Palliative treatment is especially important for mesothelioma patients who often live with severe side effects and symptoms, distress, anxiety, and fear. More than just treating the disease, palliative care is supportive care for the person as a whole and aims to improve their quality of life for as long as possible.
What is Palliative Treatment?
Palliative treatment is any type of care provided for a patient with a serious or terminal illness with the goal of improving quality of life. Instead of solely treating a disease, it focuses on factors that affect symptoms as well prioritizing personalized care. Treatment is geared towards what matters most to patients. This includes all kinds of supportive care:
- Physical and medical care
- Pain management
- Management of cancer side effects
- Management of treatment side effects
- Psychological, social, and spiritual care
While there may be some overlap in strategies, palliative care is not the same as other cancer treatments. The goal of treatments that are not palliative is to cure, slow, or stop the progression of a disease. Many patients with mesothelioma benefit from both palliative and non-palliative treatments.
Why Palliative Care is Important
Studies find that malignant mesothelioma patients have a high burden of symptoms. In one study, for instance, 92 percent of patients lived with three or more difficult symptoms: shortness of breath, fatigue, chest pains, loss of appetite, and cough, among other less common symptoms. They also experience distress, uncertainty, and a sense of lack of control.
Management of symptoms to improve quality of life is the main reason to use palliative care. Without treatment for symptoms, patients may struggle with severe, uncomfortable, and painful side effects of the cancer and its treatments. Palliation can help patients physically but also give them better control over quality of life, which improves mental health.
Historically, palliative care was reserved for patients in the latter stages of cancer. However, literature supports introduction of palliative care at the time of diagnosis, especially for those cancers that tend to be aggressive with shorter survival trends. Palliative care can work in conjunction with the medical and surgical oncology teams to provide patient centered care. Mesothelioma is a particularly painful cancer, though, and palliation early on in the disease can be beneficial too.
Studies have shown that cancer patients with early access to palliative care enjoyed better quality of life and improved survival times.
Who Provides Palliative Treatments?
Patients in need of palliative care will generally work with a specialist. Some centers have dedicated palliative care teams. They have specialty training in palliative care and can create a strategy with the patient and their family. If a dedicated team is not available, the medical care team can certainly have a more palliative approach and work to provide support that best fits an individual’s goals.
The actual medical procedures are provided by physicians. The palliative care specialist will also reach out to other caregivers to help implement the plan: pain specialists, holistic care providers, pharmacists, physical therapists, psychologists, spiritual leaders, and others.
Palliative Treatment in Hospice Care
Palliative treatments do not have to wait until a patient is in hospice car. Hospice may be in a medical facility or at home, but is care that is provided to patients at the end of their lives. Palliative care does not require enrollment into hospice.
Palliative care becomes especially important in hospice, where it provides relief, comfort, and the best possible quality of life for the time a patient has left.
Palliative Treatments for Pleural Mesothelioma
Patients living with pleural mesothelioma experience a number of difficult symptoms, including pain, a relentless cough, and difficulty breathing. Several treatments, including surgery, chemotherapy, and radiation therapy can be used for relief and palliation:
- Thoracentesis. This is the draining of fluid from the chest cavity, a typical source of discomfort, pain, and difficulty breathing. The surgery is minimally invasive, using a thin needle.
- Pleurodesis. To prevent recurring fluid buildup, a doctor may insert a tube to inject a medicine that causes the pleural tissue to adhere to the chest wall.
- Pleurectomy/decortication. This surgery can be used to slow disease progression but also to palliate. Removing cancerous tissue helps to relieve symptoms.
- Chemotherapy. Chemotherapy can be used alone to reduce tumor size, which may relieve some symptoms. The downside is that it causes side effects that patients find difficult to tolerate.
- Radiation therapy. When focused on the tumor in the chest, radiation can shrink tumors and relieve the pressure they put on surrounding tissues, relieving pain. Studies show radiation is particularly useful in relieving pain in localized areas.
Palliative Treatments for Peritoneal Mesothelioma
Many of the same strategies used for pleural mesothelioma palliation can be applied to the peritoneal patient. Paracentesis is the term for removing fluid from the abdomen. Standard chemotherapy may provide some benefits, but radiation is not generally used for peritoneal mesothelioma.
The buildup of fluid in the abdomen, know as ascites, can be particularly uncomfortable for peritoneal patients. Specialists who provide HIPEC, a debulking surgery followed by heated chemotherapy, may offer this service for palliation. It is generally used as a treatment to slow or cure the cancer, but studies have also found it can improve quality of life as a palliative treatment.
Palliative Treatments for Pericardial Mesothelioma
Managing this rare type of mesothelioma is especially challenging because it is so close to the heart. A percardiocentisis a surgical procedure that can be used to drain fluid from around the heart, which relieves pressure and pain. Chemotherapy may also help relieve symptoms, but radiation is not effective with pericardial mesothelioma.
A surgical procedure known as a pericardiectomy may help relieve symptoms specific to this type of mesothelioma. It involves removing part or all of the pericardium around the heart. This may help relieve pressure on the heart, which is both uncomfortable and dangerous.
Pain Management in Mesothelioma
For any type of mesothelioma, pain is a major symptom and focus of palliative treatment. The medical treatments used for each type can help relieve pain but are often not adequate. Medications and other management strategy can help reduce pain or make it more tolerable:
- Over-the-counter pain medications, including acetaminophen and ibuprofen
- Prescription opioids for more moderate, severe, or breakthrough pain
- Nerve blocks, which are injected and block pain signals
- Cervical cordotomy, which involves creating a permanent lesion in the spine and has shown beneficial to mesothelioma patients
Complementary and Alternative Therapies
While most complementary and alternative (CAM) practices are unproven to help treat cancer, they can help manage symptoms and play an important role in palliative care.
For example, a study from MD Anderson Cancer Center included 375 cancer patients and found that acupuncture relieved several symptoms: fatigue, hot flashes, numbness, nausea, and dry mouth.
CAM may also include aromatherapy, massage therapy, herbal supplements, and other strategies. Patients may have a CAM specialist on their treatment or palliative care team. Some CAM practices may help some patients feel better or not work for others. Most are safe to try, though.
Palliative treatments are essential for helping mesothelioma patients enjoy a better quality of life. This is a devastating disease that is most often terminal but also very painful physically. Palliative care can provide psychological and spiritual assistance and medical treatments to relieve symptoms.
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