Palliative Treatment for Mesothelioma

Palliative treatment for mesothelioma helps patients get relief from side effects and symptoms. The overall goal is to improve a patient’s quality of life. Traditionally used in hospice care for end-stage patients, these supportive treatments are increasingly used for patients in all stages.

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What Is Palliative Treatment for Mesothelioma?

Palliative treatment is any type of care provided for a patient with a serious or terminal illness to improve quality of life.

Instead of solely treating a disease, it focuses on factors that affect symptoms as well as prioritizing personalized care. Treatment is geared towards what matters most to patients. Palliative treatment includes all kinds of supportive care:[1]

• Physical and medical treatments
• Pain management
• Management of cancer side effects
• Management of treatment side effects
• Psychological, social, and spiritual care

While some strategies and procedures overlap, palliative care is not the same as cancer treatment. The difference is the goal:

• The goal of cancer treatment is to cure, slow, or stop the progression of the disease.
• The goal of palliative treatment for mesothelioma is to improve quality of life through symptom relief.

Many patients with mesothelioma benefit from both palliative and non-palliative treatments.

Palliative Care and End-of-Life Treatment

Palliative treatment is often associated with terminal illness and the end of a patient’s life. It is an essential part of end-of-life care for mesothelioma patients, but it is not restricted to terminal or late-stage patients.

What Happens at the End of Life in Mesothelioma?

The end of life for any patient is challenging. Stage 4 mesothelioma can be particularly painful, which is why palliative care is so important.

During stage 4, mesothelioma tumors have metastasized to more distant parts of the body, such as the opposite lung, the kidneys, the liver, or the brain.

Metastatic, end-of-life mesothelioma causes a range of uncomfortable symptoms that palliation can relieve to some extent:

• Difficulty swallowing and eating
• Difficulty breathing
• Loss of appetite
• Extreme weight loss and fatigue
• Severe pain
• Coughing with blood
• Fever
• Night sweats
• Malaise

Is Palliative Care the Same as Hospice Care?

Hospice and palliative care are often associated, but they are not the same thing. The main difference is life expectancy. Patients enter hospice care when they are in the end stages of an illness, typically with less than a year to live.

Palliative care, on the other hand, is available to patients at any stage of a severe or terminal illness. Their life expectancy doesn’t come into the equation. Hospice care may be delivered in a hospice facility or in the patient’s home.

How Mesothelioma Patients Benefit from Palliative Care

Studies find that malignant mesothelioma patients have a high burden of symptoms: shortness of breath, fatigue, chest pains, loss of appetite, and cough, among other less common symptoms. They also experience distress, uncertainty, and a sense of lack of control.

• Management of symptoms to improve quality of life is the main reason to use palliative care. Patients may struggle with severe, uncomfortable, and painful side effects of cancer and its treatments without treatment for symptoms.
• Palliative care may extend life expectancy. Studies have shown that cancer patients with early access to palliative care enjoyed a better quality of life and also had improvd survival times.[2]
• Palliation is good for mental health. Palliation can help patients physically but also give them better control over their quality of life, which improves mental health. Studies show improval in key markers of mental health, like depression.[2]
• Palliative care helps prevent and minimize complications. Patients with mesothelioma may have related complications that interfere with treatment and quality of life. Good palliative care can catch these early or even prevent some.

Historically, palliative care was reserved for patients in the latter stages of cancer. However, research supports early palliative care, especially for those cancers that tend to be aggressive with shorter survival trends.

Palliative care can work in conjunction with the medical and surgical oncology teams to provide patient-centered care. Mesothelioma is a particularly painful cancer, and palliation early on in the disease can be beneficial.

What Is Palliative Treatment for Lung Cancer?

Pleural mesothelioma is most often associated with asbestos exposure, but exposure can also cause lung cancer. The prognosis is not always as poor with asbestos lung cancer, but it is still a difficult, often terminal illness.

Palliative treatment for asbestos lung cancer is often the same as for mesothelioma patients. Exact treatments vary depending on the patient, but there is a lot of overlap with palliation for mesothelioma.

