A mesothelioma diagnosis comes with many important questions. Perhaps the most crucial question is – what is the prognosis? In fact, the prognosis of mesothelioma varies depending on a number of variables. These variables include:
The patient – their age, biology, and state of health
The cancer – has the mesothelioma spread or is it localized when it is diagnosed and what is the cell type
The treatment or treatments selected
The expertise of the treatment team (doctors and other clinicians)
The Patient’s Health
A patient’s general state of health is an important prognostic factor in fighting any disease and mesothelioma is no exception. In addition, a patient’s biology or physiology also plays a role. For example, will chemotherapy work or can it be tolerated? Does the patient have a heart condition so that surgery is not an option? How will the patient’s biology interact with the treatment? The answers to these questions can all play a role in the prognosis.
The Cancer
The spread or lack of spread of the cancer is also an important factor. If mesothelioma is localized it can be easier to treat. In fact, surgery is usually only an option if the cancer has not metastasized. If it has spread then treatment options may be more limited. In addition, there are three cell types of mesothelioma – epithelioid, biphasic, and sacramatoid. The first, epithelioid, often has the best prognosis of the three.
The Treatment
The treatment or therapies selected is also important. Patients can select from conventional therapies (radiation, chemo, and surgery), clinical trials or integrative or alternative modalities. Not every therapy works in every patient. There is an important connection between a person’s physiology, cancer and the treatments selected. The interchange or intersection of these three factors often dictate what the treatment outcome and prognosis will be. Unfortunately, it is often difficult to predict because how a tumor or a treatment acts in a patient’s body is often not known until after the fact.
The Doctors’ Expertise
The last factor is the expertise of your doctors or licensed care givers. How these people do their jobs can be a key factor in prognosis. Are the surgeons experienced with mesothelioma? For example, what is their mortality rate for surgery? The smallest rate bodes better than the highest rate. Also, what options can these treaters suggest? Do they only offer chemo or can they offer a wide range of different modalities and treatment options. All these factors play a role in the prognosis of mesothelioma.
Below are some more details about the prognosis for mesothelioma.
Prognosis of Pleural Mesothelioma
The prognosis of pleural mesothelioma with standard treatment is typically not great. Median overall survival is a little over a year. However, there are a number of factors that affect prognosis.
A number of studies have been performed over the years to determine what treatments are optimum for mesothelioma and what factors lead to a better prognosis. Below, we report on several of these.
In a September 2016 Austrian study, a total of 210 patients with malignant pleural mesothelioma were followed.
167 (79.5%) were men and 43 (20.5%) were women
The average age was 67 at the time of diagnosis
Asbestos exposure was confirmed in 109 (69.4%) patients
The majority of patients had epithelioid cell type (67.2%)
Sarcomatoid comprised 16 (7.6%)
Biphasic was found in 28 patients (13.3%)
In 25 patients, the cell type was not specified
Data about survival was available for 185 patients. The study found:
Median overall survival was 19.1 months.
Pleural mesothelioma patients with early-stage disease (stages I, II) had an overall survival of 26.4 months.
Pleural mesothelioma patients with late-stage disease (stages III, IV) had an overall survival of 13.0 months .
Patients with epithelioid cell type had overall survival of 25.1 months.
Patients with sarcomatoid or biphasic cell type had overall survival of 10.2 months.
There was no survival difference between males and females.
There was no survival difference between patients below or above the age of 65 years.
Survival was significantly better in patients undergoing surgery. However, these patients were significantly younger, had earlier-stage disease, better performance status, and more often had epithelioid subtype.
The study concluded that factors that indicated a better prognosis included: higher Karnofsky score, earlier stage disease, epithelioid cell type, and surgery within multimodality treatment.
Management of malignant pleural mesothelioma – part 3 : Data from the Austrian Mesothelioma Interest Group (AMIG) database. Klikovits T, et al., Wien Klin Wochenschr. 2016 Sep;128(17-18):627-34.
Prognosis of Peritoneal Mesothelioma
The prognosis of peritoneal mesothelioma has become much better with the advent of surgery and HIPEC. The following studies illustrate the improvements in prognosis over the last several years.
