What Is a Prognosis?
A prognosis is an estimate of how a disease will progress. Medical professionals make prognoses for patients based on multiple factors. These include evidence from past patients, patient averages, and individual factors like disease stage, health, and response to treatment.
Doctors may state or describe prognosis in several ways. They may give a patient an estimated life expectancy or survival time, for instance. They may also tell a patient how likely they are to achieve remission.
Doctors can also give patients differing prognoses based on the treatment plan they choose. For example, an aggressive approach may result in a more positive prognosis.
What Is the Life Expectancy for Mesothelioma?
The life expectancy for a mesothelioma diagnosis can be anywhere from a couple of months to just under two years. The median actual survival time for all types and stages of mesothelioma is fifteen months.
What Factors Affect Prognosis?
Each patient will have their own prognosis based on several key factors. It is important to remember that survival time is always an estimate, and they are based on large numbers of patients with similar characteristics.
- Cancer stage – Earlier stages have a better prognosis.
- Type of mesothelioma – Peritoneal mesothelioma has a better outlook than pleural.
- Cancer cell type – Epithelial cells have a better prognosis than sarcomatoid.
- Overall health – Patients otherwise healthy at the time of diagnosis may be eligible for more aggressive treatments and may survive longer.
- Age – Generally younger patients have a better prognosis since they tend to have fewer medical issues.
- Type of treatment chosen – More aggressive and early treatments give patients a better chance at longer survival times.
- Gender – Although the reasons are not known, women survive longer with mesothelioma.
What Are Cancer Survival Statistics?
Survival rate is a common statistic cancer researchers and oncologists use to describe prognosis. Collected information on many patients informs the different measurements for survival rate:
- Cancer-specific survival measures the percentage of patients who survive a specific type and stage of cancer for a period of time, typically one, two, or five years.
- Relative survival compares cancer patients’ survival time to the general population. It does not include just deaths from the cancer but from any cause.
- Overall survival measures the percentage of people with a certain type and stage of cancer who have not died from any cause in a period of time.
- Disease-free survival describes the percentage of patients who have no cancer signs for a period of time after receiving treatment. This is also called progression-free and recurrence-free survival.
What Are the Average Survival Rates for Mesothelioma?
Five-year survival rate is the most common statistic used. It refers to the percentage of patients living five years or longer after an initial diagnosis.
Five-year survival rates are only estimates but are fairly accurate because they are based on a large number of patients; however, every case of mesothelioma is unique. The most accurate prognosis comes from this general statistic and consideration of individual, personal factors.
Taking into account patients with pleural mesothelioma at any stage, the five-year survival rate is 9%. This means that 9% of diagnosed patients live more than five years.
Younger patients can receive different treatment modalities and have a better outlook. One large study, for instance, found that 37% of patients younger than forty-five survived five or more years after a mesothelioma diagnosis. The survival rate for patients forty-five or older at five years was significantly lower, just 20%.
What Is the Prognosis by Type of Mesothelioma?
Prognosis also depends on the type of mesothelioma. Mesothelioma may be pleural, peritoneal, or pericardial, depending on whether it begins in the tissue around the lungs, the abdomen, or the heart.
The five-year survival rates by type are:
There are also three main types of mesothelioma based on cell type: epithelial, sarcomatoid, and mixed. The cell type affects prognosis:
- Epithelial cells stick together more and don’t spread to other areas as readily as sarcomatoid cells. This type is easier to treat and has a better prognosis.
- Sarcomatoid cells spread more readily. This type of mesothelioma comes with a worse prognosis.
- Biphasic tumors contain a mix of both types of cells. The prognosis depends on which cell type predominates.
What Is the Prognosis by Stage?
Staging is the most crucial factor in determining prognosis. Cancer is staged to describe the extent of the tumor, meaning how large it is and what structures it invades around the main tumor. It also describes any metastasis, the spread of the cancer to distant areas of the body.
The American Cancer Society utilizes information from the SEER database, maintained by the National Cancer Institute (NCI), to provide five-year survival rates for patients diagnosed between 2009 and 2015. Instead of using stages of cancer, they group them into three sections:
Localized: The cancer is limited to pleura.
Regional: The cancer has spread to nearby lymph nodes or structures.
Distant: The cancer has spread to other distant parts of the body.
SEER Stage Five-year survival rate
All SEER stages combined 10%
The median survival times for patients given a diagnosis at each stage of pleural mesothelioma are:
- Stage I – 22.2 months
- Stage II – 20.0 months
- Stage III – 17.9 months
- Stage IV – 14.9 months
How Treatment Affects Prognosis
Treatment choice has a big impact on prognosis and survival times. Multimodal treatment, a combination of more than one therapy, provides the best prognosis for most patients.
Many patients with mesothelioma receive a diagnosis in the later stages, making it too late to benefit from curative surgery. Those who qualify may see a significant improvement in prognosis.
Aggressive procedures may extend life expectancy, but they also come with risks. Surgery to remove a long, for instance, can cause complications but for some patients, it can lead to remission.
Patients usually get the best results from combining surgery and chemotherapy. Peritoneal mesothelioma patients, for instance, benefit significantly from cytoreductive surgery followed by HIPEC, a circulation of chemotherapy drugs throughout the abdomen.
Patients not eligible for surgery can improve their prognosis with chemotherapy. This treatment slows the spread of cancer and may even shrink tumors. Studies show that patients undergoing chemotherapy live as long as 12 months as compared to 4 months for patients receiving no treatment.
Doctors may include radiation therapy with chemotherapy or surgery. By itself, radiation does not have much impact on prognosis for mesothelioma patients. Other more experimental treatments, like cryotherapy or photodynamic therapy, may also help improve prognosis.