Does Palliative Care Improve Prognosis?

The goals of a palliative care plan generally do not include prolonging life. However, palliation can help patients live longer. It cannot change the fact that mesothelioma is terminal, nor does it treat the cancer itself, but it can help patients feel better.

This is important because when patients feel better and are healthier, they can tolerate more aggressive treatments. As a result, they may live longer.

Which Mesothelioma Patients Are Eligible for Palliative Care?

Many people assume that palliative care is restricted to late-stage cancer patients. This isn’t true. Accepting palliative care does not mean that you are dying or even in the later stages. It simply means you want to receive medical care that helps you feel better.

Anyone with a diagnosis of mesothelioma or another severe or terminal illness can benefit from palliative care. Early palliation may help patients live longer, enjoy a longer, better quality of life, and avoid later risky and aggressive treatments.

Who Provides Palliative Treatments?

When choosing palliative care, patients usually work with a specialist or a dedicated palliative care team. They have specialty training in palliative care and can create a strategy with the patient and their family.

If a dedicated team is unavailable, the medical care team can certainly have a more palliative approach and work to provide the support that best fits an individual’s goals.

Physicians provide the actual medical procedures. The palliative care specialist will also reach out to other caregivers to help implement the plan:

• Pain specialists
• Holistic care providers
• Pharmacists
• Physical therapists
• Psychologists
• Spiritual leaders
• Complementary and alternative medicine practitioners

Where Do Patients Receive Palliative Care?

Palliative care occurs wherever patients receive treatment: hospitals and medical centers, cancer centers, physician and specialist offices. They can also receive care or use treatments at home. Hospice facilities provide palliative treatment.

Palliative treatments do not have to wait until a patient is in hospice care. Hospice may be in a medical facility or at home, but care is provided to patients at the end of their lives. Palliative care does not require enrollment into hospice.

Palliative care becomes especially important in hospice, where it provides relief, comfort, and the best possible quality of life for the time a patient has left.

Palliative Treatments for Pleural Mesothelioma

Patients living with pleural mesothelioma experience several difficult symptoms, including pain, a relentless cough, and difficulty breathing. Several treatments, including surgery, chemotherapy, and radiation therapy, can be used for relief and palliation:

• Thoracentesis. This is the draining of fluid from the chest cavity, a typical source of discomfort, pain, and difficulty breathing. The surgery is minimally invasive, using a thin needle.[3]
• Pleurodesis. To prevent recurring fluid buildup, a doctor may insert a tube to inject a medicine that causes the pleural tissue to adhere to the chest wall.[3]
• Pleurectomy/decortication. This surgery can be used to slow disease progression but also to palliate. Removing cancerous tissue helps to relieve symptoms.[4]
• Chemotherapy. Chemotherapy can be used alone to reduce tumor size, which may relieve some symptoms. The downside is that it causes side effects that patients find difficult to tolerate.
• Radiation therapy. When focused on the tumor in the chest, radiation can shrink tumors and relieve the pressure they put on surrounding tissues, relieving pain. Studies show radiation is particularly useful in relieving pain in localized areas.[5]

Palliative Treatments for Peritoneal Mesothelioma

Many of the same strategies used for pleural mesothelioma palliation can be applied to the peritoneal patient. Paracentesis is the term for removing fluid from the abdomen.[4] Standard chemotherapy may provide some benefits, but radiation is not generally used for peritoneal mesothelioma.

The buildup of fluid in the abdomen, known as ascites, can be particularly uncomfortable for peritoneal patients. Specialists who provide HIPEC, a debulking surgery followed by heated chemotherapy, may offer this service for palliation. It is generally used to slow or cure the cancer, but studies have also found it can improve quality of life as a palliative treatment.[6]

Palliative Treatments for Pericardial Mesothelioma

Managing this rare type of mesothelioma is especially challenging because it is so close to the heart. A percardiocentisis a surgical procedure that can be used to drain fluid from around the heart, which relieves pressure and pain.[3] Chemotherapy may also help relieve symptoms, but radiation is ineffective with pericardial mesothelioma.

