A family member has been diagnosed with Mesothelioma that is not surgecially treatable as it is the worst genetic type and has also spread into the mediastinum.
The Doctor wants to start chemotherapy ASAP, and I am not sure if they plan on Radiation as well?
The patient is questioning if he should even take this treatment? His Wife passed away from lung cancer and he has seen what the chemo does.
How much life extension would chemotherapy +/- radiation provide to someone with this sort of situation? Quaility of life would be ????
I would sincerely appreciate your frank and experienced opinion as he is struggling with this decision and they want he to decide in the very near future (one or two days). I would appreciate it if you could look at the situation as a : "if this was your parent, what would you do"...
Thank you very much.
Fri, 04/05/2019 - 09:57
Welcome to Grace. I'm very sorry to know your relative is going through this. It's not possible for anyone to say what should be done or what someone might do if this were their patient because there are too many other issues that go into making a plan. Having said that there is a lot of information about managing unresectable mesothelioma. I've posted a couple of links below that will help you understand what options may be available.
It is always possible to get a second opinion from a meso specialist. However, if his cancer is unresectable radiation or other focal treatment (treating just one site as opposed to systemic treatment that treats the whole body) isn't helpful unless it's for palliative purposes (to aid in comfort care).
Unfortunately, mesothelioma is a difficult disease to treat. From the website, uptodate, a prominent, mostly subscription based site for health providers says, "Malignant mesothelioma is a rare neoplasm that arises most commonly from the mesothelial surfaces of the pleural cavity, less commonly from the peritoneal surface, and extremely rarely from the tunica vaginalis or pericardium. It often has an extremely poor prognosis; the median survival is 4 to 13 months for untreated patients  and 6 to 18 months for treated patients, regardless of the therapeutic approach [2,3]." https://www.uptodate.com/contents/systemic-treatment-for-unresectable-malignant-pleural-mesothelioma?search=pleual%20mesothelioma&source=search_result&selectedTitle=2~59&usage_type=default&display_rank=2
There are clinical trials that are testing chemo with immunotherapy that are showing promise and your relative may be interested in checking that out. His oncologist should be able to get info on them.
Whether or not to accept treatment is a personal decision and appropriate to consider with unresectable mesothelioma. If he doesn't like it he can quit at anytime. It's important for him to know though that he doesn't have to make the decision today or tomorrow however this is usually an aggressive disease so the more time taken the greater chance of becoming too frail to have treatment. Side effects of chemo are most often managed with meds given with chemo and most people are surprised by how well they feel compared to how difficult it was for loved ones in the past.
At any time he decides not to have or continue treatment, hospice should be called in to manage the symptoms of cancer both physical and emotional for patients and caregivers. The sooner they are allowed to help the better.
Again I'm so sorry you and he are going through this. He's lucky to have you
All the best,
I joined GRACE as a caregiver for my husband who had a Pancoast tumor, NSCLC stage III in 2009. He had curative chemo/rads then it was believed he had a recurrence in the spine/oligometastasis that was radiated. He's 10 years out from treatment.