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Understanding a Prognosis

When physicians reveal a patient’s prognosis after a mesothelioma diagnosis, they are speaking to the likely outcome of the disease process. Like a diagnosis (which is the medical classification of a disease), a prognosis can seem daunting and frightening.

A prognosis is a hypothesis, or educated guess, based on previous research of groups of other patients with similar diseases. A prognosis only speaks to generalities and does not address individual circumstances.

According to the National Cancer Institute, a prognosis is defined as, “the likely outcome or course of a disease; the chance of recovery or recurrence.” A prognostic factor is defined as “a situation or condition, or a characteristic of a patient, that can be used to estimate the chance of recovery from a disease or the chance of the disease recurring (coming back).”

Life Expectancy for Mesothelioma

The average life expectancy for mesothelioma patients ranges nine months to four years, depending on factors that include stage, location and type of asbestos cancer. In the past decade, the life expectancy for mesothelioma patients has increased due to better research, a commitment to finding a cure and patient access to funding to pay for advanced treatments.

Patients who are diagnosed at an early stage of mesothelioma cancer have a longer life expectancy. Patients who can undergo surgery to remove cancerous tissue live longer than those who have cancer that has metastasized. Other factors that influence the life expectancy of mesothelioma patients include general health, gender and eligibility to undergo aggressive treatments.

Common Terms to Describe a Prognosis

In discussing a prognosis with patients or their families, most physicians use medical terms to describe the outcome, including the following:

  • Survival rate – Expressed in percentages, a survival rate reflects the percentage of people in a treatment group who are still alive after a set time frame following a diagnosis. Survival rates are often expressed in one-year, two-year and five-year intervals. Survival rates are also called overall survival rates.
  • Median survival – A median survival is the length of time that half of the patients in a group diagnosed with the same disease are still alive. This is usually measured from the day of diagnosis or the start of treatment and is often used in clinical trials to determine the effectiveness of new treatments. Median survival is also called median overall survival.
  • Progression-free survival – Progression-free survival, or PFS, describes the length of time a patient lives with a disease that does not get worse and is used in clinical trials to determine the effectiveness of a treatment. Also known as PFS.
  • Disease-free survival – Disease-free survival, or DFS, describes the length of time after treatment a patient lives without any signs or symptoms of the disease. DFS is also used in clinical trials to determine the effectiveness of a treatment. It is also known as relapse-free survival or RFS.
  • Overall survival – Overall survival describes the length of time patients survive after a diagnosis or start of treatment and is also called OS.

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Factors That Impact a Prognosis

Doctors use a number of factors when calculating a prognosis, many of which are based on individual circumstances such as age, gender, patient’s overall general health and the patient’s response to treatment. Anyone who has been diagnosed with mesothelioma and is seeking a disease prognosis should consult with a mesothelioma specialist for the most accurate determination.

  • Type of Mesothelioma – Of the four types of mesothelioma (pleural, peritoneal, pericardial and testicular), pleural (lung) mesothelioma is the most common with the most abundant treatment options. Pleural mesothelioma has been the focus of the most mesothelioma clinical trials and research when compared to other forms of mesothelioma.
  • Stage of the Disease – The stage of cancer describes the spread of the disease, the impact on parts of the body and the likelihood of response to treatment. Mesothelioma specialists also use stage to describe the extent of the tumors and the likely response to surgical intervention, which can be an effective treatment. Patients with early stage mesothelioma (stages I, II and sometimes III) often have a better prognosis than those with late or advanced stage mesothelioma (stages III and IV).
  • Cell Types – Cell type, or histology, is one of the factors used in determining prognosis because they spread, or metastasize, at different rates. Various cell types (most often epithelioid, sarcomatoid or biphasic) also respond to treatment in different ways. Epithelioid mesothelioma cells generally provide a better prognosis than other cell types.
  • Symptoms – Severe symptoms such as chest pains, difficulty breathing or abdominal pains may be signs of advanced mesothelioma cancer. Late-stage mesothelioma cancer is harder to successfully treat.

