What Is Life Expectancy and Survival Rate?
Life expectancy is the amount of time a patient is likely to live after a specific diagnosis. Several factors determine life expectancy, but it is not set in stone. Patients can take steps to improve their life expectancy, such as getting treatment.
Life expectancy is an individual estimate made for each patient, but it can also be applied generally to the population with mesothelioma. On average, life expectancy for mesothelioma patients ranges from 12 months to 21 months.
Survival rate is a more general measurement. It is the percentage of patients who lived for a certain period of time after a diagnosis. It is usually measured as a percentage of survival after five years.
It’s important to talk to your treatment team about life expectancy, what it means, and what you can do about it. An understanding of this term, and how it applies to you, impacts the decisions you make.
How Is Life Expectancy Measured?
As a general statistic, researchers calculate life expectancy as a time period based on average survival numbers. For instance, the median life expectancy for stage I mesothelioma based on what has actually happened to patients is about 22 months.
For an individual patient, life expectancy is an estimate based on multiple factors, not a specific measurement. Your life expectancy depends on your circumstances and illness and is not definite or exact.
What Do Doctors Mean by Prognosis?
Prognosis is a term used to describe the expected outcome of a disease. When a doctor gives you a prognosis, they may provide details about how the disease will progress, expected life expectancy, and probable outcomes of treatment.
Your doctor may also give you a very simple prognosis of positive or negative. They may offer it in terms of your chances of achieving remission.
Talk to your medical team about prognosis, based on your individual circumstances. Prognosis can change as you undergo treatment and can help you make decisions about the next steps to take.
What Factors Affect Life Expectancy?
Life expectancy is a general estimate of how long you may live with your cancer. Medical specialists make this estimate by considering both the specifics of your disease and averages based on past patients.
While no one can make an exact prediction, several individual factors provide a fair estimate:[2]
- The kind of mesothelioma diagnosed (pleural, peritoneal, or pericardial) and the stage of the cancer at diagnosis
- The type of cells that became cancerous
- Whether the cancer has spread to other areas of the body
- Overall health, which includes age, fitness, smoking status, and the presence of other illnesses or diseases
Location of the Primary Tumor
An important variable in estimating life expectancy is the location of the original tumor:
- Pleural mesothelioma is the most common form and affects the pleural tissue lining the lungs.
- Peritoneal mesothelioma is the next most common, originating in the lining in the abdominal cavity.
- Pericardial mesothelioma affects the lining of the heart and is rare.
- Testicular mesothelioma affects the lining of the testes and is extremely rare.
Peritoneal Mesothelioma
Peritoneal mesothelioma usually has the longest life expectancy, followed by pleural mesothelioma.[2] Because the peritoneal form is in the abdomen, patients can usually tolerate more aggressive treatments. For example, surgery followed by heated chemotherapy instilled directly into the peritoneal cavity, or HIPEC is effective but not available for other types of mesothelioma.
Pleural Mesothelioma
Although more common, the life expectancy of pleural mesothelioma is shorter than for peritoneal mesothelioma. One reason for this is the difficulty of providing treatment to the chest cavity. Both surgery and radiation are risky and can potentially cause damage to the lungs and heart.
Pericardial Mesothelioma
Pericardial mesothelioma is incredibly rare, and the prognosis is poor. Because so few patients are diagnosed, it can be difficult to provide specific information on estimated survival.
A recent review of 103 published cases found that the overall median survival time for pericardial mesothelioma is six months.[3] However, those who received chemotherapy had a median survival of thirteen months.
Testicular Mesothelioma
Testicular mesothelioma is the rarest subtype, making survival time estimates impossible. The first documented case was in 1957, and only about 250 cases have been reported since then. Overall prognosis varies but is generally poor.[4]
Median Life Expectancy by Stage
The stage of the cancer is often even more important than primary tumor location in estimating life expectancy. Stage designation describes the extent of the cancer’s local, regional, and distant spread in the body.
The earlier the stage, the longer the life expectancy; however, other factors must also be considered.[5]
Mesothelioma is typically staged from one to four:
- Stage I
Stage I is an early diagnosis and rare for mesothelioma. It means the original tumor remains local. It may have penetrated the tissue surrounding the pleura. Based on averages from previous cases, the life expectancy in stage I is 22.2 months. - Stage II
By stage II, the tumor has invaded tissues like the lung and diaphragm. The average life expectancy is 20 months. - Stage III
In stage III, mesothelioma has spread farther, possibly into the lymph nodes. Patients with stage III mesothelioma have an average life expectancy of 17.9 months. - Stage IV
By stage IV, the cancer has spread into lymph nodes and possibly into more distant sites in the body. Life expectancy at this stage is just 14.9 months.