A surgical procedure known as a pericardiectomy may help relieve symptoms specific to this type of mesothelioma. It involves removing part or all of the pericardium around the heart. This may help relieve pressure on the heart, which is both uncomfortable and dangerous.[7]

Mental Health Care for Mesothelioma Patients

Mesothelioma therapy or cancer therapy is often considered palliation. It does not help cure cancer, but mental health care does improve quality of life.

Therapists trained to work with cancer patients can provide an outlet for emotional expression and tools for coping with end-of-life fears and anxiety.

Managing Pain with Mesothelioma

For any type of mesothelioma, pain is a major symptom and focus of palliative treatment. The medical treatments used for each type can help relieve pain but are often not adequate.

Medications and other management strategies can help reduce pain or make it more tolerable:

• Over-the-counter pain medications, including acetaminophen and ibuprofen
• Prescription opioids for more moderate, severe, or breakthrough pain
• Nerve blocks, which are injected and block pain signals
• Cervical cordotomy, which involves creating a permanent lesion in the spine and has shown beneficial to mesothelioma patients[8]

Pain management is a complicated science that is different for everyone. One thing that can help is to keep a pain diary. Patients record the type of pain, location, severity, and related factors or incidents with a pain diary worksheet.

This information helps a patient’s medical team understand what is causing the pain, factors that make it worse, and which treatments help.

Complementary and Alternative Therapies

Most complementary and alternative (CAM) practices are unproven to help treat cancer. CAM treatments can help manage symptoms and play an important role in palliative care.

For example, a study from MD Anderson Cancer Center included 375 cancer patients and found that acupuncture relieved several symptoms: fatigue, hot flashes, numbness, nausea, and dry mouth.[9]

CAM may also include aromatherapy, massage therapy, herbal supplements, and other strategies. Patients may have a CAM specialist on their treatment or palliative care team. Some CAM practices may help some patients feel better or not work for others. Most are safe to try, though.

Late-Stage Mesothelioma and Palliative Care

Patients at any stage of mesothelioma benefit from quality palliative care. However, palliation becomes especially important in the later stages. This is when the symptoms, such as pain, difficulty breathing, and fluid buildup, worsen and even become debilitating.

Any type of late-stage cancer can be very painful, uncomfortable, and frightening, as treatments fail to slow or stop cancer’s growth. These patients need thoughtful, effective, and high-quality palliative treatments. It should become the focus of a treatment plan.

Is Palliative Care Right for Me?

If you have mesothelioma, talk to your medical team about palliative care. Explain your symptoms and your goals. The earlier you address these, the more effective palliative treatment will be.

When Should I Start Mesothelioma Palliative Care?

Being very sick or even terminal does not mean you have to live with unbearable symptoms. Palliation is effective and beneficial. You may even live longer by strengthening yourself for cancer treatments.

Palliation can also help you cope with the fact of having a terminal illness. Consider palliative treatments if you have a diagnosis of mesothelioma at any stage. There is no need to wait until the pain is severe or you are in stage 4. Palliation is appropriate at any time.

How Will I Pay for Palliative Care?

If you have health insurance, it is likely to cover many palliative treatments. Talk to social workers or financial counselors where you receive treatment. They can help you figure out insurance coverage and how to pay for treatments if they are not covered.

Palliative treatments are essential for helping mesothelioma patients enjoy a better quality of life. This is a devastating disease that is most often terminal but also very painful physically. Palliative care can provide psychological and spiritual assistance and medical treatments to relieve symptoms.

Page Medically Reviewed and Edited by Anne Courtney, AOCNP, DNP

Anne Courtney has a Doctor of Nursing Practice degree and is an Advanced Oncology Certified Nurse Practitioner. She has years of oncology experience working with patients with malignant mesothelioma, as well as other types of cancer. Dr. Courtney currently works at University of Texas LIVESTRONG Cancer Institutes.

Connect with Doctor of Nursing Practice Anne Courtney