What is Palliative Care?
For serious illnesses, some patients may receive palliative care, or palliative treatment. Palliative care treats the symptoms of the disease, not the disease itself, in an attempt to provide relief and make the patient as comfortable as possible during their illness. Palliative treatment can be provided at the beginning of treatment, soon after the initial diagnosis and despite popular belief, is not reserved only for the dying. It can be used in many serious conditions such as heart failure, kidney failure, Alzheimer’s disease, and many cancers such as mesothelioma.
Current Palliative Care Treatments
Mesothelioma is a rare and aggressive cancer that unfortunately can cause a great deal of pain in the patient. Those suffering from pleural mesothelioma might have a severe cough and shortness of breath which can create pain throughout the chest cavity. Pleural effusions, or fluid build- up restricts the lung’s ability to expand and contract, making it difficult to breathe. In peritoneal (abdominal)mesothelioma patients, fluid build-up in the abdomen has similar consequences, with the abdomen unable to expand and contract normally. Pressure on the lungs and diaphragm because of bloating can also cause discomfort in peritoneal mesothelioma patients. The following are current surgical palliative treatments:
- Pleurodesis – Excess fluid from pleural effusion is drained and to prevent more fluid from building up, the space between the inner and outer pleura of the lung is closed with a chemical adhesive.
- Thoracentesis – By inserting a needle into the pleura, excess fluid is drained, and pressure relieved. Since thoracentesis is less invasive than pleurodesis, it can be used on patients who are not in good overall health.
- Paracentesis – Peritoneal mesothelioma patients may undergo paracentesis as a palliative treatment. Much like thoracentesis, fluid is drained from the peritoneal cavity using a needle that inserted into the area.
Chemotherapy and radiation therapy are commonly used as regular treatments for mesothelioma, but each can be used as a palliative treatment as well. Side effects from chemotherapy often discourage patients from seeking this course of action, but advances in medicine and immunotherapy treatments are decreasing those side effects to make this a more viable option.
The Future of Palliative Care
In late 2016, the American Society of Clinical Oncology recommended that palliative care options should be further explored to determine if early palliative care improved mesothelioma prognosis after a 2010 trial showed improvement in symptoms and prognosis after palliative treatment was given. This most recent randomized control study investigated 174 mesothelioma patients who were given palliative treatments every four weeks for 12 to 24 weeks. Unfortunately, results did not yield what was expected, and there was virtually no improvement in the over-all health and symptom management among patients. By week 24, 30 of the patients had passed away.
While this may be a setback in determining a more effective treatment, those suffering from mesothelioma should not be discouraged. Palliative treatment may not be more effective the sooner it is administered but it does over all relieve the pain and symptoms associated with this this aggressive cancer and should be considered a positive treatment for those suffering.
Hillary Wasserman, “Early Palliative Care Provides No Additional Quality of Life Benefits for Recently Diagnosed Malignant Pleural Mesothelioma (MPM) Patients,” International Association of the Study of Lung Cancer (October 16, 2017). [Link]
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