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While researchers have made some progress in developing new ways to detect mesothelioma earlier, the majority of patients are still diagnosed at more advanced stages. By stage 3 and stage 4, patients face a life expectancy of just 12 – 16 months with limited treatment options available to extend survival. By these final stages of disease, the cancer has typically spread to other organs beyond the point of origin and likely has also spread to the lymph nodes, so surgery is no longer an option and other treatments like chemotherapy may be rather ineffective.
For patients diagnosed at these later stages, it can feel rather hopeless. But there are still options for palliative care to improve quality of life, and some may even be eligible for clinical trials with the hopes of extending survival. As these mesothelioma patients and their loved ones face such a devastating diagnosis, it’s also important to plan for the future and the unfortunate realities of malignant mesothelioma.
The Importance of Palliative Care
When mesothelioma progresses to more advanced stages, the common symptoms patients experience may become severe. Depending on the type of mesothelioma, patients may have an extremely hard time breathing, severe chest pain or abdominal pain, night sweats, and fluid buildup in their lungs or abdomen (pleural effusions or peritoneal effusions). If the cancer has spread to the lymph nodes and to the other side of the body, patients may also experience some new mesothelioma symptoms that weren’t present or very mild before.
Palliative care is meant to help lessen these symptoms and improve quality of life, rather than seeking a curative intent. Palliative treatment options are generally the same as curative care (surgery, chemotherapy, radiation therapy), but will be approached in a different manner. For instance, pleural mesothelioma patients may experience pressure from tumors in their lungs and fluid buildup. Eligible patients may undergo procedures like a pleurocentesis or pleurodesis to remove some of this excess fluid and pressure and make breathing easier.
Even palliative treatment options, however, can be dependent on the patient’s age and overall health. Treatments like chemotherapy may carry more risks for patients with stage 4 mesothelioma and may not be an option for patients with more aggressive metastasis or overall worse health. But for eligible patients, some of these treatments may be able to improve life expectancy. A study of late stage pleural mesothelioma patients found a combination therapy of the standard chemotherapy treatments (Alimta® and cisplatin) plus a newer immunotherapy drug, bevacizumab, could slow tumor growth and extended median survival to about 19 months.
Consider Clinical Trials
For rare cancers like mesothelioma, it can be more difficult to find clinical trials one is eligible for, but the potential results can make pursuing a clinical trial so worth it. While mesothelioma prognosis is poor at any stage, researchers have seen promising results from a variety of emerging treatments and new multimodal methods, even for patients in the final stages.
While the clinical trial mentioned above extended survival by seven months, some studies have been able to add years to a patient’s life expectancy. One recent clinical trial explored the curative effects of surgery with photodynamic therapy, a new treatment that involves using specific targeting agents injected into the bloodstream followed by light targeted at the tumors. The study involved stage 3 and stage 4 malignant pleural mesothelioma patients. Of the participants, 73 patients extended their survival to 3 years on average. A small group of patients hadn’t seen the cancer spread to their lymph nodes and achieved a median survival of seven years.
Even while these and other clinical trials show great promise for even late stage patients, it’s important to remember there is still no cure for mesothelioma. But these emerging options may offer more effective treatment plans and get closer to finding a much-needed cancer cure. Survival rates, especially for peritoneal mesothelioma, have been gradually improving, so there is always hope for patients at every stage.
End of Life Planning
Though there is always hope for extended survival, patients diagnosed at the end stages of mesothelioma cancer should consider preparing for the realities of a terminal diagnosis. Patients and their loved ones should consider some of the important medical and legal decisions they need to make in planning for the future.
While it is difficult to think about, patients with any late stage cancer should consider creating a will and/or a living trust. A will is a legal document that will dictate how a patient would like their personal effects, including money, handled after their death. A living trust works in a similar way. The trust is established by the patient while they are alive, while a last will and testament goes into effect upon the patient’s passing. A living trust allows the patient to determine how their personal effects will be handled but remains in control while they are living.
Similarly named, patients should consider creating a living will, which dictates the type of medical treatment a patient is interested in. For instance, if a patient does not wish to be placed on a respirator in the case of further declining health, the medical staff will ensure they abide by the patient’s wishes. Along the same lines, patients with such wishes may consider another legal document called a “Do Not Resuscitate” order (DNR). This type of document will ensure that a mesothelioma patient does not get resuscitated against their wishes in the case of cardiac arrest or another complication.
These are just a few of the considerations patients and their loved ones should keep in mind when facing such a grim prognosis. Though it is difficult to think about, having a good support system and medical team can aid the patient every step of the way.