Mesothelioma care and treatment options depend on several factors, including the extent of the disease, the patient’s age and the patient’s overall health. Most commonly, people with mesothelioma undergo a treatment protocol that includes chemotherapy and radiation. In some cases, patients are candidates for surgical removal of cancerous tumors and tissue.

Mesothelioma sufferers also benefit from alternative and complementary treatments that are used in addition to traditional medical management options. Many patients also opt to try clinical trials to receive the newest treatments.

Any mesothelioma plan of care should be guided by a physician who specializes in asbestos cancer treatment. Doctors who are mesothelioma specialists can examine the facts of the case and provide expert recommendations and superior care.


How to Treat Mesothelioma

Even though there is no cure for mesothelioma, advances in medical science have made it possible for patients to live longer and more comfortable with the disease. Today, mesothelioma specialists are working tirelessly to uncover even more treatment protocols.

In 2018, the American Society of Clinical Oncology (ASCO) updated its recommended treatment protocols for mesothelioma based on new research. In addition to the traditional protocols for mesothelioma (chemotherapy, radiation and surgery), the organization recommended multimodal therapy, which combines two or more of the conventional treatment options.

Treatment options for mesothelioma involve different procedures depending on the type of mesothelioma. There are four main types of mesothelioma:

  • Pleural – Plearal mesothelioma makes up 75% of cases and affects the outer lining of the lungs, or the pleura. Pleural mesothelioma is treated by chemotherapy, surgery, and radiation. Specific procedures include:
    • Extrapleural Pneumonectomy (EPP)
    • Pleurectomy Decortication (P/D)
    • Combination Chemotherapy
    • External Beam Radiation Therapy
    • Brachytherapy
  • Peritoneal – Peritoneal mesothelioma makes up 20% of cases and affects the lining of the abdominal cavity, or the peritoneum. Peritoneal mesothelioma is treated by surgery and chemotherapy. Specific procedures include:
    • Cytoreductive Surgery
    • Heated Intraperitoneal Chemotherapy (HIPEC)
  • Testicular – Testicular mesothelioma makes up around 4% of cases and ussually develops as a secondary tumor from peritoneal mesothelioma. Testicular mesothelioma is treated by surgery and chemotherapy. Specific procedures include:
    • Pericardiectomy
    • Pemetrexed and Cisplatin
  • Pericardial – Pericardial mesothelioma is a rare form of mesothelioma that only makes up 1% of all cases. This form of mesothelioma grows around the lining of the heart sac, or pericardium. Pericardial mesothelioma is treated by surgery, chemotherapy, and radiation. Specific procedures include:
    • Orchiectomy
    • Pemetrexed and Cisplatin

Traditional Treatments

Traditional treatment plans for mesothelioma include the following procedures:

Chemotherapy

Chemotherapy works by eradicating fast-dividing cancerous cells, allowing healthy cells to take their place. Chemotherapy can be used alone but is often used in conjunction with radiation (and sometimes surgery) for the most effective course of action. While chemotherapy comes with unpleasant side effects, including hair loss and nausea, it has been proven effective.

For pleural mesothelioma – the most common type of the disease — a standard combination of medication includes pemetrexed (Alimta), cisplatin and/or carboplatin.

Chemotherapy is also a primary component of hyperthermic intraperitoneal chemotherapy (HIPEC), a treatment protocol for peritoneal mesothelioma that involves surgically removing cancerous tumors and bathing the abdominal cavity with heated chemotherapy. It has been proven to reduce or eliminate cancerous tissues in some mesothelioma patients.

ASCO recommendation: The first-choice treatment for newly diagnosed mesothelioma patients who are not candidates for surgery is pemetrexed plus platinum.

Radiation

Radiation uses beams of targeted high-intensity energy to shrink cancerous tumors, which makes them easier to remove surgically and alleviates patient pain. Radiation alone may not be used in curative measures but has helped reduce patient pain (often associated with tumorous masses).

