A new Danish study suggests that, when it comes to palliative chemotherapy for mesothelioma, patients, families, and doctors may have very different expectations.
Malignant mesothelioma is an aggressive cancer caused by asbestos. It is not curable but chemotherapy can sometimes slow it down. Palliative chemotherapy is chemotherapy aimed at relieving mesothelioma symptoms.
But researchers at Odense University and University of Southern Denmark say nearly a third of families expect palliative chemotherapy to cure their cancer. This was especially true of patients younger than 70.
Palliative Chemotherapy for Mesothelioma
Chemotherapy has been the main treatment for mesothelioma since the early 2000s. Pemetrexed (Alimta) and a platinum drug like cisplatin is the standard drug combination. But this treatment is rarely a cure. Studies show that it extends life by an average of four months.
Palliative chemotherapy may use the same drugs. But the intention is different. The goal of palliation is to keep patients comfortable. Radiation and other therapies can also be used for palliative treatment.
Palliative chemotherapy aims to keep quality of life as high as possible for as long as possible. But the Danish study suggests that some families either do not understand the expectation or simply do not accept it.
Unrealistic Expectations or Optimism?
Researchers found that 28% of patients under 70 expected a cure for their mesothelioma. Among patients 70 or older, only 7 percent expected a cure. Family caregivers were more optimistic. Thirty-six percent expected palliative chemotherapy to cure their loved one’s cancer.
“This study emphasizes the importance of initiating conversations about treatment expectations and paying attention to expectations that may differ by the age of the patient and between patients and family caregivers,” writes lead study author Tine Ikander. Dr. Ikander is an oncologist in the Academy of Geriatric Cancer Research at Odense University in Denmark.
Decline in Quality of Life in Spite of Treatment
Palliative chemotherapy helps to manage the symptoms of mesothelioma. But it cannot make them go away. And it cannot stop the progression of the disease indefinitely.
Across both age groups in the Danish study, quality of life declined during palliative treatment. Patients had an average quality of life score of 73.2 when they had their first palliative chemotherapy. That went down to 70.5 by their third cycle.
Physical and emotional well-being declined, too. Patients had an average physical well-being score of 20.3 at their first cycle of chemotherapy. That score dropped to an average of 18.4 at the third cycle. Emotional well-being from the first to the third cycle of palliative chemotherapy dropped from 15.4 to 14.6.
The research team says doctors should keep a close eye on mesothelioma patients’ quality of life to make sure the treatment is doing what it should.
“Addressing treatment expectations among patients and family caregivers and monitoring quality of life among patients is important in clinical practice,” they conclude.
Likewise, mesothelioma patients in palliative therapy should make their doctor aware of how they feel. Sometimes, small adjustments in treatment can improve quality of life.
Ikander, T, et al, “Patients and family caregivers report high treatment expectations during palliative chemotherapy: a longitudinal prospective study”, February 26, 2021, BMC Palliative Care, Article #37, https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-021-00731-4