Symptom Management

96% of patients with mesothelioma experience dyspnoea, it may be a result of:

• Recurrent pleural effusion
• Reduction in lung volume—entrapped lung
• Anxiety
• Side effects of therapy

Management may include:

• Further surgical intervention or insertion of a pleural drain to remove fluid
• Liquid morphine (Ordine)
• Oxygen therapy may be useful, but is not required by all
• Psychological support—mindfulness meditation is recognised as a beneficial self-help therapy
• Chest physio
• A handheld fan—stimulation of mechanoreceptors or temperature receptors mediated via the trigeminal nerve may alter feedback to the brain and modify perception of dyspnoea
• Education on positioning and equipment, such as recliner chairs and hospital beds

Both a symptom of mesothelioma and a side effect of treatment. It is important to conduct a comprehensive pain assessment to determine the location and severity of pain. Many people may need a combination of medications to achieve good pain control. Referral to palliative care for symptom management is recommended.

Cachexia and malnutrition are common among patients with mesothelioma and are associated with impaired quality of life, reduced tolerance to treatment and increased mortality. Regular malnutrition screening and input from a dietician is essential in managing weight loss and poor appetite. Guidance for the carer around achieving and maintaining adequate dietary intake may be helpful.

Fatigue and lethargy are both a symptom of mesothelioma and a side effect of treatment. It is important the treating team is aware so that it can be treated appropriately. Fatigue is best managed by exercise throughout the day, pacing activities and eating a nutritious diet. You could seek advice from an exercise physiologist or dietician at this point.

A cancer diagnosis has a significant psychosocial impact on the patient. Anxiety, depression and post-traumatic stress disorders as well as anger, guilt and pressure on relationships are common among patients diagnosed with mesothelioma. Ongoing psychological support is essential in promoting positive patient outcomes and good quality of life. Referral to psychology and counselling services may be considered for these patients.