Written by: Devin Golden
Mesothelioma Pain Management and Palliative Treatment
Mesothelioma pain management involves a combination of treatments, medications and other complementary care. Palliative treatment for mesothelioma is beneficial in any stage of the cancer.
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Important Facts About Mesothelioma Pain Management and Palliative Care
- Palliative care for mesothelioma helps manage pain and symptoms, such as fluid buildup and chest pain.
- Options for palliative care include surgery, pain medication, and low doses of chemotherapy and radiation.
- Palliative care also includes relaxation exercises, nutrition changes and spiritual counseling.
- Most palliative surgeries for mesothelioma have a short recovery time and aren’t invasive, but they don’t impact survival significantly. Pleurodesis is the only surgery with a major survival impact.
Overview of Palliative Care for Mesothelioma
Palliative care is a noninvasive type of medical treatment aimed to improve quality of life. For mesothelioma, the primary methods to improve quality of life is by reducing pain from symptoms, mental and physical distress, and the fear of dying. Palliative care for mesothelioma may also extend life expectancy by a few weeks or months.
The increased quality of life is accomplished through:
- Draining fluid from the mesothelium (pleura, peritoneum and pericardium), allowing organs to function properly
- Improving patient comfort by reducing pressure against the chest or stomach
- Helping the patient emotionally through their diagnosis through psychosocial support
- Providing support and guidance to caregivers
Palliative care specialists may recommend a mixture of medical, spiritual and psychological aspects to achieve the goals. Some examples include relaxation techniques, nutrition and lifestyle changes, and counseling.
The medical aspects of palliative care are:
- Low doses of chemotherapy or radiation
- Noninvasive surgery
- Pain-relief medications
What Is the Difference Between Palliative Care and Hospice Care?
Palliative care and hospice care both increase comfort for patients. The main difference is when to use each. Palliative care is not limited in use, whereas hospice care is limited to end stages of mesothelioma.
Palliative care is available at any point during the patient’s cancer journey. Patients can receive palliative care concurrently with curative, aggressive treatment. In fact, many suggest doing so.
Hospice care is only available in the late stages of mesothelioma. It’s explicitly for people who stopped curative treatment. Their prognosis must be six months or less.
When to Begin Mesothelioma Palliative Care
Many associate palliative care with late-stage cancer, when aggressive treatment cannot help patients. Scientific research shows mesothelioma palliative care helps in early stages, too.
One study used palliative care with curative treatments like chemotherapy and surgery. There was a financial and quality of life improvement. After 12 weeks of the study:
- Patients receiving curative care and palliative care scored 81.10 (out of 100) for quality of life.
- Patients receiving just standard care scored 77.70.
After 24 weeks, the gap in quality of life widened (81.26 versus 75.90).
Palliative care also reduced costs for mesothelioma patients:
- $1,285 for immediate comfort-focused care
- $3,180 when palliative care isn’t used
What Are the Causes of Mesothelioma Pain?
Mesothelioma pain occurs mostly due to the buildup of fluid and growth of tumors in the chest and abdomen. This is a primary mesothelioma symptom. Mesothelioma originates almost always in one of two cavities, the pleura or peritoneum.
These cavities have fluid sandwiched between two tissue linings. The original tumor develops in either tissue lining. As it grows and takes up more room — and other tumors form nearby to take up space — fluid bunches up in specific areas.
This buildup presses against the patient’s chest or stomach, causing discomfort. It’s one of the initial symptoms of mesothelioma.
The fluid buildup and growing tumors also leaves less room for nearby organs. The lungs, for instance, need space to expand fully against the chest wall. With less free space, the lungs cannot expand and patients have difficulty breathing. This is a primary symptom of pleural mesothelioma.
In the abdomen, the lack of space causes digestion issues and decreased appetite. These are symptoms of peritoneal mesothelioma.
Medications for Mesothelioma Pain Management
Doctors often prescribe patients medication to decrease pain and discomfort. The first medication is usually acetaminophen, which is the generic name for Tylenol. Another common over-the-counter medication for pain management is ibuprofen (Advil).
