Mesothelioma Patients to Benefit from New ASCO Guidelines Encouraging Frank Discussions About Prognosis and Care
No one wants to talk about end-of-life care, but when patients are faced with the diagnosis of an advanced, incurable cancer such as mesothelioma, the American Society of Clinical Oncology (ASCO) believes it is the doctor’s responsibility to broach the subject. In their newly released guidelines, ASCO encourages physicians to discuss a patient’s treatment options and preferences immediately after their terminal diagnosis so the treatment can be individualized from the start.
Mesothelioma, an asbestos-related pulmonary cancer, is often not diagnosed until symptoms appear leaving patients with few treatment options. Once symptoms become apparent, mesothelioma may rapidly progress to cause life-threatening complications. The treatment at this point is often palliative, and is aimed at relieving the symptoms and improving the patient’s quality of life. However, according to ASCO, the patient may not be fully aware of their grim prognosis.
Doctors Should Assess Patients Personal Preferences
The authors found that “realistic conversations about prognosis, the potential benefits and limitations of disease-directed therapy” most often don’t occur until late in the illness, and sometimes not at all. While ASCO says the focus of the patient should be on their quality of life, they also say it is time for a change of paradigm and to step back from using one line of therapy after the other and to focus instead on disease-directed interventions.
According to the guidelines published in the Journal of Clinical Oncology, physicians need to consider how to “personalize or tailor care to the diverse physical, psychological, social, and spiritual consequences of cancer for the individual patient.” The only way to do this correctly is to thoroughly assess a patient’s options, goals and preferences early in his treatment. The individualized care can then be managed throughout the continuum of treatment.
Encourage Palliative Care
In the table “Key Elements of Individualized Care for Patients with Advanced Cancer,” the authors identify 6 items for how the therapy should be handled for a patient with advanced cancer. Included in the list is ensuring the patient is kept well informed, discussing options for enhancing the patient’s quality of life as well as encouraging participation in appropriate clinical trials. The final element instructs the doctor, when all treatment options are exhausted, to encourage patients to “transition to symptom-directed palliative care alone with the goal of minimizing physical and emotional suffering and ensuring that patients with advanced cancer are given the opportunity to die with dignity and peace of mind.”
Palliative care treatment, for end-stage mesothelioma patients, is intended to control pain, stop bleeding, and relieve pressure, even though the cancer can no longer be controlled. The expectation is that the patient will maintain a good quality of life until the end.