Medical Appointments for Advanced Mesothelioma Patients: How Much is Too Much?

A pair of researchers in New Zealand say the typical number of in-person medical appointments for people with untreatable pleural mesothelioma may be more stressful than helpful.

Their study focused on lung cancer and pleural mesothelioma patients with no active treatment options. They found that what most of these patients really want is reliable information, hope, and a positive relationship with their medical team. 

The report suggests that doctors could meet many of these with fewer visits or virtual medical appointments.

Coping with Advanced Mesothelioma

Malignant pleural mesothelioma is a rare but highly aggressive lung-related cancer. Mesothelioma starts on the lining around the lungs. It can quickly spread into the lungs and to other organs in the chest. 

Most patients have to go to many medical appointments to get a diagnosis. Mesothelioma diagnosis usually requires a detailed history, blood tests, biopsies, and imaging studies. 

Chemotherapy and surgery are the main treatments for pleural mesothelioma. But not all patients are candidates. If mesothelioma is very advanced and the patient does not qualify for a clinical trial, there may be nothing more doctors can do.

Reducing the Stress of Medical Appointments

The New Zealand study found that even patients who are not having treatment are still asked to go to many medical appointments. A mesothelioma patient may have frequent follow-up visits to monitor their disease and manage symptoms. These follow-up visits can be stressful, time-consuming, and costly. 

“Visits also place considerable strain on the health system,” observe study authors Dr. Anne Fraser and Dr. Rob McNeill of the University of Auckland. 

The two suspected that some of these medical appointments may be unnecessary. Could fewer visits improve quality of life at the end of life? Their goal was to see how lung cancer and mesothelioma patients felt about it. They reviewed nine studies on the subject from 1998 to 2018. 

The authors conclude that patients need reassurance, hope, and trusted advice more than they need face-to-face doctor visits. 

“Current surveillance is based on expert opinion with little consideration of patient preferences, quality of life, impact on anxiety, and impact on survival outcomes,” they write. 

The study suggests that virtual medical appointments could take some of the strain away. But the authors say more patient input is needed. They say the medical system should let cancer patients help design less stressful ways to follow-up with them. 

“Further research needs to be conducted, ensuring directed surveillance models that meet the holistic needs of patients,” they conclude.

Source: 

Fraser, A and McNeill, R, “Surveillance of Lung Cancer and Mesothelioma Patients With Noncurative Treatment Intent: A Narrative Review”, September 2, 2020, Cancer Nursing, Epub ahead of print, https://journals.lww.com/cancernursingonline/Abstract/9000/Surveillance_of_Lung_Cancer_and_Mesothelioma.98904.aspx