Coping with End-of-Life Decisions | Online Support Group

Older couple sitting in park

No one enjoys talking about end-of-life decisions. It’s scary stuff to think about.

Yet, talking about it makes it less scary.

It’s normal to want to avoid talking about topics that feel depressing. In psychology, this is called avoidance coping, and it’s a common way people
respond to difficult experiences.

Coping strategies fit into one of two categories: active or avoidant.

Active coping strategies involve awareness of the source of stress, followed by efforts to reduce a potentially negative outcome. Conversely, avoidant
coping strategies involve ignoring the source of stress, which often leads to activities that distract our attention and aid in denial of a problem
existing.

While appropriate for certain situations or as a temporary method of coping, avoidance coping can increase anxiety around the thing you’re trying to avoid.
Ignoring stress leaves no opportunity to come up with creative solutions. As time passes and nothing
is done to remedy the source of stress, the subconscious mind realizes things aren’t getting better and fears things may get worse.

People often can’t control the stressful situations that come into their lives, but they can control how they respond to stress. Thankfully, there are
numerous healthy alternatives to replace avoidance as a coping strategy.

Alternatives to Avoidance Coping

The following active coping strategies help people healthfully respond to stress:

  • Instrumental Coping. Also called problem-solving, this approach involves identifying the source of the problem and creating potential solutions to remedy it.
  • Seeking Support. Reaching out to family, friends, neighbors or a professional for help or emotional support can be an effective way to cope with stressful situations.
  • Adjusting Expectations. Sometimes it’s helpful to anticipate a range of outcomes of how a situation may turn out. This activity can help people achieve rational expectations. When our expectations line up with reality, life becomes easier to accept.
  • Relaxation. Emotional situations can make people anxious, and anxious thinking can hinder the ability to think calmly and rationally. Engaging in relaxing hobbies or trying relaxation techniques can reduce the effects of stress
    and help people to cope better.

Questions and Answers from the July 2015 Online Support Group

Patients and caregivers asked a number of questions during the recent online support group. Here, we include answers to some of them.

Q: Why is radiation therapy on its own not commonly recommended for pleural mesothelioma?

A: Radiation therapy isn’t powerful enough on its own, or in combination with other treatments, to cure mesothelioma. Applying radiation therapy
to the chest area is risky because it can damage vital organs like the heart.

Radiation therapy is most often given to pleural mesothelioma patients who underwent an extrapleural pneumonectomy to have their cancerous lung removed.
Removal of the lung allows for easier application of radiation therapy to spaces in the chest where residual cancer may remain after surgery.

Sometimes, pleural mesothelioma tumors grow in a solid mass rather than forming like a sheet around a lung. Solid mass tumors are easier to treat with
radiation therapy, especially if they aren’t located too close to vital organs. In these cases, radiation therapy has the potential to shrink tumors to
reduce symptoms like chest wall pain and difficulty breathing.

Q: Is it safe to consider temporarily taking an antidepressant to help with depression related to mesothelioma?

A: Yes, it is considered generally safe to temporarily take an antidepressant to cope with cancer-related depression. Both patients and family members may
benefit from temporary use of an antidepressant without high risk of developing dependence. Patients can speak with their oncologist and family members can
speak with their primary care physician about treatment options for depression.

Q: I’m having difficulty sleeping. Are there any medications that could help?

A: Yes, there are effective medications to help cancer patients sleep. Some doctors recommend over-the-counter (OTC) sleep aids, such as melatonin, which
happens to be a natural sleep chemical produced by the body. Taking an antihistamine like Benadryl may be helpful for sleeplessness caused by steroids, but
some people feel more awake after taking antihistamines. If OTC sleep aids don’t help, ask your oncologist about pharmaceutical-strength sleep medicine.

Q: Is chemotherapy effective for recurring mesothelioma tumors?

A: For some patients, second-line chemotherapy can halt recurring tumor growth and may even shrink tumors in some cases. In general, mesothelioma patients
who are eligible for second-line chemotherapy are those who responded to first-line chemotherapy and are physically fit enough to handle another round.

Research shows that patients who responded to pemetrexed the first time tend to survive longer when pemetrexed and cisplatin are used as second-line
chemotherapy versus pemetrexed alone. Other chemotherapy drugs used in second-line treatment for mesothelioma include vinorelbine, gemcitabine, epirubicin,
mitomycin and doxorubicin.

Third-line chemotherapy has proven effective for some mesothelioma patients. A Denmark study published in 2015 evaluated the effects of third-line chemotherapy with carboplatin, doxorubicin and gemcitabine in people with pleural mesothelioma. Tumors stopped growing in 60 percent of participants and 14 percent had tumor shrinkage. The results impressed researchers, but blood toxicity postponed treatment for 56 percent of participants. Less toxic drug combinations will likely be researched in the future.

  1. Boyes, A. (2013, March 5). Why avoidance coping is the most important factor in anxiety. Retrieved from https://www.psychologytoday.com/blog/in-practice/201303/why-avoidance-coping-is-the-most-important-factor-in-anxiety
  2. Harvard Health Publications. (2009, June 9). What are the real risks of antidepressants? Retrieved from http://www.health.harvard.edu/mind-and-mood/what_are_the_real_risks_of_antidepressants
  3. Nowak, A.K. (2012). Chemotherapy for malignant pleural mesothelioma: A review of current management and a look to the future. Annals of Cardiothoracic Surgery, 1(4):508-515. doi: 10.3978/j.issn.2225-319X.2012.10.05
  4. UCLA Duel Diagnosis Program.(n.d.) How do you cope? Retrieved from http://www.semel.ucla.edu/dual-diagnosis-program/News_and_Resources/How_Do_You_Cope
  5. Zucali, P.A., Simonelli, M., Michetti, G., Tiseo, M., Ceresoli, G.L., Collova, E., … Garassino, M. (2012). Second-line chemotherapy in malignant pleural mesothelioma: Results of a retrospective multicenter survey. Lung Cancer, 75(3):360-367. doi: 10.1016/j.lungcan.2011.08.011

Joining the team in February 2008 as a writer and editor, Michelle Whitmer has translated medical jargon into patient-friendly information at Asbestos.com for more than eight years. Michelle is a registered yoga teacher, a member of the Academy of Integrative Health & Medicine, and was quoted by The New York Times on the risks of asbestos exposure. If you have a story idea for Michelle, please email her at michelle@asbestos.com.

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