Pain Management as Treatment Plan for Mesothelioma Patient

Treatment Plan Includes Pain Management for Mesothelioma Patient

Pain management is an important part of the medical management of mesothelioma. Over fifty percent of mesothelioma patients report they suffer from pain at some time during their battle with the disease. The most common pain-related symptoms reported by patients with malignant pleural mesothelioma are general pain, back pain, and chest pain. Patients can get pain from several different sources, which is why the assessment of pain needs to be thorough and extensive.

Pain can be managed if it is included as part of the mesothelioma treatment plan. Pain and palliative care specialists are experts in pain control. Palliative care specialists treat the symptoms, side effects, and emotional problems of both cancer and its treatment.

There are different types of pain from malignant mesothelioma – tumors can infiltrate the intercostal nerves (nerves which arise from the thoracic nerves, and run between the ribs) causing a painful syndrome known as neuropathic pain syndrome. If a patient has chemotherapy, they might develop a peripheral neuropathy. If they receive the chemotherapy through an abdominal port, they can experience pain at the port site and diffuse abdominal pain.

Some patients who undergo surgery, either a pleurectomy or an extrapleural pneumonectomy can develop post-thoracotomy pain, neuropathic pain localized to the region of the thoracotomy scar. This can be experienced months post-surgery. The pain is often described as an aching or burning. A small percent of surgical patients can also develop post-operative frozen shoulder which is limited shoulder range of motion usually caused by untreated thoracotomy pain and inadequate rehabilitation.

Treatment for mesothelioma pain depends on the source of the pain. For pain caused by the chemo agent cisplatinum, which can cause peripheral neuropathy, corticosteroids, tricyclic antidepressants, and alpha-2 agonist may be used. Specific medicines that may be used are Gabapentin, Pregabalin, Phenytoin, Carbamazepine, Dexamethasone, Prednisone, and Amitriptyline. For patients with thoracotomy syndrome, lidocaine patches—worn for 12 hours per day—have been found to help. Other treatments shown to be effective are trigger-point injections, nerve blockers, and neurolytic procedures.

According to an article in Cancer Investigation, “It is estimated that chronic pain in patients undergoing cancer treatments range from 33 to 50 percent, it is considerably higher (over 70 percent) in patients with advanced disease.” If someone is having continuous pain, opioids (narcotics) will be ordered. Opioids consist of Morphine, Codeine, Oxycodone, Hydromorphone, Oxymorphone, Fentanyl, and Meperidine. They can be taken by mouth, injection, intravenously, rectally, transmucosal- lollipops, or by spinal infusion.

The most important thing to remember is that pain can be managed effectively with help from your medical team. However, you play a critical role by describing the pain, keeping records of when the pain happens, communicating with your team, and being honest about the effectiveness or lack of relief from the treatment.

UK Mesothelioma Clinical Trial Tests for Mesothelioma Patients

Early Detection of Mesothelioma Could Someday be Possible Through Simple Urine Test

Researchers and physicians agree that the best way to combat cancer is to detect the disease at its earliest stage, when patients have the most treatment options available to them. Many cancers, including mesothelioma, however, do not have reliable, noninvasive screening methods. Now, researchers report success in detecting cancer through a simple urine test.

According to an article in MIT News, a team led by Sangeeta Bhatia, a member of MIT’s David H. Koch Institute for Integrative Cancer Research, has found a way to “amplify” cancer proteins to enhance the ability to detect them. Specifically, the researchers “developed nanoparticles that can home to a tumor and interact with cancer proteins to produce thousands of biomarkers, which can then be easily detected in the patient’s urine.”

Not only could this process be used to detect cancer, but it is also useful for monitoring disease progression and responsiveness to treatments.

Researchers at both MD Anderson Cancer Center and Massachusetts General Hospital Cancer Center are also in the early stages of developing a cancer detection tool using circulating tumor cells (CTCs). The tests must be highly sensitive to detect such few cells in the bloodstream. These tests, while still in the early phases of testing, can detect lung cancer as well as determine the efficacy of the treatment. The hope is that the tests may also be able to detect mesothelioma.

Although finding CTCs in the bloodstream has been likened to finding a needle in a haystack, the MIT researchers found a process to treat the nanoparticles so that they would accumulate at the tumor site. Hundreds of peptides are then released from the nanoparticles, flooding the bloodstream. They then rapidly accumulate in the kidneys where they are excreted in the urine, and are detected using mass spectrometry.

“There’s a desperate search for biomarkers, for early detection or disease prognosis, or looking at how the body responds to therapy,” says Bhatia.