Radiation is most commonly used in pleural mesothelioma treatment because the proximity to vital organs in other types of mesothelioma (such as the heart and liver) makes the procedure risky.

ASCO recommendation: The dosing fractionation of radiation therapy must be determined based on the site and extent of disease. Radiation should be offered as palliative care to patients with symptomatic disease.

Surgery

In the past decades, experts have developed treatment protocols that have made dramatic improvements in patient’s lives. Some of the protocols are aimed at significantly reducing or eliminating the disease while others are palliative, allowing patients to live with the disease with reduced pain. Some of the surgeries include:

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Alternative Treatment Options

Alternative and multimodal treatment options for mesothelioma include the following procedures:

Cytoreduction

Also called debulking, cytoreduction seeks to remove visible tumors in the peritoneal (stomach) cavity. Debulking is often used in conjunction with chemotherapy for a targeted approach to disease eradication.

Pleurectomy/Decortication (P/D)

By stripping away the cancerous pleural lining and visible tumors that surrounds the lungs and other organs in the chest area, surgeons are able to leave the lungs intact. P/D is also called lung-sparing surgery.

Extrapleural Pneumonectomy (EPP)

By removing an entire diseased lung, lymph nodes, the diaphragm and the pleural lining, surgeons are able to eradicate the disease. EPP can be used in conjunction with HIPEC.

Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

After cancer tumors are removed during a cytoreduction procedure, heated chemotherapy is placed into the abdominal cavity. This procedure is most often effective in treating peritoneal mesothelioma.

ASCO recommendation: Careful patient selection (or the process of determining which treatments would best suit a patient) is key to deciding if surgery is an option. Physicians should understand the disease level in early stage patients (stages I and II) might upstage (increase/worsen) as a result of the surgery.

Multimodal Treatments

Recent research shows that a multimodal approach (using a combination of chemotherapy, surgery and/or radiation) can significantly impact a patient’s survival rate. The combination and order of treatments largely depend on the physician’s expert opinion and the patient’s choice.

ASCO recommendation: Patients who undergo cytoreduction (debulking) surgery should undergo multimodal therapy that includes chemotherapy and/or radiation for maximum impact.

Palliative (supportive) Care

Palliative care helps patients by reducing pain and improving their quality of life. It is aimed at providing supportive relief that allows patients to focus on general wellbeing. Palliative treatment options include:

  • Thoracentesis – Used to remove the fluid build up around the lungs. Also called pleurocentesis.
  • Pleurodesis – Used to remove the fluid accumulation in the pleural space.
  • Paracentesis – Used to drain fluid from the abdominal cavity, particularly in peritoneal mesothelioma cases.
  • Pericardiocentesis – Used to drain fluids from the heart area, particularly in pericardial mesothelioma cases.

Clinical Trials

Clinical trials allow patients to try the newest tests and treatment protocols while helping advance the science behind disease control. Clinical trials, which are sponsored by mesothelioma centers, pharmaceutical companies and the National Cancer Institute (NCI) nationwide, can last for weeks or months. The following clinical trials are all approved by the NCI.

  • NCI-COG Pediatric MATCH
  • NCI-MATCH Trial (Molecular Analysis for Therapy Choice)
  • The ALCHEMIST Lung Cancer Trials
  • Lung-MAP: Master Protocol for Lung Cancer
  • The TAILORx Breast Cancer Trial
  • TMIST (Tomosynthesis Mammographic Imaging Screening Trial)
  • National Lung Screening Trial
  • The Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial 

Emerging Treatment Approaches

As researchers continue finding treatment methods that can help mesothelioma patients, they have discovered some new treatments that have proven helpful. They include:

  • Immunotherapy – Uses the body’s immune system to treat, control or prevent cancer.
  • Photodynamic therapy (PDT) – Uses photosensitizing agents to kill cancer cells.
  • Virotherapy (gene therapy) – Uses viruses to target and kill cancer cells.
  • Cryotherapy – Cryotherapy involves freezing the cancer cells and is minimally invasive. Cryotherapy is ussually done before a surgery to help reduce tumors and then after to manage symptoms.

