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 NICE NG122.
For patients with large airway involvement or impending endobronchial obstruction, external beam radiotherapy, endobronchial debulking, or stenting should be offered to alleviate symptoms NICE NG122.
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 NICE NG122.
Pharmacological options include opioids such as codeine or morphine to reduce cough and manage breathlessness NICE NG122.
Referral to specialist palliative care teams is essential to assess symptom burden, plan symptom management strategies, and provide psychological support NICE NG122,NICE NG31.
Other symptoms such as weight loss, loss of appetite, fatigue, and depression should be managed by multidisciplinary groups including palliative care professionals NICE NG122.
In cases of superior vena cava obstruction, chemotherapy, radiotherapy, or stent insertion may be considered depending on disease stage and symptom severity NICE NG122.
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 NICE NG31.