Month: June 2016
Mesothelioma Patients Should Not Have to Choose Between Hospice Care and Active Treatment
One of the most important things mesothelioma patients and their families cite when it comes to end-of-life care is the desire to be home and with their family. To many in the U.S., this means hospice care and, therefore, the end of active mesothelioma cancer treatment. Now, researchers point to a model adopted by the U.S. Veteran’s Administration where hospice and active cancer care are given concurrently.
Hospice is designed to improve the quality of a patient’s last days by offering comfort and dignity, and often allows the patients to remain in their own home surrounded by their loved ones. Today, once hospice is established in the U.S. active cancer care is ended and the patient receives palliative care that is intended to control pain and relieve mesothelioma symptoms.
According to Drs. Jeanie M. Youngwerth and D. Ross Camidge from the University of Colorado, the U.S. trails behind many other countries when it comes to providing quality medical care for patients with terminal conditions. But, straying from the norm, the VA does not limit “curative” therapies while a veteran is receiving hospice care.
“Consequently, in theory, the VA would permit life-prolonging measures, such as chemotherapy, to be administered while a patient simultaneously receives hospice services,” said the doctors.
For veterans, this is good news since this population makes up one-third of those who suffer from mesothelioma, a terminal cancer caused by past asbestos exposure. Approximately 3,000 Americans are diagnosed with mesothelioma each year. Asbestos was used as insulation in military buildings and ships. It was also used as an insulator around heat and cooling systems, in Navy vessels and in the gaskets placed inside airplane engines and large machinery.
For other mesothelioma patients, the option for concurrent care is still being assessed. The doctors point out that several clinical trials found “ early initiation of palliative/hospice care with active anti cancer therapy, so called “concurrent care,” improves quality and, potentially, quantity of life for patients with advanced cancer.” In addition, they note, that a 2010 study found that “patients with advanced lung cancer did better in terms of both quality and quantity of life when they received palliative care integrated with standard anticancer care as opposed to receiving anticancer care alone.”
Other government agencies hope to join the VA in their treatment model. Centers for Medicare & Medicaid Services, through the Medicare Care Choices Model, is piloting a program for Medicare beneficiaries to receive palliative care services from certain hospice providers while concurrently receiving anticancer therapies provided by their oncology providers, according to the doctors.
Other medical professionals agree with the need for concurrent care for critically ill patients. In a 2012 presentation at the annual meeting of the American Academy of Hospice and Palliative Medicine, Dr. Diane E. Meier, director of the Center to Advance Palliative Care and professor of geriatrics and internal medicine at Mount Sinai School of Medicine, stressed that now is the time to educate physicians as well as the general public that palliative care is “actually about relieving the pain, symptoms, and stress of serious illness in patients of any age and at any stage of disease, and that palliative care can be delivered alongside curative or life-prolonging therapies.”
Sources :
- University of Colorado
https://connection.asco.org/magazine/features/hospice-and-cancer-therapy-must-we-choose-only-one
Protein Could Be Used to Develop Mesothelioma-Fighting Drug
Researchers report they have found an effective way to induce apoptosis, or cell death, and to suppress cancer growth. The team is targeting the BaK protein and has found a way to transform it “into a killer protein” that kills cancer cells. The hope is that this approach will lead to developing drugs that will be effective in fighting treatment-resistant cancers like mesothelioma.
Mesothelioma, an asbestos-caused cancer, like many cancers, is resistant to standard treatments, and, thus, to apoptosis. Apoptosis is often referred to as cell suicide because when cells are damaged they sacrifice themselves to prevent damaging additional cells. However, in cancer, the process goes amok and the diseased cells continue to divide and grow.
According to researchers from the Walter and Eliza Hall Institute of Medical Research, of Melbourne, Australia, the BaK protein, which is central to apoptosis, is present but inactive in healthy cells. But when a cell receives the trigger to die, BaK is activated and helps destroy the cell. In cancer cells that are notorious for tricking the body’s natural defense mechanisms, however, BaK is not activated and apoptosis does not occur leaving the cells unchecked.
