Since it is difficult to achieve a diagnosis of mesothelioma regardless of cytology, radiology and biopsy, the routine management of mesothelioma patients should be done by a multidisciplinary team comprising of oncologists, respiratory physicians, radiologists, lung cancer specialist nurses and palliative care physicians. Moreover, after the diagnosis has been achieved, there should be close coordination with the primary care physician of the patient. Both family members and the primary care physician should be made aware that a post mortem examination is generally carried out in the event of the mesothelioma patient’s death

Mesothelioma – supportive and palliative care

Since overall prognosis is poor in case malignant mesothelioma, it would be appropriate to refer the patient to specialist palliative care services at some point of time during the course of the disease. Majority of patients need palliation of symptoms during the early stages of the disease and the acknowledgement of this fact by the patient, family members and the primary care physician is crucial for effective management of the disease. A central lung cancer nurse specialist can provide the right means to the patient, as is required to gain access to the effective delivery of care via the following primary elements:

  • Information
  • Communication
  • Coordinated care with multidisciplinary team comprising of oncologists, respiratory physicians, radiologists and palliative care specialists.
  • Accessibility
  • Nursing care
  • Support

Prognosis and survival

Life expectancy is poor in pleural mesothelioma cases, and median survival rates vary between 8-14 months. A large number of patients who have been enrolled in treatment trials for mesothelioma have been analyzed by the Cancer and Leukemia Group B, and the European Organization for Research and Treatment of Cancer. The following poor prognostic factors have been identified in the process:

  • Poor performance status
  • Non-epithelioid histology
  • Age older than 75 years
  • Chest pain
  • Male gender
  • LDH greater than 500 IU/L
  • Platelets greater than 400,000 μL
  • White blood cell count of 8.3 × 109/L or more

Most of the patients who live for more than 2 years after diagnosis have epithelioid histology and fatalities related to mesothelioma tend to occur due to respiratory failure.

 

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