How Long Do Mesothelioma Patients Live Without Treatment?
People diagnosed with the earliest stage of mesothelioma, known as stage 1a, live an average of two years without treatment. Those diagnosed with stage 4 mesothelioma live an average of six to eight months without treatment.
Comparatively, patients who have surgery for pleural mesothelioma stages 1 or 2 may live longer than three years. Half of the patients who receive surgery and heated chemotherapy for peritoneal mesothelioma live longer than five years.
Survival can vary greatly depending upon several other prognostic factors, including the cancer’s tumor grade, the patient’s overall health, age and gender, and whether the patient elects palliative care to control symptoms and improve their quality of life.
About one-third of people with mesothelioma choose not to receive any form of anti-cancer treatment, according to a 2019 study published in Thoracic Surgery.
What Happens if Mesothelioma Is Left Untreated?
What could happen varies upon the stage of mesothelioma and how quickly it grows. A fortunate few have a slow-growing cancer, but most cases of mesothelioma grow quickly. It’s also completely normal for a slow-growing cancer to suddenly grow and quickly spread.
Certain factors, such as female gender, epithelial cell type, younger age and good overall health, improve prognosis and help people live longer with mesothelioma. Regardless of prognostic factors, survival is affected for most people who turn down treatment.
Growing Tumors Affect Symptoms
Without treatment, pleural mesothelioma tumors may quickly spread from their origin in the lining of the lungs to the rest of the chest cavity.
Physiological changes caused by growing tumors will cause symptoms that affect how patients feel. As tumors grow and spread, symptoms such as chest pain, shortness of breath and coughing often worsen.
Peritoneal mesothelioma also quickly progresses without treatment, and certain symptoms, including abdominal pain, swelling and digestive dysfunction, usually worsen.
As both types of mesothelioma progress, other symptoms, such as weight loss, fever, night sweats, fatigue, difficulty swallowing and hoarseness, may. The cancer can also cause high platelet count, high calcium and low sodium levels.
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Anti-Cancer Treatment Versus Palliative Care
If you don’t want to do anti-cancer treatment for mesothelioma, you can consider palliative care.
Managing mesothelioma symptoms, known as palliative care, to keep patients comfortable becomes the No. 1 priority when a patient turns down anti-cancer treatments. It can help patients with advanced mesothelioma live longer by controlling symptoms and improving overall health.
Examples of anti-cancer treatment for mesothelioma include surgery, chemotherapy, radiation therapy and Tumor Treating Fields. These therapies directly attack cancer cells to remove them or kill them.
Examples of palliative care for mesothelioma include pleurodesis, thoracentesis, pain medication, physical therapy and occupational therapy. These therapies do not attack the cancer, but they can improve overall health and may boost the immune system.
Beginning pain management and other palliative care therapies as soon as possible can help patients maintain their quality of life, and it may help some patients live longer.
Managing Pain with Palliative Care
Some people are reluctant to take pain medicine because they have fears about potential side effects and becoming addicted. Palliative care specialists have extensive experience helping people manage pain with medication and know side effects can be controlled.
Addiction is rare and shouldn’t be a concern for most people with mesothelioma. It’s more important to keep pain to a minimum, so patients can enjoy a higher quality of life.
Opiate-based pain medicine, such as morphine and tramadol, are effective at controlling cancer-related pain. Certain antidepressants help to reduce pain, while steroids can reduce pain caused by inflammation.
Over-the-counter pain medicine, including NSAIDs such as ibuprofen, is helpful for mild to moderate pain. Be careful taking NSAIDs on your own because they can easily damage the stomach’s lining and cause ulcers if taken for too long or in combination with alcohol.
Other palliative care treatments enable patients to live fuller lives. Complementary therapies, such as occupational therapy, help patients engage in activities, while physical therapy helps people feel better in their bodies.
Ask your doctor for a referral to a palliative care specialist if one isn’t available at your treatment center.
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Studies on Survival Without Treatment
Most studies focus on how treatments can improve mesothelioma survival rate, so there is little research regarding survival in untreated patients.
However, a few studies have reported on survival without treatment:
The 2019 study published in Thoracic Surgery that reported about a third of mesothelioma patients receive no treatment also reported their survival rate. Of the 3,419 mesothelioma patients included in the study, 31.1% decided against receiving treatment, and their overall survival was 10.2 months.
An MD Anderson study did report on life expectancy for untreated cases in 2011. The study reviewed survival in 238 cases of mesothelioma diagnosed between 1977 and 2009. The average survival for untreated patients was 6.4 months. Treated patients lived an average of 11.3 months.
Tumor Grading and Life Expectancy
In 2011, a study published in Modern Pathology reported on a prognostic factor known as nuclear grading, or tumor grading, in pleural mesothelioma patients with epithelioid tumors. This study did not report on untreated patients, but it did report on a prognostic factor that can be used to estimate how fast a tumor may grow and how well it will respond to aggressive treatment.
Tumor grading is measured by several factors such as cell abnormalities and how rapidly the mesothelioma cells are dividing. These factors are associated with survival and response to treatment, which can help doctors identify the best patients for aggressive treatment.
Patients with a low tumor grade tend to respond better to treatment and live longer, which makes them great candidates for anti-cancer treatment. Patients with a high tumor grade are unlikely to respond well to treatment, which means they may benefit less. You can talk to your doctor about whether your pathology report included tumor grading to weigh the risks and benefits for your personal case.
