Mesothelioma is a rare and aggressive form of cancer caused by exposure to asbestos. The disease has proven to be extremely resistant to traditional cancer treatments and is always considered fatal. Though many patients choose aggressive treatment to extend their survival, not all do. Some patients choose a path of palliative care, which helps them manage symptoms and maintain their quality of life without undergoing painful, invasive treatments.
How Long Can Mesothelioma Patients Live Without Treatment?
Pleural mesothelioma is the most common form of the disease. Options offered by mesothelioma specialists generally include aggressive treatments such as multimodal therapy combining surgery, chemotherapy, and radiation. Though these procedures can extend survival, not all patients are eligible for aggressive surgery, and many simply aren’t interested in putting themselves through physical trauma and pain. Peritoneal mesothelioma treatment generally involves cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC), a combination procedure that surgically removes as much tumor material as possible, and then administers heated chemotherapy directly into the surgical site. The procedure can extend survival to five years or more but is not available for all patients.
Approximately one-third of mesothelioma patients opt out of cancer treatment altogether. When patients leave their malignant mesothelioma untreated, it progresses rapidly, dramatically reducing life expectancy from what surgical intervention would provide. The prognosis for the disease is always poor, but especially so for those diagnosed at an advanced stage, who face an average survival of about six to eight months if their disease is left untreated. Patients diagnosed at an earlier stage may live as long as one to two years without treatment, with outcomes affected by several factors, including the cancer’s stage, cell type, and the patient’s overall health.
Factors Affecting Prognosis
Several factors influence life expectancy for mesothelioma patients who choose not to receive cancer treatment:
- Tumor Grade: The aggressiveness of the tumor. Physicians can determine this by cell division rates and abnormalities.
- Overall Health: Patients who are in good health and who have strong immune systems may experience slower disease progression.
- Age and Gender: Younger patients and women often have better prognoses and live longer than older patients, and men.
- Cell Type: Patients diagnosed with epithelioid mesothelioma, the slowest-growing form of mesothelioma, tend to respond better to treatment. Their disease status generally progresses more slowly without treatment than those diagnosed with other cell types of mesothelioma.
- Palliative Care: Palliative care gives patients the option of managing their symptoms, improving quality of life, and, in some cases, prolonging survival.
Disease Progression Without Treatment
Though most patients experience swift disease advancement, mesothelioma’s progression can be unpredictable. For some patients, tumors grow slowly. Still, regardless of the speed, the disease’s mechanism remains the same.
- Pleural Mesothelioma: Tumors form in the mesothelium, the lining of the cavity that holds the lungs. They then spread to the chest cavity, eventually exacerbating symptoms including chest pain, shortness of breath, and persistent coughing.
- Peritoneal Mesothelioma: Tumors form in the mesothelium that lines the cavity that holds the abdominal organs, causing symptoms like persistent abdominal pain, swelling, and digestive issues as the tumors grow and spread.
No matter whether the mesothelioma forms in the pleural cavity or the peritoneal cavity, additional symptoms of both generally include weight loss, fever, night sweats, fatigue, and hoarseness. Changes in blood composition, such as elevated platelet and calcium levels or low sodium levels, may also occur as the condition progresses.[1]
Tumor Grading and Survival
Tumor grading is a process that evaluates cell abnormalities, as well as the speed at which cells divide. In mesothelioma patients, it serves as a valuable predictive tool for disease progression and treatment response.[2]
In mesothelioma patients, the different tumor grades are:[2]
- Grade 1: Average survival of 28 months.
- Grade 2: Average survival of around 14 months.
- Grade 3: Average survival drops to about 5 months.
