How should I approach the management of a patient diagnosed with mesothelioma, including palliative care options?

Management of a patient diagnosed with mesothelioma involves a multidisciplinary approach focusing on symptom control, disease management, and palliative care.

Initial management includes monitoring for complications such as pleural effusions and airway obstruction. Pleural aspiration or drainage should be performed to relieve symptoms caused by pleural effusion, and if beneficial, talc pleurodesis is recommended for longer-term control of effusions ¹.

For patients with large airway involvement or impending endobronchial obstruction, external beam radiotherapy, endobronchial debulking, or stenting should be offered to alleviate symptoms ¹.

Non-drug interventions for breathlessness, including psychosocial support, breathing control, and coping strategies, should be provided by a multidisciplinary team with expertise in breathlessness management, accessible in all care settings ¹.

Pharmacological options include opioids such as codeine or morphine to reduce cough and manage breathlessness ¹.

Referral to specialist palliative care teams is essential to assess symptom burden, plan symptom management strategies, and provide psychological support ¹,³.

Other symptoms such as weight loss, loss of appetite, fatigue, and depression should be managed by multidisciplinary groups including palliative care professionals ¹.

In cases of superior vena cava obstruction, chemotherapy, radiotherapy, or stent insertion may be considered depending on disease stage and symptom severity ¹.

End-of-life care should focus on managing pain, breathlessness, nausea, and other distressing symptoms promptly and effectively, using both pharmacological and non-pharmacological methods, with specialist palliative care advice sought if symptoms are difficult to control ³.