Palliative Treatment

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While the search for a mesothelioma cure continues, most people who fight the various forms of the disease undergo palliative treatment, which aims to manage pain and symptoms of the cancer. There are a number of palliative treatment options such as surgery, radiation therapy, chemotherapy and medications. Recommended treatments depend on the stage and the type of cancer diagnosed, as well as age and overall health.

The goal of palliative treatment is simple: relieve pain, reduce symptoms and improve overall quality of life. This type of care is often for patients with terminal cancer and a poor prognosis. Patients with a late-stage diagnosis, either stage III or stage IV, will often choose this type of treatment because of the lack of curative treatment options. Although palliative treatment does not provide a cure, it has the potential to prolong life expectancy for pleural, peritoneal and pericardial patients.

Pleural Mesothelioma

If aggressive surgery is not recommended for someone with pleural mesothelioma, several palliative treatments can help reduce symptoms and pain. Pleural mesothelioma symptoms generally include coughing, chest pain and shortness of breath. These symptoms result from tumors pressing against vital organs and pleural effusion, a condition marked by a buildup of fluid in the lungs.

  • Surgery

    Two palliative procedures that treat pleural effusion include a pleurodesis and a thoracentesis. Both procedures extract fluid through a tube and relieve pressure on the lungs in the process. A pleurodesis also eliminates the space where fluid can build up by using a talc-like substance to seal the space and is a more permanent fix to the problem, but some pain is felt during recovery.

    After either one of these treatments, breathing should become easier and coughing should lessen. In one study, 92 percent of those with a pleural effusion experienced relief from shortness of breath following a pleurodesis that uses talc to seal the pleural space.

  • Chemotherapy

    Most often used in combination with or after surgery, chemotherapy is a palliative treatment option when used as a solo approach. However, chemotherapy does cause side effects like nausea, fatigue, vomiting, hair loss and lack of appetite. Such side effects are what some patients try to avoid, and this may discourage them from trying chemotherapy.

    After a pleural diagnosis, a combination of the medications pemetrexed (Alimta) and cisplatin is most often recommended. These chemotherapy drugs have demonstrated the ability to kill cancerous mesothelioma cells, relieve symptoms, improve quality of life and prolong survival in many patients.

    Additionally, respiratory therapy can improve breathing and lung function in many mesothelioma patients.

  • Radiation Therapy

    This treatment is commonly utilized with surgery and chemotherapy to shrink tumors. When used alone, it can reduce tumor size to effectively relieve chest pain by relieving pressure on the lungs and chest. There are side effects associated with radiation therapy that some patients may wish to avoid, but sometimes the benefits can outweigh the side effects. Such side effects can include skin irritations, fatigue, pleural effusion and pulmonary toxicity if a high dosage is used.

Peritoneal Mesothelioma

Doctors Perform Palliative Surgery

The majority of peritoneal mesothelioma patients are not candidates for curative surgery. Instead, doctors recommend a treatment option that reduces symptoms, alleviates pain and improves overall quality of life while avoiding the rigorous recovery that follows surgery. The procedure is called a paracentesis, which removes fluid that has collected in the abdominal cavity, known as ascites. This treatment can relieve pain and reduce future complications concerning the bowels, kidneys and other parts of the digestive system caused by that fluid.

Another option considered standard is a combination of cytoreductive surgery along with heated chemotherapy in the abdominal cavity. This procedure is highly invasive, although it's still considered palliative in nature. Cytoreductive surgery, or debulking surgery, is the surgical removal of part of the malignant tumor. This is performed when all of the tumor cannot be removed. After cytoreductive surgery, the efficacy of chemotherapy is significantly improved.

Although the implementation of chemotherapy following surgery has been successful, it's not always considered palliative because of the side effects. Radiation is not typically used on peritoneal patients.

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Pericardial Mesothelioma

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Pericardial mesothelioma is an exceedingly rare type of asbestos cancer, composing around 1 percent of all cases. Because of its rarity, little research is performed into developing treatments that can prolong life expectancy. Although surgery to remove cancerous tumors is an option in some cases, treatment for pericardial is almost strictly palliative, largely because of its proximity to the heart and the risk of complications.

