End of Life Care for Mesothelioma Patients

Mesothelioma is a cancer of the thin lining surrounding the lung, heart or abdominal cavity. Mesothelioma is cause by exposure to asbestos, a name given to naturally occurring minerals that are toxic. Asbestos has a high ability to resist heat, fire, chemical and erosion and therefore was widely used in many manufacturing, commercial, and industrial products. When asbestos becomes airborne, fibers can be easily ingested or inhaled, where they slowly create damage in the body. Symptoms of mesothelioma do not usually appear until decades after exposure. Therefore the disease is often not diagnosed until it has reached advanced stages. Currently, there are no known cures and survival times are often short, although research is offering hope that new treatments may improve mesothelioma prognosis.

 

Patients diagnosed with advanced malignant mesothelioma will benefit most from good palliative care and end of life strategies that ensure quality care. When patients with mesothelioma are nearing the end of life, they and their families will sometimes find it difficult to decide on what medical treatments to continue, if any, and for how long. In the best of circumstances, the patient, family, and treating physician will have discussed treatment options, including length and invasiveness of treatment, chance of reducing pain and symptoms, overall prognosis, and quality of life during and after any treatments. By having such discussions with the patient early on, the family and health care team can make choices based upon the patient’s desires.

 

Physicians and other members of the health care team can help mesothelioma patients with advance care planning, allowing the chance for patients to state their preferences for care at the end of life. 

 

Two terms patients should understand are Advance Directives, also known as living wills, and Durable Power of Attorney, also known as health care proxy. Advance directives are formal legal documents that allow patients continued autonomous choice and provide instructions for care in the case they are unable to speak for themselves. A durable power of attorney is a document that allows a patient to designate another person to make treatment decisions should the patient become incapacitated. 

 

Often oncologists, physicians or palliative care nurses are in the best position to know when to initiate discussions of end-of-life care. For many mesothelioma patients, functional disability occurs in the two months prior to death. It is best to bring up the subject of end of life care prior to this time when the patient can still clearly communicate their preferences and decisions about which treatments to provide or to withhold and conversations can take place between the patient, physician and family members.   Studies have shown that patients who talked about their preferences for end of life care with their families and medical team:

 

Having ongoing discussions enabled patients, family members and physicians to come to agreement about patient’s preferences for providing or withholding treatments under specific circumstances.  

 

Physicians can provide information, referrals, and resources to answer questions and address concerns. Patients should be encouraged to complete an advance directive and durable power of attorney, and be given the opportunity to talk with clergy or a social worker to address any other concerns. Ongoing discussions should be held on a regular basis and preferences revised and updated, with investigation into the cause of why changes are being requested.