Complementary and Alternative Medicine

Complementary and Alternative Medicine (CAM) has been recognized by the NCI to have a place in cancer treatment:

  • Complementary therapies – Treatments that include acupuncture, hypnosis and massage are used in addition to traditional cancer treatments
  • Alternative therapies – Using a special diet to treat cancer in place of standard medical treatment
  • Integrative medicine – Combines safe and effective CAM treatment with conventional medical practices

The NCI recommends patients consult with their medical team before beginning any CAM regimen.


Mesothelioma Treatment Cost

Mesothelioma treatment leads to similar costs per year as lung cancer. According to the US National Library of Medicine, for someone aged 72 “the first 6 months of care ranged from $2,687 (no active treatment) to $9,360 (chemo-radiotherapy), and varied by stage at diagnosis and histologic type.”. Per the NCBI, this cost varies from patient to patient and depends on the type of treatment pursued. Assesed in the same article by the NCBI, the following are the breakdowns of total, cancer-attributable, and patient-share cost for surgery, radiotherapy, and a combination of chemotherapy & radiotherapy per month.

Stage I & II

  • Surgery – $5,255
  • Radiotherapy – $5,671

Stage III

  • Radiotherapy – $5,794
  • Radiotherapy & Chemotherapy – $9,257

Stage IV

  • Radiotherapy – $5,391
  • Chemotherapy – $7,677
  • Radiotherapy & Chemotherapy – $8,927

Paying for mesothelioma costs can put a large financial burden on families. With the help of mesothelioma trusts set aside for victims of asbestos exposure, these costs do not have to be paid entirely out of pocket. Aside from trust funds and private insurance, there are many government programs, charity resources, and clinical trials available to help with the cost of treatment.

Assisted Living and Hospice

Patients who need assistance with their daily activities look to assisted living facilities and hospice care. The two options allow patients to live with mesothelioma through the stages of the illness:

Assisted living

Assisted living facilities, sometimes called senior living, allow patients to live independently but receive help as needed, including with housework, medication management and self-care. Some people move to assisted living facilities because they allow patients to have independence while having their personal and medical needs addressed.

Most assisted living facilities provide health care services but are not equipped to handle seriously ill patients. Instead, these facilities provide transportation to doctors, healthy meals and general supervision. They act as a bridge between fully independent living and living in a skilled nursing facility (nursing home).

Hospice

Hospice provides care to patients who are expected to survive six months or less. Hospice services can be used either in a hospital, nursing home, hospice outpatient facility or the patient’s home. Hospice provides palliative care or treatment that helps alleviate the pain associated with mesothelioma.

Since hospice is patient-focused (not disease-focused), the services and supports are aimed at reducing pain and improving quality of life. Hospice provides spiritual assistance and counseling for patients and their families and respite services for caregivers.

Financial Considerations for Assisted Living and Hospice

Mesothelioma patients who are considering assisted living or hospice should understand the options for paying for services:

Medicare – Medicare, a federally funded health insurance plan, pays for hospice care and stays at skilled nursing facilities. Medicare does not typically pay for assisted living residence.

Private insurance – Long-term care insurance can cost thousands of dollars and may ultimately not provide the financial backing needed for extended care. Long-term care insurance usually does not cover pre-existing conditions, so the insurance must be purchased before a diagnosis.

Asbestos/Mesothelioma trust funds – Trust funds provide mesothelioma victims with the funds for medical care, living expenses and any other expenses. More than 30 companies that knowingly manufactured and distributed asbestos-containing products have established trust funds for individuals who have been injured by their products.

Mesothelioma lawsuits – With the help of a skilled attorney, asbestos-exposure victims may be able to file a lawsuit against a negligent company. Most companies do not want the publicity that comes with a trial, so they settle out of court.

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