This research “is an exciting approach to overcoming the problem of biomarker scarcity in the body,” says Sanjiv Gambhir, chairman of the Department of Radiology at Stanford University School of Medicine. Gambhir was not part of the research team.

Mesothelioma is a rare, serious cancer most often affecting the lining of the lungs that occurs in individuals exposed to airborne asbestos fibers. Diagnosing the disease is extremely difficult and many patients are not diagnosed until they exhibit life-threatening complications. Research of this type is needed to help prevent the nearly 3,000 Americans from dying of the disease each year.

Mesothelioma Metastasis Closer to Being Understood, Stopped

Researchers from the Massachusetts Institute of Technology report they have found the mechanism that allows cancer cells to break off the initial tumor site and spread to other parts of the body. Cancer cells are typically anchored in place, but understanding how they break free and migrate, the researchers believe, is the key to uncovering a new approach to cancer treatment.

The researchers report that metastasis is the cause of nearly 90 percent of cancer deaths. Pleural mesothelioma, a cancer of the lining of the lungs caused by past asbestos exposure, is one cancer that is highly aggressive and spreads quickly. The National Cancer Institute reports that treatments for patients with metastatic cancer are to control further growth of the cancer or to relieve symptoms caused by it. In some cases, metastatic cancer treatments may help prolong life. However, according to the NCI, most people who die of cancer die of metastatic disease. Understanding how to stop metastasis is critical for increasing survival in mesothelioma patients.

In a study published Oct. 9 in Nature Communications, MIT researchers reported that proteins called integrins, located on cell surfaces, form the anchors that hold the cells in place. But cells temporarily lose their ability to adhere as they become more metastatic, and the anchors “let go.” The freed cells then move to another area and regain their ability to adhere or stick to tissues, forming another tumor.

“If we can prevent them from growing at these new sites, we may be able to interfere with metastatic disease,” says Sangeeta Bhatia, the John and Dorothy Wilson Professor of Health Sciences and Technology and Electrical Engineering and Computer Science, and leader of the research team.

The authors of the study found that metastatic tumors stuck especially well to fibronectin and galectin-3 proteins that are made of proteins that contain or bind to sugars. This finding, they suggest, can lead to development of new anti-cancer drugs that focus on “a specific protein-protein or protein-sugar interaction, rather than a particular gene mutation.”

The research team is currently developing drugs aimed at inhibiting tumor cell interactions with galectin-3.

2,500 to 3,000 people are diagnosed with mesothelioma each year in the U.S. Mesothelioma takes decades to appear after exposure, but then advances rapidly.

Lifestyle Choices Can Make a Difference but Cannot Prevent Mesothelioma

According to the National Cancer Institute only 5% of cancers are caused by genetics. The remaining 95% of the cancer diagnoses are dependent on choices we make every day, such as food selection, smoking decisions, sun exposure and exercise habits. Medical experts report that by making lifestyle changes Americans can improve their quality of life and can largely eliminate their likelihood of developing cancer. Exposure to environmental hazards, however, also determines whether someone will contract cancer. But for the close to 3,000 Americans diagnosed with mesothelioma each year, prevention of the disease is not an option as they were often unwittingly exposed to asbestos, a toxic mineral, years ago as they worked for a living.

Most cases of mesothelioma, a deadly form of cancer, are diagnosed 30 years or more after exposure to asbestos, with the latency or incubation period sometimes being as long as 50 years. While many uses for asbestos were banned in the mid-1970’s, the effects of the mineral continues to be a threat to workers exposed through their occupations and in buildings that were erected or renovated prior to the ban. Most at-risk for the disease are trade workers who inhaled asbestos fibers in the workplace or Navy veterans exposed to asbestos in ships.

No Safe Level of Asbestos Exposure

The health risks of asbestos have been thrust back into the spotlight on the heels of the announcement that Quebec will not only resume mining of asbestos, but will also export the mineral to developing countries where safe handling requirements are not in place. Production at the Jeffrey Mine could result in the mine eventually producing up to 225,000 tons of chrysotile asbestos per year.

The International Mesothelioma Interest Group (IMIG) stated in March that it “deeply regrets that the Quebec Government has provided the loan guarantee that enables resumption of asbestos mining in Canada.” They contend that all types of asbestos have demonstrated their ability to cause asbestos-related diseases. Formed to improve communication and collaboration among workers interested in mesothelioma, the IMIG reiterated their long-standing position, “there is no safe use of asbestos.”

Philip Landrigan, Dean of Global Health at the Mount Sinai School of Medicine in New York, agrees with IMIG and stated in a letter to Quebec Premier Jean Charest in an attempt to halt reopening the Jeffrey Mine that “there is no safe exposure level [of asbestos]. It goes on killing for generations.”

