A study out of the UK says more doctors should consider using a minimally invasive surgical technique called PCC in mesothelioma pain management. They also say it should happen earlier.
Percutaneous cervical cordotomy (PCC) uses an electrode to destroy a small set of nerves in the spinal cord. These nerves send pain signals to the brain.
Although the evidence for PCC is limited, the researchers say their study shows it is safe and effective for mesothelioma pain management. Unfortunately, the patients who do have PCC tend to have it late in their illness.
Pleural Mesothelioma Discomfort
Malignant pleural mesothelioma is a cancer of the thin tissue that encases the lungs. There are no nerves in this tissue, so patients do not usually feel any pain in the early stages of mesothelioma. This is part of why many people are not diagnosed until they have more advanced mesothelioma.
There is no cure for mesothelioma and tumors usually continue to grow. As mesothelioma progresses, the cancer may invade the chest wall. At this stage, patients often do need mesothelioma pain management.
Doctors have a number of ways of treating cancer pain, including opioid medications. But opioids come with their own risks and side effects. Also, most mesothelioma patients experience one-sided pain, which cannot be addressed by medication alone.
The UK study suggests that PCC may be a viable alternative for mesothelioma pain management, especially in people who do not get adequate relief from medication.
The Potential of PCC in Mesothelioma Pain Management
During a PCC procedure, a surgeon inserts a needle into the spine. The needle acts as a guide for a tiny electrode. The electrode passes through the needle to direct a burst of radiofrequency waves into the nerves that transmit pain messages from the chest.
The UK researchers note that there are not many studies on PCC for mesothelioma pain management. But the studies that do exist suggest that it is effective and helps reduce opioid use.
The UK study ran from 2012 to 2017 and included 159 patients with cancer pain. Fifty-seven percent of the patients had pleural mesothelioma. The median time from diagnosis to PCC was 13 months, with the longest being nearly two years.
Before the procedure, patients had an average cancer pain score of six out of 10. On follow-up (an average of 9 days later), the average score had dropped to just two. Other issues linked to mesothelioma pain management were also positively impacted.
“The median reduction in strong opioid dose at follow-up was 50 percent,” writes researcher Marlise Poolman of Bangor Institute for Health and Medical Research at Bangor University. “With the exception of ‘activity’, all health-related quality of life scores either improved or were stable after PCC.” Only six patients had any PCC-related adverse events.
The team concludes that PCC is effective for mesothelioma pain management but that “PCC referrals tended to be late in patients’ disease trajectories.”
In addition to more studies on the earlier use of PCC, they say a consensus from cancer doctors on the procedure “will further enhance opportunities to improve patient care.”
Poolman, M, et al, “Percutaneous cervical cordotomy for cancer-related pain: national data”, March 27, 2020, https://spcare.bmj.com/content/early/2020/03/26/bmjspcare-2019-002057