If needed, doctors will prescribe strong opioids such as oxycodone, tramadol, morphine or fentanyl. Doctors will likely prescribe small doses of morphine or oxycodone (such as 5-10mg) every few hours.
Doctors may combine opioids with adjuvant medication. These include:
- Antidepressants (amitriptyline)
- Anticonvulsants (gabapentin)
- Antianxiety (alprazolam or lorazepam)
Many mesothelioma patients are aware of opioid drugs’ addictive nature. We recommend discussing your concerns with an oncologist or pain management specialist.
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What Are the Primary Mesothelioma Palliative Treatment Options?
The three palliative treatments for mesothelioma are surgery, chemotherapy and radiation. The surgeries used are usually noninvasive, involving a camera-assisted needle to create a small incision.
Palliative Surgeries for Mesothelioma
Palliative surgeries drain fluid and allow organs near the tumors to work properly. For example, palliative surgery for pleural mesothelioma lets lungs expand normally.
The palliative surgeries for mesothelioma are:
- Pleurodesis (pleural mesothelioma)
- Thoracentesis (pleural mesothelioma)
- Paracentesis (peritoneal mesothelioma)
- Pericardiocentesis (pericardial mesothelioma)
Pleurodesis for Mesothelioma
Pleurodesis and thoracentesis are palliative surgeries for pleural mesothelioma. Pleurodesis drains fluid from the pleural cavity and closes the pleural space permanently, eliminating future buildup of fluid (pleural effusions).
Doctors use an adhesive, such as talc, to stick the two pleural linings (visceral and parietal) together. Doctors can use either a thoracotomy or thoracoscopy. The former involves a large incision while the latter uses a small needle incision. Thoracoscopy is less invasive and doctors may attach a video camera to the needle for assistance with the surgery.
Other information about talc pleurodesis is:
- The surgery takes 1-2 hours, according to the St. Vincent’s Hospital website
- The median survival time following the surgery is 14 months
- The recovery time for pleurodesis is 2-3 weeks, with the first 3-5 days spent in the hospital
- Doctors may leave the chest drain in for a few days
Thoracentesis for Mesothelioma
Thoracentesis, also called “pleurocentesis”, drains fluid from the pleural space and around the lung cavity. It is similar to pleurodesis but doesn’t close the pleural space permanently. The operation solves pleural effusions temporarily, but fluid buildup can return.
Doctors use a needle to make a small incision in the chest (thoracoscopy) and drain fluid from the space. A small camera may attach to the needle for best results.
Surgeons may also remove small amounts of tumor-ridden tissue. Thoracentesis can be a part of diagnosing pleural mesothelioma if cancerous cells are found in the fluid.
Paracentesis for Mesothelioma
Paracentesis, also called an “abdominal tap”, drains fluid from the peritoneum and around the abdominal cavity. It’s for peritoneal mesothelioma, which forms in the peritoneum. Fluid buildup in the peritoneum is called ascites.
Doctors use a needle to make a small incision in the stomach (laparoscopy) and drain fluid. Cameras may attach to the needles for optimal results. This is a temporary solution for ascites and patients may need to undergo paracentesis multiple times to reduce mesothelioma pain.
Surgeons may remove small amounts of diseased tissue. Paracentesis can be part of diagnosing peritoneal mesothelioma.
Pericardiocentesis for Mesothelioma
Pericardiocentesis, also called a “pericardial tap”, drains fluid from the pericardium. This is the lining around the heart. Another term for the pericardium is pericardial sac.
Fluid buildup around the heart prevents the organ from pumping blood at full function. Doctors make a small incision in the chest (thoracoscopy). They use a needle to drain the fluid from near the heart, allowing it to function fully.
Other Palliative Therapies
Chemotherapy and radiation are administered at low doses to reduce uncomfortable side effects. While neither option will eradicate mesothelioma, it can slow the disease’s growth and reduce tumor burden on or near organs.
