Malignant Mesothelioma Patients in Italy Seen to Enter Palliative Care Late in Disease

Malignant Mesothelioma Patients in Italy Seen to Enter Palliative Care Late in Disease

Many patients with malignant mesothelioma do not have access to palliative care prior to experiencing the worst of this aggressive cancer’s symptoms, according to a study conducted by cancer researchers in Italy.

The study, “Symptom Burden in mesothelioma patients admitted to home palliative care,” was published in the journal Current Medical Research and Opinion.

Malignant pleural mesothelioma is a very aggressive cancer that can arise many years after asbestos exposure, one of the most important factors known to be associated with this disease. When treated at earlier stages, it usually has a better prognosis. But most patients present with advanced disease, and many survive less than a year after diagnosis. Mesothelioma is generally resistant to radiation, surgery, and chemotherapy treatment, and long-term survival and cures are exceedingly rare.

Although mesothelioma survival rates are improving, palliative care is the mainstay of treatment for a disease with a poor prognosis.

To examine the epidemiological characteristics and symptom burden of mesothelioma patients when admitted to home palliative care, researchers — led by Sebastiano Mercadante, MD, with the Pain Relief and Palliative Care Unit in Palermo — reviewed 674 medical charts of patients admitted to home palliative care programs with a diagnosis of mesothelioma in an endemic industrialized area.

Of all patient histories reviewed, a total of 56 people (8.3%) had a mesothelioma diagnosis. About three-fourths reported feelings of pain with their mesothelioma, especially in the chest, despite receiving medium-to-high doses of opioids. Eighteen reported moderate pain, and two severe pain.

Medical records also revealed many of these patients had symptoms of advanced disease even before they were admitted to the palliative care program.

Among the mesothelioma patients included in the study, pain, shortness of breath, weakness, and poor appetite were among the most intense and difficult symptoms. Many also suffered with cough and a buildup of fluid around the lungs.

“This study shows that mesothelioma is a devastating cancer with a relevant symptom burden, and that patients were referred to palliative care late in the course of their disease, suggesting that earlier integration of palliative care should be considered to relieve suffering in all disease stages — not only at the end of life,” the researchers concluded.

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