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Mesothelioma palliative care

Palliative care is a specialized form of care that alleviates pain and other symptoms. The goal of palliative medicine is not to prolong life or hasten death, but rather, to keep the patient as comfortable as possible, while offering support to the patient and their family. Palliative care contributes to the quality of life for patients with life-threatening illnesses at any phase of the disease.

For the patients who are undergoing life-prolonging therapies, palliative care includes symptom management and therapy aimed at restoring function. For the dying patient, it addresses the traditional roles of the hospice movement. During the course of a serious illness, patients and their families should realize that the goals of care can, and do, change, sometimes rapidly. An open line of communication is essential to optimize patient care.

Palliation of symptoms is an important part of mesothelioma therapy. Intractable pain will replace the initial dull pressure after the cancer has penetrated into intercostal nerves. NSAIDs often relieve pain well in the beginning, opiates and adjuvant medications (e.g. amitriptylin) have to be added later.

Shortness of breath due to fluid accumulation can alleviated by drainage, chest tube placement with talk pleurodesis or if the lung does not appose to the chest wall, which is common, by inserting a tunneled “Pleurex” catheter. Such a catheter will be left in place for weeks during which it drains the chest slowly, allowing gradual lung expansion. The catheter will eventually cause autopleurodesis, after which it can be removed.

Palliative therapy focuses on two major symptoms, dyspnea and chest wall pain. All previously described modalities may contribute to the palliation of patients with MPM. Radiation has shown palliative benefit in reducing pain and symptoms of dyspnea, surgical pleurodesis can reduce the symptoms associated with recurrent or persistent pleural effusions, and chemotherapy has demonstrated palliative benefit in terms of overall quality of life. Judicious use of these treatments in combination with adequate pain control and attention to respiratory function has formed the basis of effective palliation in MPM.

You may choose supportive or palliative care if the disease has progressed very far and your health is too fragile for surgery or chemotherapy, or if you decide that you simply don't want aggressive treatment. Mesothelioma patients given supportive care generally live four to nine months after they are diagnosed.

Treatment of MPM with more than palliative intent remains inadequate at all stages of presentation.12 Generally, surgery as a single modality has failed to improve survival, and several investigators have explored the use of combined modality therapy incorporating radiation and chemotherapy in conjunction with surgery.

In advanced disease, chemotherapy remains the main therapeutic modality, although either surgical intervention or local radiation therapy may be useful for the local control of pain or symptoms often associated with pleural fluid accumulation. Chemotherapy has generally failed to significantly impact survival.

This has been due both to the lack of control subjects in most studies and the lack of statistical power in those randomized trials that have been done. However, recently presented data from a large, well-powered phase III trial45 comparing the combination of pemetrexed and cisplatin with cisplatin alone are encouraging, and may represent a standard chemotherapeutic regimen against which future treatments can be measured.

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