What Else Affects Prognosis?
Prognosis is a complicated measurement that is never 100% accurate. In addition to stage, type, and treatment choices, several other factors impact an individual patient’s outcome:
- Cell Type. By cell type, mesothelioma can be epithelioid, sacromatoid, or biphasic, a mix of the two. Epithelioid cells spread less readily, so the cancer progresses more slowly. Prognosis is better for epitheliod mesothelioma than for biphasic or sarcomatoid.
- Age and Health. Older patients and those in poorer health generally have a worse prognosis. Younger and healthier patients can tolerate more aggressive treatments.
- Gender. Although not fully understood, women live longer with mesothelioma than men. One explanation may be that peritoneal mesothelioma is more common in women and more treatable.
- Response to Treatment. Just as important as the treatment they choose, a patient’s response to it affects prognosis. If the side effects are too intense, for instance, a patient may not complete treatment.
How to Improve Your Prognosis
After a diagnosis of mesothelioma, there are some steps you can take to try to improve your outlook. One of the most important steps you can take is getting treatment from a mesothelioma specialist team.
- Start treatment immediately. Work with your specialists to put together a treatment plan as soon as possible and start it right away. The more aggressive the treatment, the better the prognosis.
- Combine therapies. Some patients cannot have surgery, but they can be given chemotherapy and radiation therapy to shrink tumors or slow the growth rate. For those who can have surgery, the procedure to remove as much of the tumors as possible is often followed by chemotherapy and radiation to eliminate more of the cancerous tissue.
- Consider aggressive treatment. Some of the surgical procedures that give pleural mesothelioma patients the best outlook are aggressive. They involve removing a lot of tissue, and in the case of one procedure, an entire lung.
- Choose HIPEC for peritoneal mesothelioma. Patients with peritoneal mesothelioma who choose a treatment called heated intraperitoneal chemotherapy, or HIPEC, have some of the best survival rates. The treatment involves circulating heated chemotherapy drugs through the abdominal cavity, as opposed to administering the drugs intravenously.
- Join a clinical trial. Another approach to extending the life expectancy of a patient after a mesothelioma diagnosis is to try experimental therapies. Trials determine the safety and the efficacy of new treatments. Patients with terminal conditions are usually chosen to be a part of the trials. There are risks associated with clinical trials, but they can also lead to positive results.
- Try alternative and complementary medicine. While treatment by specialists is most important, other factors can potentially improve your prognosis and certainly help you feel more comfortable. Make healthy lifestyle choices such as quitting smoking, exercising more, and eating well. Try alternative therapies–such as acupuncture or aromatherapy–to complement traditional treatment.
Living with a Negative Prognosis
A poor prognosis is difficult, especially while you are also feeling unwell and trying to make big treatment choices. With support from loved ones, coming to terms with this is easier.
Rely on Friends and Family
Most importantly, you need strong social support. Keep your family and friends close, and let them help you. Let them lend a shoulder to cry on, be someone to shout at, or just be there when you feel you can’t be alone. If you have the people you love around you, the prognosis will be much easier to live with.
Connect with Other Asbestos Victims
As much as family support systems may be there for you and willing to help, they can’t fully understand your situation. It helps to have connections with other people struggling with cancer and mesothelioma.
Look for a support group you can meet with, online or in person, to talk about your feelings and experiences. This can help you to feel better about accepting your mesothelioma diagnosis.
Is it Possible to Be Cured of Mesothelioma?
Yes, although this is extremely rare. Doctors are unlikely to tell their patients that they have a chance of curing the disease. They speak in terms of extending life expectancy or achieving remission.
Curing mesothelioma is most likely in the earliest stages, before the cancer spreads. It is also more common with aggressive and quick treatment that a patient can tolerate to completion.
Is Remission Possible, and What’s the Difference?
Remission is possible with mesothelioma, but it’s not the same as curing cancer. Cure means no signs of cancer at all and that it never returns.
Remission means there are no detectable signs of cancer. Some cancer cells may remain in the body, leading to a later recurrence. After several years of complete remission, a patient may be considered cured.
If you achieve remission with mesothelioma, it is important to keep up with regular screenings. If it returns, you want to catch it early and begin treatment right away.
How Could COVID-19 Affect Prognosis?
Patients with mesothelioma faced a new threat with the pandemic. According to a study, 20% of patients with mesothelioma received a diagnosis of COVID-19. This led to more hospitalizations and severe illness in this population.
Thoracic cancers like pleural mesothelioma make patients more vulnerable to severe illness with COVID-19. Being diagnosed with the infection worsens the overall prognosis for someone with mesothelioma.
Seeking justice for the harm caused can bring some peace of mind during this difficult time. Filing a lawsuit or taking part in an asbestos trust fund can also provide you and your family with much-needed compensation. An experienced mesothelioma lawyer can help you take the next step to get justice and compensation.
Page Medically Reviewed and Edited byLuis Argote-Greene, M.D.
Luis Argote-Greene is an internationally recognized thoracic surgeon. He has trained and worked with some of the most prominently known thoracic surgeons in the United States and Mexico, including pioneering mesothelioma surgeon Dr. David Sugarbaker. He is professionally affiliated with University Hospitals (UH). His areas of interest and expertise are mesothelioma, mediastinal tumors, thoracic malignancies, lung cancer, lung transplantation, esophageal cancer, experimental surgery, and lung volume reduction. Dr. Argote-Greene has also done pioneering work with video-assisted thoracoscopic surgery (VATS), as well as robotic assisted minimally invasive surgery. He has taught the procedures to other surgeons both nationally and internationally.