Peritoneal Mesothelioma Prognosis with Chemotherapy
In a 2011 Greek Study, chemotherapy was used to treat peritoneal mesothelioma patients. Six patients with peritoneal mesothelioma were treated with 6 cycles of pemetrexed (500 mg/m2) and cisplatin (75 mg/m2). Chemotherapy was administered on an outpatient basis every 3 weeks. The estimated median overall survival was 24 months.
Systemic chemotherapy with pemetrexed and cisplatin for malignant peritoneal mesothelioma: a single institution experience. Lainakis G, et al., Tumori. 2011 Jan-Feb;97(1):25-9.
Peritoneal Mesothelioma Prognosis with HIPEC
An April 2014 United States Study examined 65 patients with pleural mesothelioma who underwent surgery and HIPEC (hyperthermic intraperitoneal chemoperfusion) between 2001 and 2010.
What is HIPEC for Mesothelioma?
HIPEC is where heated chemotherapy is used to bath the surgical cavity putting the chemo in direct contact where the tumor cells remain. The study found that overall mesothelioma survival was 46.2 months. The study also found that although survival was better, there were side effects associated with this treatment approach that included:
Six percent of the patients died within 60 days.
Of the 65 patients, 91 % were admitted to the intensive care unit (ICU) postoperatively, with median hospital length of 12 days.
A total of 12 patients (18 %) underwent reoperation: four patients (33 %) for enteric leak, 1 patient (8 %) for an intra-abdominal abscess, and seven patients (58%) for other reasons.
Factors that contributed to a poor prognosis included:
Older patient
More widespread tumors
More aggressive cell type
Incomplete surgery
Post-operative infection
The study concluded that better prognosis is associated with patients who have the epithelioid cell type, lower volume of tumor, and more effective surgery (most tumor removed).
Malignant peritoneal mesothelioma: prognostic factors and oncologic outcome analysis. Magge D., et al., Ann Surg Oncol. 2014 Apr;21(4):1159-65.
Is Right-Sided Pleural Mesothelioma Worse than Left-Sided?-Pleural mesothelioma develops from the thin layer of tissue that covers the lungs and chest wall. Pleural mesothelioma may develop in the lining of the chest wall on just one side of the chest. Previous research has suggested that right-sided pleural mesothelioma is associated with a poorer prognosis. Yet, these were very small studies and estimates were not precise. Dr. Adjepong’s team decided to see if the side mattered. Does it matter if pleural mesothelioma is more on the left or right side? Using National SEER Database to Study Pleural Mesothelioma Malignant pleural mesothelioma is a highly aggressive and rare form of cancer. There are approximately 2,000 cases of mesothelioma diagnosed in the U.S. every year. Mesothelioma is caused by exposure to … Continue reading Is Right-Sided Pleural Mesothelioma Worse than Left-Sided?»
Second Treatment Course May Increase Mesothelioma Patient Survival-Oncologists report that a second treatment course may be a good option for some mesothelioma patients. Almost all mesothelioma patients experience progression after the first treatment. Recommendations for a second treatment are still unclear. There is very limited information available on second and repeat treatments. Pemetrexed combined with platinum-based chemotherapy is a standard first treatment for mesothelioma. A report in BMC Cancer says that a repeat treatment may be good for eligible patients. In this study, patients who received a second treatment of chemotherapy survived longer. Understanding Second Treatments or Retreatments Malignant pleural mesothelioma is a rare, aggressive cancer linked to asbestos exposure. There have been several recent treatment advances. But the mesothelioma prognosis is still poor with an average … Continue reading Second Treatment Course May Increase Mesothelioma Patient Survival»
Is Asbestos Fiber Type or Concentration More Important in Mesothelioma?-Malignant pleural mesothelioma is strongly associated with occupational asbestos exposure. The total asbestos fiber concentration may be associated with an increased risk of mortality. Asbestos fiber type was not as important. A new study looked at different types and concentrations of asbestos fibers in the lung tissues of mesothelioma patients. The team investigated their effects on patient mortality. Asbestos Fiber Analyses A Finnish team of scientists identified 590 patients to study. All patients had malignant pleural mesothelioma and underwent pulmonary asbestos fiber analysis. A pulmonary asbestos fiber type analysis is a special clinical test. It extracts fibers and asbestos bodies from a patient’s lung tissue. Usually, this uses a digestion-and-concentration technique. The examination may even include electron diffraction and energy-dispersive … Continue reading Is Asbestos Fiber Type or Concentration More Important in Mesothelioma?»
