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Supportive care for mesothelioma

Supportive careSupportive careTreatment given to improve the quality of life of people who have a serious illness (such as cancer). helps people meet the physical, practical, emotional and spiritual challenges of mesothelioma. It is an important part of cancer care. There are many programs and services available to help meet the needs and improve the quality of life of people living with cancer and their loved ones, especially after treatment has ended.

Recovering from mesothelioma and adjusting to life after treatment is different for each person, depending on the extent of the disease, the type of treatment and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects. A person who has been treated for mesothelioma may have the following concerns.

Loss of appetite

Many people with mesothelioma have advanced disease when they are diagnosed. As the cancer progresses, people can lose their appetite and their nutritional intake can be poor. Loss of appetite can also cause a person to lose weight.

Trying small amounts of high-calorie foods or fluids, having smaller, more frequent meals and nutritional supplements can be helpful. Anti-nausea drugs can be used to control nausea and vomiting. Cold foods may be better tolerated and using plastic cutlery can help if foods have a metallic taste. When appropriate, the doctor may order medicines to help increase appetite.

Cachexia (severe loss of body weight and muscle mass) can occur in people whose mesothelioma is very advanced.

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Shortness of breath

Mesothelioma can cause a buildup of fluid around the lungs (pleural effusion). This can cause fluid to press on the lung, which makes it harder for the person to breathe and for the lung to fully expand. Pleural effusion is common with pleural mesothelioma, but can also occur with some peritoneal mesotheliomas. Treatment options for pleural effusion may include:

  • removing fluid from the chest cavity through a hollow needle (thoracentesis)
  • sealing the 2 layers of the pleura together by instilling a chemical powder (talc) or a drug into the pleural space through a chest tube (pleurodesis)
  • inserting a chest tube or pleural catheter to drain the fluid that has collected in the pleural space
    • The chest tube may be attached to a plastic drainage container or a catheter with a special valve (pleural catheter) may be attached to a bag so that these can be drained.
  • radiation therapy may be given after thoracentesis to try to prevent fluid from building up again

Relaxation and breathing exercises may help with problems breathing. Sitting near a fan or open window are other measures that may help shortness of breath. Oxygen therapy may be ordered if the doctor feels it will help relieve difficulty breathing.

The fluid may build up again and a thoracentesis may need to be done on a regular basis to remove fluid.

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Peritoneal mesothelioma can cause a buildup of fluid in the abdomen called ascites or peritoneal effusion. Ascites causes the abdomen to swell and can be uncomfortable. It can also cause shortness of breath or nausea.

Fluid from the abdomen is usually drained through a small tube (catheter) by doing a procedure called a paracentesis. The fluid may build up again and a paracentesis may need to be done on a regular basis to remove fluid.

Another option is to put in a tube (catheter) into the abdomen, which is attached to a bag so that the fluid can be drained.

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People with advanced mesothelioma may experience pain because the tumour grows into surrounding nerves and organs. The amount of pain often increases as the cancer advances.

Pain may be treated by:

  • external beam radiation therapy
    • Palliative radiation therapy may help relieve pain by shrinking tumours that press on nerves or other organs.
  • palliative surgery or procedures
    • Palliative surgery or procedures are not used to remove the tumour, but are done to relieve pain or other problems, such as pleural effusion or ascites. Palliative surgery or procedures may include:
      • pleurectomy and decortication (P/D)
      • thoracentesis
      • pleurodesis
      • paracentesis
  • pain-relieving medications

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Another problem people with mesothelioma may have is fatigue. Poor appetite and trouble breathing can also make fatigue worse. It can be hard to cope when you are feeling very tired and don’t have a lot of energy, especially for a while after treatment or if the cancer is advanced.

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Bowel obstruction

A bowel obstruction occurs when the large or small intestine becomes blocked (obstructed) and the intestinal contents cannot pass through. It can occur in people with peritoneal mesothelioma. A bowel obstruction can cause abdominal pain, nausea, vomiting and an inability to pass feces. Resting the bowel by not having anything to eat or drink, or feeding through a nasogastric tubenasogastric tubeA flexible tube (catheter) that is inserted through the nose, down the throat and esophagus, into the stomach. may help, but surgery to remove the obstruction may be necessary.

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Coping with advanced cancer

Mesothelioma is often diagnosed at quite an advanced stage. People with advanced mesothelioma are offered palliative care. This is a special type of care that focuses on making the person as comfortable as possible, relieving symptoms, providing support and improving or maintaining the person’s quality of life.

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Financial concerns

People with mesothelioma may have financial concerns as a result of their illness. There are special services or benefits to help workers (and their families) who have developed mesothelioma from workplace (occupational) exposure to asbestos. Conditions about exposure and legal processing of claims for asbestos-related cancers can differ by province or territory. Ask your doctor about these programs or check with worker’s compensation or health insurance agency about filing for compensation in your province or territory.

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See a list of questions to ask your doctor about supportive care after treatment.


Dr Lisa Barbera Canadian benchmarks for quality of end-of-life care in cancer

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