Time to End Asbestos Use

According to the World Health Organization (WHO), asbestos causes approximately half of all deaths from occupational cancer. 125 million people worldwide are exposed to asbestos in the workplace. In addition, they estimate 90,000 people die each year from asbestos-related lung cancer, mesothelioma and asbestosis.

The tragedy of mesothelioma is that the disease is completely preventable through the ban of asbestos. Unfortunately, this is not at a choice that an individual has control over, as it is often made at the government level. Advocates for mesothelioma patients continue to call for a ban of asbestos as the only way to halt mesothelioma.

For more information please check our New York Mesothelioma Resources page.

Nanotechnology Targets Mesothelioma; FDA Keeps Watchful Eye on Developments

The latest emerging medical technology, nanotechnology, has heralded myriad breakthroughs in the development of novel therapies for orphan diseases and cancers. Mesothelioma researchers have started focusing on using nanotechnology to deliver cancer-fighting drugs directly to cancerous cells, thus, leaving healthy cells intact.

The infinitesimal size of nanoparticles – the size of one-billionth of a meter – allows payloads of drugs to home in on tumors while minimizing side effects from toxicity due to excess medicine that is currently needed to effectively attack cancer cells. Most often, capsules, referred to as “magic bullets,” are developed to deliver the medicines directly to the targeted cells.

In an article in FDAVoice, the U.S. Food and Drug Administration’s blog site, Celia Cruz, PhD, reports that “materials at the nanoscale can have different chemical, physical, or biological properties compared to their conventionally-scaled counterparts.” As a result, the safety and effectiveness of the drug can be affected, leading the FDA to study the issues and monitor developments with nanotechnology.

Primarily, the FDA set out to determine if the “current regulatory processes are adequate to identify any potential risks and reduce those risks.” The FDA’s Center for Drug Evaluation and Research Nanotechnology Risk Assessment Working Group (Nano Group) was used to conduct an extensive review of the emerging technology.

The Nano Group concluded that the FDA’s current processes are adequate for monitoring nanomaterials. However, the team also identified areas for improvement, such as increased nanotechnology regulatory science research and up-to-date training of the review staff who evaluate marketing applications for drug products developed using nanomaterials.

Nanotechnology Benefits Mesothelioma Researchers

Mesothelioma is a rare, aggressive cancer primarily caused by exposure to airborne asbestos fibers. Designated as an orphan disease in the U.S., a disease that affects fewer than 200,000 people, mesothelioma treatment is limited to managing symptoms and extending survival. Currently, there is no cure available, and the average survival time is less than 18 months. However, researchers are now looking to nanotechnology as a way to attack mesothelioma.

The NYU Langone Medical Center’s Cancer Institute recently purchased a NanoString Technologies nCounter Analysis System with funds donated by the New York mesothelioma lawyers of Belluck & Fox, LLP. Dr. Pass, Chief of Thoracic Oncology, NYU Cancer Center and Chief, Division of Thoracic Surgery, NYU Langone Medical Center, is a renowned mesothelioma specialist and is a past winner of the Pioneer Award from the Mesothelioma Applied Research Foundation for his dedication to mesothelioma research. This tool allows Dr. Pass and his colleagues to obtain faster results as they seek the clues to better treatments and, one day, a cure for mesothelioma.
In 2011, the University of Pennsylvania established the Penn Center for Orphan Disease Research and Therapy focused on discovering novel treatments for rare diseases. One of the primary goals of the Center is to focus on nano-scale systems for developing new ways to deliver drugs.
Researchers at the Institute of Bioengineering and Nanotechnology in Singapore developed a miniaturized biochip using nanotechnology that can assess the effectiveness of anti-cancer drugs on cancer stem cells. This is especially important for allowing oncologists to offer personalized medicine to mesothelioma patients.

“Nanotechnology is a new and exciting field that offers scientists the opportunity to control matter at very small dimensions, opening many possibilities for making all kinds of new products,” said Ms. Cruz.

Sources:

FDAVoice
http://blogs.fda.gov/fdavoice/index.php/2013/10/as-nanotechnology-is-being-used-to-develop-new-drugs-fda-is-working-to-ensure-quality-safety-and-effectiveness/
MIT News
http://newsoffice.mit.edu/2012/noninvasive-diagnostics-for-cancer-1216
University of Pennsylvania
US FDA Nanotechnology Fact Sheet
http://www.fda.gov/Food/GuidanceRegulation/default.htm
Bioengineering and Nanotechnology in Singapore
http://www.ibn.a-star.edu.sg/
University of Pennsylvania
http://www.uphs.upenn.edu/news/News_Releases/2011/07/orphan/

Month: November 2013