Palliative Care

The World Health Organization (WHO) defines palliative care as “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness”. Palliative care may be given to those with side effects from “potentially curative” procedures such as surgery or chemotherapy, or may used only for symptom control in those not seeking aggressive treatment.

For some mesothelioma patients, aggressive treatment is not an option. This may be because of the age of the patient, because the disease has progressed to the point where aggressive treatment is not feasible or simply because of the personal wishes of the patient. In these situations, palliative care, which is aimed at improving quality of life by controlling pain and reducing other physical symptoms, becomes important.

Two symptoms very common to mesothelioma and addressed by palliation early in a mesothelioma diagnosis are:

• Pleural effusion (fluid build-up) and
• Wound seeding

Because pleural effusion is often acute and leads to extreme shortness of breath, chest tube drainage is most often required to make the patient more comfortable. The procedure used to prevent fluid from recurring once it has been drained is called pleurodesis or in layman’s terms, a “talc treatment”. In this technique, a sclerosing agent is used to abrade or rough up the pleural surfaces producing an adhesion. This prevents further effusion by eliminating the intrapleural space where the fluid builds. Talc appears to be the most effective agent with a success rate of nearly 95%. Before instilling the talc, all fluid is removed and the lung is completely collapsed. The talc is then administered, and the pleural cavity is inspected to be sure the talc has covered the entire pleural surface.

The second palliative care measure is preventative radiation along sites of invasive procedures such as needle biopsy tracks, thoracoscopy incisions and/or chest tube drainage sites. A French randomized study determined that of those treated with radiotherapy, none developed tumor seeding, whereas in the untreated group, seeding occurred in 40% of patients.

Beyond these early controls, other common symptoms managed through palliative care include:

• Pain
• Shortness of breath
• Fatigue
• Dry mouth
• Loss of appetite
• Gastrointestinal problems
• Skin problems
• Anxiety and depression

Hospice Care

When health care is given over entirely to palliative measures, this is often referred to as hospice care. In the UK, palliative care of this nature has long been considered a specialty, and training for hospice workers is governed by the same regulations as for any other medical specialty. Throughout the UK, and in many other European nations, all hospice care is offered at no cost to the patient and their family, and is available through either the National Health Service or through various charities working in partnership with them.

The hospice philosophy is care for the whole person and addresses their physical, emotional, social and spiritual needs. This care can be provided at home, in day care facilities or in the hospice itself. Services may include pain control, symptom relief, nursing care, physical therapy, counseling for the patient and their family and bereavement services. Clearly, a loved one’s diagnosis of mesothelioma creates difficult times for every one involved, but there is no need to feel you must deal with it alone. Hospice offers a good alternative.

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