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Families of Mesothelioma Patients Face Tough Choices When Weighing Surgical Options

doctor with patientWhen you’re taking care of a loved one with malignant pleural mesothelioma (MPM), each decision is difficult. How can I keep them comfortable? Where can we get medical consultations or legal advice? Should we think about the full round of treatments or stay more conservative? At Kazan, McClain, Lyons, Greenwood and Harley, we’ve spent more than three decades helping people make tough but informed choices.

One of the more difficult decisions out there is whether to pursue surgery for mesothelioma. Some doctors are adamant that radical operations (like the extrapleural pneumonectomy, or EPP) will not cure the disease, while others emphasize that such procedures do provide pain relief and may extend survival time.

For those weighing the idea of surgery for MPM, here is a quick summary of some of the arguments for and against. This is by no means a complete list. To make a fully informed decision, talk with your oncologist and/or surgical specialist before making any decisions.

How surgery can help

Most public health agencies agree that, even for a disease as virulent as mesothelioma, surgery has several notable benefits. The first is that it can lengthen a loved one’s life by months, if not years. The National Cancer Institute (NCI) estimates that patients who receive surgery for MPM live an average of 16 months beyond their diagnosis.

Of course, survival time depends on several things. First, the earlier a patient’s disease is caught, the longer they may be expected to live. In a study published in the Journal of Thoracic and Cardiovascular Surgery, researchers determined that patients with Stage I or II mesothelioma had much better odds of surviving two, three or even four years, compared to those with Stages III or IV.

The same report noted that pleurectomy/decortication and EPP are the two operations associated with the highest likelihood of prolonged survival.

Another benefit of surgery is that it often provides comfort for mesothelioma patients. In fact, the NCI currently categorizes all MPM procedures as palliative, meaning they do not cure the disease but they may ease chest pressure and make breathing easier.

There are a number of operations for MPM, some more extensive than others. A thoracentesis, in which fluid is drained from the pleura, is one of the simplest and most common procedures. More radical is the pleurectomy/decortication, which involves the removal of one lung and as much tumor mass as possible. Finally, the EPP is the most radical, removing as it does a lung, the lung and heart linings, and most of the diaphragm. Each surgery may provide pain relief or extend survival.

How surgery can be counterproductive

Sadly, not all operations for MPM increase a patient’s lifespan – or, if they do, it may be by a matter of weeks or months only. In the British Journal of Surgery, a pair of surgeons summarized the difficulties by pointing to Lionel Shriver’s memoir of dealing with MPM, titled So Much for That:

She plots the course, from diagnosis to death, of a woman with abdominal mesothelioma in present-day America. Fourteen months after being given a one-year expectation of life, her doctors run out of options and the family runs out of money. The oncologist comforts her bankrupt husband saying “we’ve probably extended her life a good three months.” The bitter irony of “good” strikes the spouse, but seems lost on the doctor.

Such situations are not the standard, but they do happen. It is best to know that while surgery can (and often does) help, it also may not.

Consider whether doctors believe an operation will make your loved one more comfortable. Talk to them, take some time to think about it and, in the end, do what you think is best.

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