Doctors may give patients vitamin supplements to prevent side effects caused by chemotherapy and radiation. The effects include nausea and fatigue, but vitamin B12 and folic acid are supplements to combat these discomforts.
Finding Palliative Care for Your Mesothelioma Pain
Managing symptoms and pain is an important part of your cancer journey. Mesothelioma causes severe discomfort, usually from pressure against the chest or stomach.
This discomfort can be addressed with medical care. Contact our staff to learn about your options for palliative treatment. You might be a candidate for pleurodesis, thoracentesis or paracentesis, depending on your type of mesothelioma.
Other options include pain medication, low-dose radiotherapy or even medical marijuana. Reach out to one of our patient advocates to find palliative treatment for mesothelioma close by.
Common Questions About Palliative Treatment for Mesothelioma Pain
What are the signs of mesothelioma pain?
Mesothelioma pain manifests in pressure against the chest wall or abdomen. This occurs due to tumors growing in size and duplicating along the linings behind the chest wall and abdomen. The tumors cause fluid buildup in the linings — the pleura and peritoneum — where mesothelioma tumors originate.
What are palliative treatments for mesothelioma?
Palliative treatments reduce mesothelioma pain for patients. The easiest and quickest way to relieve pain is through surgery. Doctors drain fluid from the pleura or peritoneum to reduce pressure against the chest wall, abdominal wall and nearby organs. Other palliative treatments are chemotherapy, radiation and pain medications.
What drugs help with mesothelioma pain?
Ibuprofen (Advil) and acetaminophen (Tylenol) are over-the-counter mesothelioma pain medications. Other options, such as opioids like codeine, oxycodone, tramadol, morphine and fentanyl should only be used with medical supervision or guidance. Doctors may prescribe low doses or these drugs and increase them based on the patient’s pain levels.
Sources & Author
- What is palliative care? MedlinePlus. Retrieved from: https://medlineplus.gov/ency/patientinstructions/000536.htm. Accessed: 04/27/2021.
- Early Palliative Care With Standard Care or Standard Care Alone in Improving Quality of Life of Patients With Incurable Lung or Non-colorectal Gastrointestinal Cancer and Their Family Caregivers. Clinicaltrials.gov. Retrieved from: https://clinicaltrials.gov/ct2/show/results/NCT02349412. Accessed: 12/30/19.
- How Early Palliative Care May Benefit Patients With Incurable Cancer. ASCO Post. Retrieved from: https://www.ascopost.com/issues/september-25-2017/how-early-palliative-care-may-benefit-patients-with-incurable-cancer/. Accessed: 01/03/20.
- Types of Palliative Care. American Society of Clinical Oncology. Retrieved from: https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/types-palliative-care. Accessed: 04/22/2021.
- Review of malignant pleural mesothelioma survival after talc pleurodesis or surgery. Journal of Thoracic Disease. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756994/. Accessed: 04/26/2021.
- Re-expansion pulmonary edema following thoracentesis. CMAJ. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001507/. Accessed: 04/26/2021.
- About Your Paracentesis (Abdominal Tap). Memorial Sloan Kettering Cancer Center. Retrieved from: https://www.mskcc.org/cancer-care/patient-education/paracentesis-abdominal-tap. Accessed: 04/26/2021.
- Pleurodesis. St. Vincent’s Hospital Lung Health. Retrieved from: https://www.svhlunghealth.com.au/procedures/procedures-treatments/pleurodesis. Accessed: 04/26/2021.
- Thoracentesis. National Heart, Lung, and Blood Institute. Retrieved from: https://www.nhlbi.nih.gov/health-topics/thoracentesis. Accessed: 04/26/2021.
- Learning About Paracentesis. MyHealth.Alberta. Retrieved from: https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=abo2968. Accessed: 04/26/2021.
- Pericardiocentesis (Pericardial Tap). Healthline. Retrieved from: https://www.healthline.com/health/pericardiocentesis. Accessed: 04/26/2021.