Prognosis by Type of Mesothelioma

Each type of mesothelioma impacts the body in a variety of ways due to the varying locations of the disease. The type of mesothelioma significantly impacts a patient’s prognosis.

  • Pleural Mesothelioma – Malignant pleural mesothelioma is the most common variety of asbestos cancer. Research shows about 46 percent of early stage pleural mesothelioma patients survive two years after a diagnosis. About 30 percent of late-stage pleural mesothelioma patients survive two-years following a diagnosis. The treatment options for pleural mesothelioma include advanced surgical procedures, such as the extrapleural pneumonectomy (EPP), for early stage patients. Patients also might be eligible for multimodal treatments.
  • Peritoneal Mesothelioma – The prognosis for patients with peritoneal (abdominal) mesothelioma has dramatically improved in the recent years due to treatment advances, including cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Some studies show the five-year survival rate for peritoneal mesothelioma has increased to about 50 percent.
  • Pericardial Mesothelioma – The prognosis for pericardial (heart) mesothelioma is typically poor due to the location of the disease. In rare cases, patients have survived up to five years when treated with surgery and chemotherapy. Often, however, treatment is limited because of the proximity of the tumors to the heart muscle.
  • Testicular Mesothelioma – While testicular (testes) mesothelioma is the most rare variation of the disease, the prognosis is generally good. Treatment usually includes surgical removal of the affected testicle and surrounding lymph nodes.

Improve Your Prognosis

While there is no cure for mesothelioma currently, treatment for the disease has never offered more positive results. Patients can take back some control when they use ways to improve their prognosis:

  • Seek support – Having strong emotional support helps patients face the challenges of treatment and staves off depression. Some studies show having strong support can improve survival rates in some types of cancer. While a support network alone cannot cure any type of cancer, it can help patient face the disease with the backing of friends and loved ones.
  • Ask for palliative care – Palliative care does not mean hospice care or end-of-life treatment. Today palliative care is used to improve the lives of patients in all phases of cancer by reducing pain and addressing emotional needs.
  • Try clinical trials – Clinical trials nationwide are providing hope for mesothelioma patients, giving them access to the newest experimental treatment options and allowing them to play a role in the future of disease treatment.
  • Make lifestyle changes – Patients who take extra steps to improve their health, including quitting smoking and eating healthier, may get a boost from the immune-strengthening changes.
  • Pursue treatment from a mesothelioma specialist – Mesothelioma specialists dedicate their entire careers to asbestos-cancer treatment. They have innovated medical interventions that now allow mesothelioma patients to live longer than ever. Experts recommend all mesothelioma patients seek treatment from a specialist.

A Look to the Future

While some mesothelioma patients wonder how much time they have to live, other patients (and former patients) are living life to the fullest. After successfully undergoing treatment from mesothelioma specialists, they are now focused on the future.

  • Heather Von St. James – At age 36, just three months after giving birth to her daughter Lilly, Von St. James was diagnosed with pleural mesothelioma. She was told she had just 15 months to live but was given the option to undergo an advanced treatment that might give her a better prognosis. That was more than a decade ago. Von St. James, who underwent the EPP procedure, is now a prominent mesothelioma research advocate and blogger.
  • Paul Kraus – Kraus was 52 when he was diagnosed with peritoneal mesothelioma and is now known as the world’s longest known survivor of the disease. Kraus credits his longevity to extreme changes to his diet and lifestyle including a mostly vegan diet and daily regimes of meditation and exercise.
  • Chris Gibney – Gibney was diagnosed with pleural mesothelioma more than 12 years ago and credits his long-term survival with multimodal treatment that included two aggressive surgeries, chemotherapy and radiation treatment. Gibney, 70, started building his dream home four years after his mesothelioma diagnosis. He and his wife Judy recently welcomed a group of German exchange students to their country home.

If you or a loved one has been diagnosed with mesothelioma, seek treatment by a mesothelioma specialist immediately. Contact our Patient Advocates now for information about treatment and financial support to pay for the expenses.

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