Supportive therapies for pleural mesothelioma

Possible symptoms of mesothelioma include breathlessness, a cough, pain, night sweats, loss of appetite and tiredness. There are many things that can help reduce these symptoms so it’s important to tell your doctor or nurse about any problems you have.

Breathlessness may be due to a build up of fluid between the two layers of tissue that surround the lungs. This is called a pleural effusion. It can be relieved by a doctor placing a fine tube between the two layers of the pleura and draining the fluid.

There are different types of painkillers that can be used, depending on the type of pain. Some people are treated at specialist pain clinics.

If you have night sweats keep the bedroom cool and use light bedclothes made of natural fibres such as cotton.

If your appetite is affected your doctor can prescribe you high calorie supplements or steroids to boost your appetite.

If you feel very tired tell your doctor. Try to balance rest with some gentle activity.

Some people use complementary therapies such as massage to help manage symptoms.

Breathlessness

Breathlessness is a common symptom of pleural mesothelioma. It’s often caused by a build-up of the fluid between the two layers of the pleura (the membranes that cover the lungs). This is called a pleural effusion.


Treating a pleural effusion

A pleural effusion is treated by placing a small tube between the two layers of the pleura and draining off the fluid. The tube is usually put in the side of your chest. You will have a local anaesthetic to numb the area. When the tube is in place it will usually be connected to a bag or a bottle for the fluid to drain into. You may need to have the fluid removed on a regular basis.

After the fluid from the pleural effusion has been drained, it may be possible to seal the two layers of the pleura together to prevent the fluid building up again. This is called pleurodesis. Your doctor can put sterile talcum powder (talc), or a particular chemical powder, into the pleural space through the tube. This causes the membranes to stick together and helps stop pleural effusions happening again. A pleurodesis may sometimes be done during a video-assisted thoracoscopy. Your doctor will be able to tell you about this.

Some people may have a soft flexible tube (pleural catheter) put in, particularly if they’re unable to have pleurodesis. The tube can be tunnelled under the skin and inserted into the space where fluid collects. It can be left in position so that any fluid can be drained off whenever needed without you having a tube put in each time. The end of the tube is covered with a dressing when you’re not using it.

You may have a catheter put in as a day-case procedure or you may need to stay in hospital for a few days. You can be taught how to drain the fluid yourself or the hospital staff can arrange for a district nurse to do this.

Pleural effusion
Pleural effusion

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Other ways to manage breathlessness

These include breathing techniques, relaxation and coping strategies. These can all help to reduce the distress of breathlessness and make your breathing easier.

Even simple measures, such as how you position yourself when sitting or standing, can be helpful. Using a fan or sitting by an open window with cool air blowing on to your face may also help ease breathlessness.

Your doctor may also prescribe medicines to help with breathlessness, such as a low dose of the painkiller morphine, or drugs to help relieve the anxiety and panic that breathlessness can cause. Some people may benefit from using oxygen at home. Your doctor or palliative care nurse can organise for you to have oxygen at home if it’s suitable for you.


Cough

Coughing is also a common symptom of mesothelioma. This can be difficult to cope with as it can sometimes cause other symptoms such as pain, vomiting and tiredness. Your doctor may be able to give you medicines to help. You may also find it helpful to:

  • Avoid things that seem to aggravate your cough – these will vary from person to person. 
  • Use steam inhalations or saline nebulisers. A nebuliser is a small machine that turns saline into a fine mist, so you can breathe it deep into your lungs. 
  • Sleep in a different position – maybe propped up with pillows. 


Pain

Pain is a common symptom of mesothelioma. Let your doctors or specialist nurse know if you have pain so that they can assess and treat it early on.

Painkillers

There are many painkilling drugs available to treat different types and levels of pain. They include: painkillers, such as paracetamol, codeine or morphine; and anti-inflammatory drugs, such as ibuprofen (Brufen®) and diclofenac (Voltarol®). Some people find that they have nerve pain (also known as neuropathic pain), which happens when the mesothelioma presses on nerves. This type of pain is best treated with specific painkillers that treat nerve pain such as gabapentin and pregabalin (Lyrica®).

