Clapper, Patti, Schweizer and Mason

Mesothelioma is a relatively rare cancer that is caused by exposure to asbestos. The most common form of mesothelioma affects the lining of the pleura, or lung. Pleural effusions are very common with mesothelioma, causing pain and shortness of breath. Malignant pleural mesothelioma survival rates are quite poor, with a median range of 6 – 9 months and less than 10% surviving five years.

 

Dyspnea is a common symptom of mesothelioma. Dyspnea is defined by the American Thoracic Society as “the subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.” The degree to which it feels difficult to breath is thought to be due to a combination of factors: physiological, psychological, social and environmental. 

 

Dyspnea is felt to different degrees depending on these factors, the individual, progression of the disease, and type of treatments.  Early and ongoing assessment and management of dyspnea is vital to maximizing quality of life. 

 

Dyspnea is felt as breathlessness and inability or great discomfort to breathe. Dyspnea can cause great anxiety and be quite disabling for the patient. Often it is helpful to have the patient rank the degree of severity from 1 – 10.

 

Patients with mesothelioma will often experience pleural effusion, which is likely to cause dyspnea as well as other symptoms. Evacuation of any fluid build up and any ways of preventing accumulation of fluid from re-occurring can help alleviate symptoms. 

 

Treatments for dyspnea are controversial and there is no standard approach, however the American College of Chest Physicians published a guideline about palliation of symptoms that recommended three made three main treatments.   The first was to evaluate the cause of the dyspnea and see if it couldn’t be corrected at the root cause to any degree. The second, and most commonly used method, was to use opioids, either intravenously or orally, to relieve pain and discomfort. Also recommended in some cases is using oxygen, bronchodilators and corticosteroids. Lastly, it is highly recommended to use alternative  nonpharmacological interventions, such as breathing control exercises, relaxation techniques, fans and air circulation devices, psychosocial support and pacing of activity.

 

Patients with malignant pleural mesothelioma will feel dyspnea with varying degrees of intensity and unpleasantness. When the symptom becomes severe, there is cause for immediate management strategies to be employed. Reducing fear is critical, as well as finding ways to increase quality of life.

 

Coping with symptoms of mesothelioma can be very challenging, both for the patient and loved ones. Seek out support from hospice and palliative care nurses who are trained in helping with symptoms such as dyspnea. If you are a caregiver, learn and encourage the patient to learn how to relieve the anxiety of the symptoms by alternative means that put control back in their hands.   This is a frightening experience, and yet there are things one can do to help lessen the impact of dyspnea.

 

For more information, speak to your treating physician or ask to speak to a palliative or end of life specialist.