when the patient doesn’t have insurance. For those who have been diagnosed with mesothelioma and need help with the costs of treatment, legal compensation is available. Reaching out to a law firm that specializes in mesothelioma cases can be exactly what you need to help with the bills.