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Mesothelioma Care Planning & Treatment Options

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.


Treatment Options

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.

Traditional and multimodal 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.

o 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.

o 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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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.

o 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:

o Thoracentesis
Used to remove the fluid build up around the lungs. Also called pleurocentesis.
o Pleurodesis
Used to remove the fluid accumulation in the pleural space.
o Paracentesis
Used to drain fluid from the abdominal cavity, particularly in peritoneal mesothelioma cases.
o 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.

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:
o Immunotherapy
Uses the body’s immune system to treat, control or prevent cancer
o Photodynamic therapy (PDT)
Uses photosensitizing agents to kill cancer cells
o Virotherapy (gene therapy)
Uses viruses to target and kill cancer cells

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

o Complementary therapies
Treatments that include acupuncture, hypnosis and massage are used in addition to traditional cancer treatments
o Alternative therapies
Using a special diet to treat cancer in place of standard medical treatment
o 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.


Getting a Second Opinion

Every year about 3,000 people in the United States are diagnosed with mesothelioma. Countless others who have the disease are misdiagnosed with other types of cancer or disease. A misdiagnosis can be tragic for patients because it delays potentially lifesaving treatments, sometimes for months.

Since asbestos cancer is so rare, the average oncologist is not familiar with the disease pattern. Instead of immediately identifying cancerous tissue as mesothelioma, inexperienced doctors often misidentify the disease. A 2017 Mayo Clinic study found about 88% of patients who seek second opinions are given new information or care plans that can have lifesaving benefits.

Anyone who has been diagnosed with abdominal, heart or lung cancer and may have been exposed to asbestos should consider a second opinion, even if the suspected exposure was decades ago. Also, anyone who has been diagnosed with bronchitis, emphysema or chronic obstructive pulmonary disease (COPD) and has suspected asbestos exposure should consider a second opinion.

Mesothelioma specialists who conduct second opinions can interpret test results and exams for an accurate diagnosis, which can lead to immediate treatment.

Asking for a Second Opinion
Even with the high rate of misdiagnoses in mesothelioma, some patients are reluctant to tell their doctors they would like a second opinion. Patients may feel uncomfortable with the possibility of insulting the doctor.

Rest assured, most physicians encourage patients to seek second opinions, especially when it comes to a cancer diagnosis. Doctors want the very best outcomes for their patients, even if that means another doctor finds flaws in the initial diagnosis and updates the treatment plan. Doctors who are resistant to second opinions should be avoided.

Patients seeking a second opinion should directly ask their doctors for a referral or our Patient Advocates who are connected with the leading mesothelioma treatment centers nationwide.

What To Expect From A Second Opinion Doctor
When consulting with a second opinion doctor, mesothelioma patients and their families should be prepared with copies of all of the necessary documentation and test results, as follows:

  • Complete medical history from the diagnosing doctor
  • Biopsy, surgery, pathology and treatment reports
  • Imaging tests such as CT scans and X-rays
  • Blood test results
  • Results from genetic testing
  • Discharge papers from hospital stays related to the disease
  • Treatment plan summaries
  • List of medications

The specialist will likely ask the patient questions about work and social history and want details about possible asbestos exposure. The physician may also order new tests and procedures to examine the cancerous tumors further for an accurate diagnosis.

Second Opinion Benefits

A second opinion can offer patients a host of new opportunities for lifesaving treatment and possible recovery. Other benefits include:

• A chance to participate in clinical trials
Clinical trials that are testing cutting-edge mesothelioma treatments are only open to patients who have been accurately diagnosed.

• Peace of mind
Patients who have been presented with all of the best treatment options can make better, more informed decisions.

• Control
Through self-advocacy, patients are able to take charge of their health and their future.

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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