Often, a combination of painkillers is needed to get the best pain control.

Other ways to control pain

Other general ways of relaxing and helping to reduce your pain include:

  • listening to relaxation CDs
  • having a long soak in a warm bath
  • having a massage to an area of your body that isn’t painful, such as your hand or foot.

Occasionally, if your pain is troublesome, your doctor or nurse may suggest a short admission to hospital or a hospice so that your pain can be controlled while you’re an inpatient. They may also suggest referring you to a doctor who specialises in pain control, or a specialist pain clinic. They may use other methods of pain control, such as specialised procedures to block nerves, if nerve pain is a problem.


Night sweats

Mesothelioma can cause some people to sweat a lot at night. This can be distressing, especially if you wake at night with damp bed clothes and bedding. Let your doctor know if this happens to you as they may be able to give you medicines to help. You may also find the following tips helpful:

  • Try avoiding drinks that contain caffeine before you go to bed or in the night.
  • Keep the room temperature cool or use a fan.
  • Avoid using duvets or blankets that make you too hot.
  • Lie on a towel so that you avoid getting your bedding damp.
  • Use cotton sheets and bed clothes, and have some spare so that you can change them in the night if you need to.


Loss of appetite

Mesothelioma and some cancer treatments can cause problems with eating and digestion. If your appetite is poor, try having smaller, more frequent meals. You can also add high-protein powders to your normal food. Or you can replace meals with nutritious, high-calorie drinks. These are available from most chemists and can be prescribed by your GP.

If you have lost your appetite, medicines such as steroids may help improve it. You can also ask to be referred to a dietitian at your hospital. They can advise you which foods are best for you and also whether any food supplements would help you. If you’re at home, your GP can arrange this for you.


Tiredness

Many people with mesothelioma feel tired and have less energy to do the things they normally do. This may be due to the illness or it may be a side effect of treatment. It’s important not to do too much. Your body will tell you when you need to rest, but it’s important not to stop doing things completely. Try to balance rest with gentle activity, such as walking. Some people find it helpful to set goals to help them plan their daily activities. These goals may include cooking a light meal, going for a short walk or meeting a friend.

Some causes of tiredness can be treated, for example anaemia (low red blood cells) can be treated with a blood transfusion. Your doctor can take a blood sample from you to find out if you have anaemia.

If sleep problems are causing or contributing to your tiredness, then improving your sleep will help you feel better. You can read about ways of improving your sleep in our information about difficulty sleeping.

Tiredness is also a common symptom of depression. If you think you’re depressed, talk to your doctor or nurse. You and your doctor will be able to work out if what you’re feeling is depression or fatigue. Talking about your feelings with a professional counsellor can often help depression. Antidepressants may also help you feel better.


Complementary therapies

Some people find that complementary therapies, such as acupuncture, massage, aromatherapy and relaxation techniques, can help them feel better and reduce symptoms. Many hospitals and hospices offer these therapies.

If you’d like to try a complementary therapy, check with your cancer specialist or GP before using it. This is important because some complementary therapies should be avoided during, and for a short time after, cancer treatments.

Back to Treating

Making treatment decisions

Your doctors may tell you there are different options for your treatment. Having the right information will help you make the right decision for you.

Chemotherapy

Chemotherapy uses drugs to treat many different types of cancer. It is most commonly given as an injection into a vein or as tablets or capsules.

Radiotherapy

Radiotherapy is the use of high-energy rays, usually x-rays and similar rays (such as electrons) to treat cancer.

Surgery

Surgery involves removing all or part of the cancer with an operation. It is an important treatment for many cancers.

Clinical trials

Many people are offered a trial as part of treatment. Find out more to help you decide if a trial is right for you.

After treatment

After treatment you will have regular check-ups. If you have any problems, let your doctor know.