A New Prognostic Signature Discovered for Malignant Pleural Mesothelioma-Immune-related genes play an important role in malignant pleural mesothelioma prognosis. They can affect the tumor immune microenvironment and affect tumor prognosis. Immune-related genes can be used to predict the course of a disease or patient outcomes. These genes are often called a genetic prognostic signature. Chinese surgeons recently discovered a prognostic signature for malignant pleural mesothelioma patients. Constructing a Prognostic Signature with 5 Immune-Related Genes Genes play an important role in the development and progression of cancers like mesothelioma. The Chinese researchers started by searching for other studies on mesothelioma prognosis and genes. Researchers used data from the Cancer Genome Atlas to construct the prediction signature. Patients were divided into high-risk and low-risk groups. They also used this data … Continue reading A New Prognostic Signature Discovered for Malignant Pleural Mesothelioma»
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Living With Mesothelioma: Coping Strategies to Find Hope-Mesothelioma is a cancer caused by exposure to asbestos. One key question remains unanswered. How do diagnosed patients experience living with mesothelioma? A new study in Health Psychology aimed to explore the mesothelioma patient experience. Data from 22 different research studies were analyzed. The coping strategies highlighted here provide hope for mesothelioma patients and caregivers. The results bring awareness of the patient experience, coping processes, and support pathways. Two Coping Strategies to Support a Mesothelioma Patient The best coping strategies help patients reclaim a sense of mental calm, individual autonomy, and meaning. These strategies can also reduce the trauma of living with mesothelioma. Patients who accepted the diagnosis fully were more optimistic than those in denial. Patients who accepted the … Continue reading Living With Mesothelioma: Coping Strategies to Find Hope»
New Cancer Guidelines to Manage and Treat Mesothelioma-Malignant pleural mesothelioma is a type of cancer that develops from the thin layer of tissue that covers many of the body’s internal organs. Mesothelioma is a difficult disease to study on a global scale for many reasons. Yet, there has been tremendous progress in mesothelioma research over the last decade. However, current cancer guidelines are fragmented. An editorial in the Annals of Oncology recommends that new guidelines need to focus on both global and gender perspectives. Shifting Timeframes Make it Difficult to Study Mesothelioma Cases of mesothelioma are rising in some countries and falling in others. This makes it difficult to study the disease on a global level. There are a few different reasons for this global variation. First, … Continue reading New Cancer Guidelines to Manage and Treat Mesothelioma»
Dentists Exposed to Asbestos Could Trigger Malignant Mesothelioma-Experts have recommended a new plan to warn dentists exposed to asbestos. Asbestos is a naturally occurring mineral that has been found throughout the world. Asbestos is toxic and cancer-causing for human beings. Dentists used asbestos in the manufacture of dental prostheses from the 1960s to 1970s. Generally, those who develop asbestos-related diseases show no signs of illness for a long time after their exposure. It can take from 10 to 40 years or more for symptoms of an asbestos-related condition to appear. Experts have recommended a new plan to prevent asbestos exposure in dentistry. This recommendation was created under the EuropeAid Assessment Guidelines. Experts also request the inclusion of the dental sector in the lists of professions with asbestos exposure. … Continue reading Dentists Exposed to Asbestos Could Trigger Malignant Mesothelioma»
Lower Platelet Count Linked to Longer Mesothelioma Survival-A high platelet count may not bode well for people battling malignant pleural mesothelioma. New evidence suggests that survival rates may be higher for mesothelioma patients with a lower platelet count. This news comes from the Kocaeli University which analyzed malignant mesothelioma patients between 2008 and 2014. They wanted to know if certain clinical characteristics could predict longer patient survival. Platelets and Health Mesothelioma is a rare form of cancer. It develops from cells of the mesothelium, the lining that covers many of the internal organs of the body. While it is uncommon, it has a high mortality rate. Smaller than either red or white blood cells, platelets are the components in blood that facilitate clotting. The normal range for platelet … Continue reading Lower Platelet Count Linked to Longer Mesothelioma Survival»
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