The main option for this type is a pericardiocentesis. This procedure removes excess fluid in the pericardium, the sac that surrounds the heart. The purpose of a pericardiocentesis is to improve quality of life and reduce symptoms, which can consist of chest pain, coughing, difficulty breathing and an irregular heartbeat. Following a pericardiocentesis, the use of the chemotherapy medication cisplatin has been used with a low frequency of complications and may prolong life expectancy.

This form of asbestos cancer is resistant to radiation as a single treatment approach and in combination with chemotherapy. The only effective chemotherapy drug for palliative treatment is gemcitabine, which can have a 40 percent rate of success.

Medication

Medicine is normally the first option in pain relief. Your doctor will recommend a type and amount of medicine depending on the type and intensity of your pain. If you experience mild discomfort, your doctor may advise you to begin taking an over-the-counter medication such as ibuprofen (Motrin) or acetaminophen (Tylenol). These medicines, which can be bought without a prescription, can help with mild bone and muscle discomfort, as well as general aches.

If you have more severe issues, or if you experience breakthrough pain (moments of sharp pain), you may be given a prescription for opioids. Drugs, such as morphine or oxycodone, are stronger and can help relieve chronic or intense pain.

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Be sure you completely understand the instructions and uses before you begin taking a new medication. Your doctor can answer any questions you may have about new prescriptions. Doctors can also suggest another medication if your current one is not helping you feel better.

Pain Management Techniques

Your doctor may also suggest you try certain pain management techniques, many of which you can do in your own home. The techniques that may work for you depend on the type and severity of your discomfort. If you have minor aches, try taking a warm bath or placing a warm washcloth on the bothersome areas. If that doesn’t help, try using ice or cold packs on painful areas.

You may also consider using alternative therapies. For example, muscular or superficial discomfort may be eased by a gentle massage, and acupuncture can help reduce inflammation.

Cognitive and behavioral techniques work for many cancer patients as well. These tend to focus on the mental aspects of pain.

Options to try at home

  • Relaxation: Deep breathing and relaxing your muscles has helped control discomfort in some patients. In addition to relieving anxiety, these techniques reduce tension, thereby managing some of your pain.

  • Distraction: Changing the focus of your attention can temporarily relieve aches. This is especially helpful when you experience breakthrough pain or when you are waiting for medications to kick in.

  • Visualization: Visualize your discomfort as a symbol or object, such as a large fire. Then, visualize the pain diminishing. For example, imagine slowly putting out the flames with water.

It is important to speak with your doctor before beginning new treatments, especially when your designed pain management program involves new medicine or potentially strenuous physical activity.

Alternative Options

Some asbestos cancer patients may wish to avoid traditional treatment, even if it is considered palliative care. One of the most impactful decisions a cancer patient can make is electing to change their diet with the supervision of a dietitian. There have been numerous cases where patients have extended their survival by eating the right foods and integrating supplements or healthy lifestyle changes. One patient used slippery elm bark, vitamin C and other holistic treatments to live longer than his expected survival. Any cancer patient should consult a nutritionist before making changes to their diet.

Patients can also benefit from a combination of traditional options and alternative treatments, such as undergoing a pleurodesis and making nutritional changes. Since difficulty breathing is often a symptom of mesothelioma, patients may be able to improve their breathing patterns through respiratory therapy, meditation and yoga. If you’d like to understand more about palliative care, call (855) 404-4592 to speak to one of our Patient Advocates.

Additional Resources

  1. Pass, I., Vogelzang, N., Carbone, M. (2005). Malignant Mesothelioma: Advances in Pathogenesis, Diagnosis, and Transitional Therapies. Springer: New York.
  2. Ed. by O’Byrne, K. and Rusch, V. (2006). Malignant Pleural Mesothelioma. Oxford University Press: New York.
  3. Baldi, Alfonso. (2008). Mesothelioma from Bench Side to Clinic. Nova Science Publishers: New York.
  4. Surgical Oncology Associates. Specialty Section for the Treatment of Peritoneal Mesothelioma. Retrieved from http://www.surgicaloncology.com/meso.htm

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