Clapper, Patti, Schweizer and Mason

Mesothelioma is a cancer caused by exposure to asbestos that begins in the lining of the lungs, abdomen, or heart. Asbestos is a naturally occurring mineral that was once widely used in many industrial and construction products because of its highly insulating and fire retardant properties. Most patients diagnosed with malignant mesothelioma have been exposed occupationally, although exposure can occur environmentally or through second hand measures.

 

Mesothelioma is often not diagnosed until it has reached advanced stages, and is very difficult to treat. Standard therapies include surgery, chemotherapy and radiation therapy. Radiation is almost always recommended along with chemotherapy, as is the case with many advanced solid tumors. Radiation has been proven to be effective, and yet can have some debilitating side effects.

 

Almost all patients who undergo radiation therapy experience nausea and vomiting, sometimes causing anguish and suffering so great that patients’ quality of life is severely decreased. When the nausea and vomiting become too distressing, it can actually jeapordize treatment success because patients will delay or decline radiation to avoid the side effects. 

 

The incidence and severity of post radiation induced nausea and vomiting (RINV) is often underestimated by radiation oncologists and treating physicians. Oncologists may not prescribe the best antiemetic drugs for several reasons: one, they are expensive; two, if patients undergo radiation on an outpatient basis, the oncologist may not witness or be aware of the severity of RINV; and three, they are more likely to prescribe AFTER symptoms but not proactively.  

 

A recent study by Jean-Claude Horiot, M.D. of France, shows that prescribing prophylactic antiemetic medications prior to the onset of RINV can improve the patients’ willingness to comply with treatment, decrease patient suffering, increase patient survival, and lead to more cost-effective therapy options. 

 

He specifically recommends a regimen using 5-hydroxytryptamine type 3-receptor antagonists (5-HT3) for reducing the debilitating effects of nausea and vomiting. Although 5-HT3 can have some side effects (headache, asthenia, somnolence, constipation or diarrhea) they are much more mild and transitory than RINV. 

 

Other factors to take into consideration are a patient specific, such as age, gender, level of alcohol consumption, previous nausea history, cardiovascular risk, and anxiety. The review encourages radiation oncologists to inform themselves about the severity and frequency of RINV and to take steps to prevent it rather than treat it after the fact. He also stresses the importance of using the 5_HT3- receptor antagonists versus older antiemetics, since the older ones have been clinically proven to be ineffective. 

 

By taking effective prophylactic measures versus a symptom management approach, lives can be saved. Patients are more likely to interrupt treatment when symptoms become severe. If antiemetic treatment is given proactively, patients are more likely to continue treatment on schedule, adding to its effectiveness. 

 

Mesothelioma patients suffer from pain, pleural fluid build up, breathing difficulties and many other symptoms. If there is a way to reduce side effects from radiation which lead to improved treatment and palliative care, then incorporating a preventative approach is recommended.

 

If you have been diagnosed with mesothelioma and are undergoing radiation therapy, talk to your oncologist about ways to reduce the side effects by taking the most current, effective antiemetic agent.   If you are experiencing nausea and vomiting, be sure to tell your oncologist the severity and frequency so that they are aware, and do all you can to keep your treatment plan in place and on schedule.