Patients assessed at Grade 1 or 2 generally respond better to treatment and tend to live longer. This makes them better candidates for aggressive interventions. Grade 3 tumors, on the other hand, are often more resistant to treatment, leading to poorer outcomes.[2]
Anti-Cancer Treatment vs. Palliative Care
Patients who decide against aggressive cancer treatments are not without options. They can derive significant benefits from palliative care, which manages symptoms and provides comfort and improved quality of life. The treatments offered by palliative medicine often involve less aggressive forms of standard therapies, including:
- Surgery: Used to remove the tumors causing patients the most severe symptoms and pain.
- Chemotherapy and Radiation Therapy: Applied at doses too low to eliminate the tumors, but strong enough to alleviate symptoms without leading to side effects
- Pleurodesis and Thoracentesis: This procedure reduces uncomfortable fluid buildup in the chest cavity.
- Pain Management: Opiate-based medications, non-steroidal anti-inflammatory drugs (NSAIDs), antidepressants, and steroids can help manage pain, anxiety, and depression.
- Physical and Occupational Therapy: These therapies help patients maintain their mobility and continue engaging in activities of daily life.
Managing pain is a critical aspect of palliative care. Though patients worry about becoming addicted, palliative care specialists say that addiction is rare in cancer patients, and stress the advantage of controlling pain so patients can spend time on the things that matter to them and maintain a better quality of life.
Studies on Untreated Mesothelioma Survival
Research on mesothelioma survival without treatment is limited, as most studies focus on evaluating treatment outcomes. Still, there have been some studies that have provided valuable insights into what untreated patients can expect. These include:
- A 2019 study published in Thoracic Surgery found that of approximately one-third of mesothelioma patients who received no treatment, the median survival rate was 10.2 months.[3]
- An MD Anderson study conducted in 2011 reviewed the case histories of 238 mesothelioma patients diagnosed between 1977 and 2009. The average survival for untreated patients was 6.4 months, compared to 11.3 months for those who underwent treatment.[4]
While some patients experience slow disease progression and longer survival without treatment, most face rapid disease progression within a relatively short period. Many researchers are working to identify the factors that may play a role in outcomes for patients who opt out of treatment and choose supportive care options instead.
Making Treatment Decisions
Choosing whether to pursue mesothelioma treatment is not easy, especially if physicians or family members are encouraging you to pursue aggressive treatment. There is significant pressure on cancer patients to put up a good fight, and many see choosing palliative treatment as surrendering to the disease or giving up. As a result, some patients wait, deciding to monitor the progression of their disease for a short time and taking a wait-and-see position. Imaging studies that assess their tumor growth can be a big help for patients working to make more informed choices about whether to begin treatments like chemotherapy, surgery, or radiation therapy.
Patients considering foregoing treatment should consult with their healthcare professional about their options, as well as whether any complementary therapies can help them as they move forward. Nutrition, meditation, acupuncture, and other alternative therapies may prove helpful in supporting patients’ overall health and enhancing their quality of life.
Talking to Your Doctor
Frequent and frank communication with your mesothelioma provider is essential when making decisions about whether to move forward with any treatment whose goal is extending life. Take the time to talk about your concerns about the side effects of aggressive treatment, as well as how they will affect your quality of life. The more your doctor knows, the better they can tailor their approach to your needs and desires. If you find that your doctor is advocating for aggressive treatments to extend survival, you may need to find another provider or take a more frank stance with them to ensure that they hear you and understand you. You may also find a middle ground that addresses your concerns by modifying treatment strategies to minimize side effects.
To make sure you achieve your goals and get all the answers you need, take the time to prepare a list of questions before your appointment so that you can discuss them in an organized way. Important topics to address include your personal preferences and understanding all the risks and benefits of treatment. In the end, the most important question is one that you ask yourself: Are you sure you’re willing to trade a shorter life expectancy in exchange for avoiding the downsides of treatment?
Being diagnosed with mesothelioma raises all types of questions. When it comes to treatment, you need to weigh your desire for the longest life possible against the ability to continue living a fulfilling life on your own terms. By understanding all of your options and consulting with your healthcare team, you can make a choice that matches your values and preferences.
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