Cell Type and Life Expectancy
Another important factor in determining mesothelioma life expectancy is the cell type or pathology. There are three main categories of cell type:
- Epithelioid
- Sarcomatoid
- Biphasic, a mixture of epithelioid and sarcomatoid
Sarcomatoid cells are more loosely attached, making it easier for them to spread to other areas of the body. Sarcomatoid mesothelioma metastasizes more rapidly and has a lower life expectancy than the epithelioid type.[2]
Biphasic mesothelioma contains a mixture of epithelioid and sarcomatoid cells. The ratio of these cells will determine how the cancer tends to act. For example, if you have more sarcomatoid cells, then the cancer will spread more aggressively.
Lifestyle Factors
The stage, cell type, and location are most useful in estimating life expectancy. Several individual factors also impact survival time. Some are things the patient can control, like smoking. Others are beyond the patient’s control, including their age. Younger patients and non-smokers have a better life expectancy.
Doctors often use something called a performance status to help gauge a patient’s overall health. This is not an evaluation of medical status or age; instead, it looks at how functional and active a person is.
A higher performance status generally means a patient has a longer life expectancy.
For example, a person who can perform all of their daily functions independently is considered to have a higher performance status. This includes things such as taking a shower, dressing and walking around independently.
Patients who spend most of their time in bed and need people to help them with routine functions have poor performance status. This factors into what treatment options may be most appropriate for a patient.
Several lifestyle factors affect performance status. Staying active both mentally and physically is beneficial to overall health and may allow a person to receive more aggressive treatment for a better life expectancy.
How Can I Improve My Mesothelioma Life Expectancy?
So much of what goes into life expectancy estimates is out of a patient’s control. There are always some things you can do to improve this metric:
- Seek medical treatment from a qualified mesothelioma specialist. They have access to the latest and most successful treatment options.
- Choose the most aggressive treatments for which you qualify and begin them as soon as possible after your diagnosis.
- Quitting smoking helps extend life expectancy.
- Staying as active as possible and eating well also help.
- Social and spiritual support to keep up spirits may improve treatment tolerance.
Which Factors Can I Not Control?
It’s important to understand that you cannot change or control everything about this illness. The stage at which you received a diagnosis, the location of the cancer, and the cell types, for instance, cannot change.
Although it may be difficult to accept, you cannot completely control the outcome of this illness. Focus on what you can control and make treatment decisions based on your goals for the future.
How Does Life Expectancy Inform Treatment?
How an estimate of life expectancy influences treatment choices depends on each individual patient. Some people are inspired to challenge it and to seek out aggressive treatments to extend life expectancy.
Other patients want to enjoy the time they have left and choose more palliative care to help them remain comfortable. Some try aggressive treatments but don’t like the side effects and decide to refocus on palliative therapies.
You should know your life expectancy so that you can make the treatment choices that are right for you and your loved ones.
Survival Rates
Doctors use a statistic called survival rate as another way to estimate life expectancy. The five-year survival rate is the percentage of patients who live five years or more after receiving a cancer diagnosis.[7]
The five-year survival rate takes into account large populations of cancer patients. For mesothelioma survival rates, only mesothelioma patients are measured. Although these numbers are useful, a prognosis is still only an estimate.
Five-year survival rates for mesothelioma are generally low compared to many other types of cancers. Patients diagnosed with mesothelioma at a younger age have one-year and five-year survival rates of 37% and 38%.[8]
Treatment Changes Life Expectancy
When looking at average statistics and survival rates, there are clear patterns in how treatment impacts patient survival. Multi-modality treatment, meaning a combination of aggressive surgery, radiation, and chemotherapy, improves survival rates:
- Average life expectancy extends from 15 to 23 months when patients receive multimodal treatment.[8]
- Survival rates increased significantly when surgical treatments were added to chemotherapy.
- However, in some cases the risks of very aggressive surgeries, like an extrapleural pneumonectomy, reduced survival time.[9]
Patients with peritoneal mesothelioma can extend life expectancy by combining surgery with heated chemotherapy, a procedure known as HIPEC. Studies have shown that this treatment significantly improves survival rates.[10]
Living with a Difficult Prognosis
Being diagnosed with mesothelioma is difficult and frightening. Receiving a poor prognosis can be shocking, but these steps can help you cope and even improve life expectancy:
- Rely on the love and support of family and friends. Let them help you by listening and providing practical assistance, like rides to appointments.
- Choose the treatments that are best for you. Aggressive treatments can extend your life, but they may also decrease quality of life.
- Include palliative care. Palliative services help relieve symptoms and address emotional and spiritual needs.
- Join support groups. Support from others in a similar situation is beneficial and comforting.
As a final step in coming to grips with your prognosis, you may consider starting a lawsuit to seek justice for the illness you are facing. If you were exposed to asbestos, a company can probably be held liable. A lawsuit can give you a sense of justice and closure but can also provide financial assistance for medical care. These funds can also help loved ones after you are gone.
Even without a lawsuit, you will be facing difficult legal decisions that you and your family will want to discuss. This includes identifying a legal representative to speak on your behalf for medical and financial decisions if you are not capable of doing so.
