Since still there is no curative treatment of mesothelioma more attention focused on finding providing patients with mesothelioma palliation. It doesn’t help to slow or to stop the disease but it can reduce painful. But it can improve patient’s day-to-day life, allowing them to live without pain in comfort until the last day.
Palliative care for mesothelioma is a critical aspect of the treatment plan, especially since mesothelioma is often diagnosed at an advanced stage when curative treatments may not be possible. The goal of palliative care is to improve the quality of life for individuals with mesothelioma, relieve symptoms, and provide emotional and psychological support. Pain management is a significant component of palliative care for mesothelioma patients. Here are some key considerations for mesothelioma palliation, particularly in terms of pain management and prevention:
- Pain Assessment: It’s essential to assess the type, location, and severity of pain in mesothelioma patients accurately. This allows healthcare providers to tailor pain management strategies to the individual’s needs.
- Medication: Opioid and non-opioid pain medications can be prescribed to alleviate pain. The choice of medication and dosage will depend on the patient’s pain level and response. Medications like morphine, fentanyl, and oxycodone are often used for severe pain.
- Interventional Procedures: For localized pain, especially if it’s caused by tumor growth, interventional procedures like nerve blocks or pleurodesis (a procedure to stop fluid accumulation in the pleural cavity) can provide relief.
- Physical Therapy: Physical therapy can help maintain mobility, reduce pain, and improve the overall quality of life. Exercises can be tailored to the patient’s needs and abilities.
- Psychosocial Support: Dealing with mesothelioma is not only physically challenging but also emotionally and mentally taxing. Support from counselors, therapists, and support groups can help patients and their families cope with the emotional toll of the disease.
- Complementary Therapies: Complementary therapies such as acupuncture, massage, and relaxation techniques can help manage pain and reduce stress and anxiety.
- Nutritional Support: Proper nutrition is crucial for mesothelioma patients to maintain their strength and overall well-being. A registered dietitian can help develop a customized nutrition plan.
- Hospice Care: When curative treatment is no longer an option, hospice care may be considered. Hospice care focuses on improving the patient’s comfort and quality of life during the end stages of the disease.
- Advance Care Planning: Conversations about end-of-life care and advanced directives are essential to ensure that a patient’s wishes are respected regarding pain management and other aspects of care.
- Prevention: Mesothelioma is primarily caused by exposure to asbestos. To prevent future cases of mesothelioma, it’s crucial to avoid asbestos exposure and to take proper precautions when handling asbestos-containing materials, especially in occupational settings.
Palliative care for mesothelioma should be a holistic approach, addressing not only physical symptoms but also emotional and psychological well-being. It’s important for patients and their families to work closely with healthcare providers to develop a care plan that addresses their unique needs and preferences.
MRI scans can help to identify those suitable for surgery.
1-5% of the patients has epithelioid tumors of low volume and is potentially suitable for radical surgery. CT scanning and, in selected cases, MRI scans can help to identify those potentially suitable for surgery.
Epithelioid disease without radiological evidence
Usually best candidates for radical surgery are patients with early epithelioid disease without radiological evidence of lymph node involvement. Interestingly but in such cases they avoid using chemical pleurodesis because it makes subsequent surgical exploration of the chest which is necessary to define the location and the size of the tumor. Before the operation patients must be given all information about the possible outcome of surgery.
Coordinate treatment with an oncologist
A specialist who takes care over a patient with mesothelioma should coordinate his treatment with an oncologist with a special interest in thoracic oncology, a cardiothoracic surgeon, a pain relief service and a specialist palliative care team. Palliative radiotherapy should be used for patients with pain or a chest wall mass. Commonly there is a reason to explain to many patients that all used forms active treatment don’t offer proven survival benefit but they can alleviate symptoms.
Some patients should be given the opportunity to discuss what may be expected from chemotherapy because it is very difficult for them to accept a treatment policy which does not include any specific anti-tumour therapy.
Some patients prefer chemotherapy
In cases when patient prefers the chemotherapy to be given, it should be offered preferably within the context of a clinical trial. For example one can use forthcoming BTS trial which compares active symptom control (ASC) with either ASC plus combination therapy of mitomycin, vinblastine and cisplatin or ASC with the single agent vinorelbine. In cases when there is no opportunity to use any trial, chemotherapy may be applied using regimens that has been reported to have some activity in mesothelioma.
Pain management
Very important that the diagnosis is communicated sympathetically and skillfully. There is no reason to dissemble a clear picture of the disease and what to expect, including a realistic prognosis. But it is essential never to imply that “there is nothing that we can do”.
Physicians should warn general practitioner, relatives and carers that a Coroner’s post mortem can be required after the death of a patient with mesothelioma. Physician should also inform patients and families about organizations with a particular interest in asbestos related cancers. Also a appropriately trained specialist nurse should be involvement to take care of the patient and the family throughout the illness. An access to specialist palliative care services is also necessary. Patients and their families must know whom to contact in case of problems.
Throughout the disease patient must have close liaison with the general practitioner and primary health care team. Even if there is no change in treatment, appropriate regular outpatient follow up is recommended, because it provides an opportunity for further discussion.
Mesothelioma prevention
Is there a possibility to prevent the development of mesothelioma? And we can answer “Yes, there is!”
First of all you must avoid exposure to asbestos. If it is not possible, for example for people who might experience asbestos exposure at work include (miners, insulation manufacturers etc) it is essential to use personal protection equipment.
The main methods that help to prevent mesothelioma cancer are
- Consultations
- Diet
- Activity
Consultations:
Consultation with a pulmonary specialist is necessary if after an adequate antibiotic treatment the infection does not resolve within 2 weeks.
Even if the infection has resolved a chest radiographs are mandatory. A full evaluation by a pulmonary specialist and oncologist is required in cases when the patient has diffuse calcification of the pleura and a weight loss with chronic cough. If the initial workup is not diagnostic a referral for thoracoscopy is also required.
Family members of workers who are exposed to asbestos should also be evaluated.
Diet:
Surgery, chemotherapy, and radiation always cause cachexia, so good supportive care and a regular nutritional status assessment are necessary. Patients should consult with a nutritionist.
Curiously women who eat ten servings of whole grain foods per week live longer with less disease. It was established by nutrition expert, Professor David Jacobs, from the School of Public Health at the University of Minnesota.
Grains contain a lot of vitamins, antioxidants, and minerals fiber that helps to remove carcinogens from intestines faster, in this way lowering the possibility of cancer development and heart disease and maintaining blood sugar and insulin levels steady. As many researches have determined whole grain foods lower the cancer risk.
Activity:
Physical activity is important to reduce postoperative complications.
During last 50 years mesothelioma has become more prevalent. By now death is the only possible end in all cases of mesothelioma. Patients have survived 13 to 25 months when treated with the best available therapy. If the care is only supportive the median survival is about 9 months. So the earlier mesothelioma is diagnosed the more successful may be attempts to help preventing this tragic end.
There is a much greater chance of successful treating the disease if we could catch it before spreading beyond the lungs. After spreading of mesothelioma, the disease quickly kills the patient. If the disease is detected in early stage, treatments would be more effective.
Doctor should inform the patient that the earlier treatment can begin, the better chance for a longer life is.