According to the World Health Organization, palliative care “is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”
The concept of palliative care started within the hospice movement. Palliative care is for anyone with a serious illness, not just those with a terminal illness. Palliative care is designed to improve the quality of life of patients by using a team approach. One of the key aspects of the care is to manage debilitating treatment side effects and improve the quality of life, recognizing that dying is part of life. Palliative care will neither hasten nor slow down death.
In “Overview of Palliative Surgery: Principles and Priorities,” published in 2012 in the Journal of Palliative Care & Medicine, Jennifer Hanna, Dan G. Blazer, and Paul J. Mosca define palliative surgery as “surgery performed with the intent of improving quality of life or relieving symptoms caused by advanced disease.”
Palliative surgeries, in fact, represent a substantial portion of medical operations. A study at a California cancer center examined the palliative procedures conducted over the previous year and found that 13% of surgeries were conducted for palliative purposes. Similarly, the aforementioned article by Jennifer Hanna, et al., demonstrates that palliative surgery accounts for anywhere between 10-20% of all operations performed in a surgical oncology practice.
Part of taking care of a patient facing malignant mesothelioma is managing the side effects of therapies or disease progression. The role of palliative surgery can come into play to manage some of these side effects and improve quality of life. Palliative surgery is intended to improve a person’s life while dealing with their disease.
For patients with pleural malignant mesothelioma, one procedure used to relieve symptoms of pleural fluid buildup is pleurodesis. This is performed to fuse the two layers of the pleura together. The outer layer (parietal layer) and the inner layer (visceral layer) are fused together. They are fused by inserting sterile talc or a sclerosing agent to cause a reaction to fuse them together to prevent fluid buildup. This operation is used for people that are having pain while breathing. The effect is to “glue” the two layers together to prevent build-up of fluid.
Another procedure for patients with pleural malignant mesothelioma is thoracentesis. This is a common procedure used to drain fluid from between the pleural space. A needle is inserted, using local anesthesia, usually under ultrasound guidance. The fluid, also called pleural effusion, is then drained. This procedure allows the lung to expand, making breathing easier. For some patients, drains may be left in the body so that caretakers can drain the fluid at home.
For those patients suffering from peritoneal mesothelioma, a paracentesis procedure can help alleviate painful fluid buildup in the abdominal cavity. Paracentesis is a procedure used to treat many different forms of abdominal fluid collections, called ascites. The abdominal discomfort can cause a lack of appetite and abdominal cramping. A needle is inserted, and the fluid is drained under local anesthesia. The fluid can re-accumulate, so repeated paracentesis are common.
For patients suffering from pericardial mesothelioma, a procedure called a pericardiocentesis can help alleviate painful build-up of fluid around the heart. A pericardiocentesis can include an operation called a pericardial window, or a subxiphoid pericardial drainage and pericardioscopy. There are three different approaches to a pericardial effusion. If the pericardial effusion is acute, a pericardiocentesis is performed to avoid general anesthesia. For infected or for systemic disease, and if the effusion is chronic, a pericardial window surgery is performed, removing part of the pericardial sac to allow fluid to drain.
The evidence is mounting that treatment for any serious condition should involve palliative care. Studies indicate that palliative care improves the patient’s quality of life and actually helps patients live longer.
Palliative care can help many people. Cancer is the second leading cause of death in the United States. Treatment options for cancer may include surgery, radiation, chemotherapy, immunotherapy, biologics, and clinical trials. These treatments may have uncomfortable side effects which would indicate palliative care. Malignant mesothelioma is an aggressive cancer that requires a team approach, including palliative care professionals. It is our hope that palliative care will bring the best quality of life for our patients and their families.
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