Tumor Grades and Survival
Grade 1 average survival is 28 months
Grade 2 average survival is 14 months
Grade 3 average survival is 5 months
Making Decisions About Treatment
If you’re on the fence about treatment, you may consider waiting three months until your next imaging scan, which allows your doctor to assess how quickly the mesothelioma is growing.
Knowing how fast it is growing will help your doctor provide a mesothelioma prognosis that is specific to your individual case. It will also help them decide whether trying chemotherapy makes sense after waiting to observe the growth rate.
During the three-month waiting period, patients can consider seeing an oncology dietitian or an integrative oncologist to access complementary therapies that may boost the immune system.
Making decisions about mesothelioma treatment may feel scary or bewildering. It can feel hard to understand the risks and benefits of treatment while facing fears about having cancer.
Consider writing down the questions and concerns you have about electing treatment or foregoing treatment. You may have to ask yourself some difficult questions such as, “Am I OK with having a shorter life expectancy if I don’t receive treatment?”
Talk to Your Doctor
It is important to be honest with your doctor about how you feel. Even though it may seem hard to express your concerns, it is best to tell your doctor what you are worried about.
Your doctor can address your specific fears and concerns, and explain the strategies they can use to limit or avoid certain side effects. If you express that quality of life is your primary concern, your doctor can closely monitor your response to treatment and make changes along the way to ensure you don’t experience unwanted side effects.
Some people who refuse mesothelioma treatment may experience backlash from family and doctors. Certain family members may not understand the situation and may have difficulty accepting a patient’s choice to refuse treatment.
Some doctors may push aggressive treatment because they have a goal to provide patients with more time, while others encourage patients to join clinical trials. Despite pressures you may feel from family or physicians, ultimately, you make the decision about the treatments you want or don’t want.
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Survivor Sallie M. Lived for Years Without Anti-Cancer Treatment
When Sallie Morton was diagnosed with pleural mesothelioma at the age of 87 in June 2013, her doctors advised against aggressive treatment.
They said the cancer was too progressed for surgery and that Morton was too advanced in age to withstand the health effects of chemotherapy. They connected her with hospice right away, and she put her affairs in order.
Morton took the news relatively well. She felt grateful for the good life she had lived, and peacefully accepted the prognosis. She had a talc pleurodesis to stop fluid from building around her lungs, and it offered great relief of her breathing difficulties.
Doctors expected Morton’s health to quickly decline within months, but she shocked everyone as she continued to feel well. Morton loved the hospice team, but after 22 months of hospice care it became clear she was stable. Morton left hospice and continued living in an active retirement community in southern California.
Morton had a scan of her lungs done when she left hospice, just to see how things were looking. Only a few tumors were found around her lung. It seemed she had a very slow-growing type of mesothelioma.
Without any anti-cancer treatment, she lived for four years with mesothelioma.
Mesothelioma didn’t stop Morton from enjoying her life. She managed the symptoms and took time to travel along the California coastline, staying beachside, appreciating the state’s landscape and pleasant weather.
“Thank you No. 1 for the talc pleurodesis, and No. 2 for not pushing treatment on me. I got to travel as a result,” Morton said in 2015.
Cases like Morton’s are atypical when it comes to mesothelioma, but some people can live comfortably for years with mesothelioma without anti-cancer treatment. Palliative therapies like pain management, physical therapy and the talc pleurodesis that Morton had, keep mesothelioma patients comfortable as they live with the disease.
While it may feel scary to face the unknown after turning down mesothelioma treatment, palliative care and hospice care can maintain quality of life. A good support system also helps people to live well with mesothelioma.Read More Mesothelioma Survivor Stories
8 Cited Article Sources
The sources on all content featured in The Mesothelioma Center at Asbestos.com include medical and scientific studies, peer-reviewed studies and other research documents from reputable organizations.
Espinoza-Mercado, F. et.al. (2019, April 17). Disparities in Compliance with National Guidelines for the Treatment of Malignant Pleural Mesothelioma.
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Pietrangelo, A. (2018, December 9). Palliative Care May Help Advanced Cancer Patients Live Longer.
Retrieved from: https://www.healthline.com/health-news/palliative-care-can-help-advanced-cancer-patients-live-longer
Oncology Nurse Advisor. (2015, September 17). Tumor Grade (Fact Sheet).
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Faig, J., Howard, S., Levine, E., et al. (2015). Changing pattern in malignant mesothelioma survival. doi: 10.1016/j.tranon.2014.12.002
Harvard Health Publishing. (2011, February). Palliative care: Sooner may be better.
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Haber, S. & Haber, J. (2011). Malignant mesothelioma: A clinical study of 238 cases. Industrial Health; 49: 166-172.
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Kadota, K. et al. (2011). A nuclear grading system is a strong predictor of survival in epithelioid diffuse malignant pleural mesothelioma.
Retrieved from: https://www.nature.com/articles/modpathol2011146
- National Hospice and Palliative Care Organization. (n.d.). Frequently Asked Questions About Hospice. Retrieved from: https://www.nhpco.org/patients-and-caregivers/about-hospice-care/frequently-asked-questions-about-hospice/
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Last Modified April 29, 2020