The researchers set out to find a way to mimic the action of BaK, or to turn on the trigger to kill cancer cells. They inadvertently found an antibody they were using to simply study BaK, actually bound to the protein and triggered its activation.
“There is great interest in developing drugs that trigger Bak activation to treat diseases such as cancer where apoptosis has gone awry,” said Dr. Ruth Kluck, BSc, PhD, QLD, lead researcher and Laboratory Head of the Molecular Genetics of Cancer. “This discovery gives us a new starting point for developing therapies that directly activate Bak and cause cell death.”
In fact, the researchers are already collaborating with others to develop their antibody into a drug that can take advantage of the BaK protein.
Finding an effective way to prevent cancer cells from evading cancer death by artificially triggering it could increase the efficacy of existing treatments leading to increased survival in mesothelioma patients. Mesothelioma is diagnosed in nearly 3,000 Americans each year, and the same number die from the cancer.
The full report can be found in the May 24 issue of Nature Communications.
Mesothelioma Patients Need More Information to Help Make Treatment Decisions
When patients are faced with a life-threatening illness like mesothelioma, the more information they have the less anxious they feel about the diagnosis. Unfortunately, according to a recent study, terminally ill patients lack even basic information about their illness.
In a study conducted by a research team from Weill Cornell Medicine in New York City, led by Dr. Holly Prigerson, professor of geriatrics, researchers report that of 178 patients who were faced with highly lethal metastatic cancers, just five percent of the patients had “sufficient knowledge about their illness to make informed decisions about their care.”
“Many did not know that they were at the end-stage of their illness or that their cancer was incurable. They were basically making treatment decisions in the dark,” explained Prigerson, who also co-directs the Center for Research on End-of-Life Care at Weill Cornell.
Treatment for mesothelioma, a terminal asbestos-caused cancer, can vary from patient to patient. Primarily, treatment options consist of surgery, chemotherapy and radiation. It is critical for the patients, however, to understand their prognosis and the benefits and risks associated with each of these options to ensure they are prepared for the arduous battle ahead.
According to the researchers, doctors are reluctant to share information about terminal illnesses for fear that they will upset the patients or the patients will view the doctor less favorably. Without the information, though, many patients have a false sense of security and do not even realize they have limited survival.
The researchers concluded that patients who have discussions with their oncologists about prognosis and life expectancy “come to have a better understanding of the terminal nature of their illnesses.” They added that improvement in the area of end-of-life patient/doctor communication can improve patient-centered care.
This research points to the fact that the more knowledge patients have about their illness, the better off they are when it comes to making their own treatment decisions. In fact, previous research has pointed out that an empowered mesothelioma patient is often the best patient for a medical team. When patients are empowered it means they are informed of their disease and their treatment options, and they are willing to take an active role in their treatment.
Managing a disease such as mesothelioma can be overwhelming, but partnering with your physician from the start may be the key to receiving the best treatment. According to a 2002 article on patient empowerment in the Hong Kong Medical Journal, researchers said, “Medical knowledge has long been used in clinical practice for professionals. It is time to shift the balance of power to include patients and their caregivers.”
The study was published the May 23 edition of the Journal of Clinical Oncology.
Know more about Mesothelioma and how you can deal with it.
Nurses and Mesothelioma Patients Benefit Equally from a Friendly Ear
This past week one of my co-workers, an RN who I have worked with for decades, lost a young family member to cancer. As a community we grieve for the loss of this young, newly-married man. His journey with cancer was swift, debilitating, and heart-wrenching to hear about. Through my co-worker, we learned what an ordeal it had been for him, and for everyone in his family. After he died she texted me with the news, and thanked me for all the support. This tragedy made me reflect on how important it is to listen more. We all have different life experiences and we can all offer something to someone going through a crisis – a suggestion, a story, or maybe just an ear.
Throughout life, our relationships note the important times and the mundane times of our life’s journey. Relationships are what keep our lives rich. Although patients and their families living with mesothelioma did not elect to go on the cancer journey, one of the unexpected side effects is that it can strengthen their relationships with each other.
As a nurse, I have been fortunate to have many coworkers with whom I have worked with for decades. We have known of each other’s relatives – husbands, parents, children – most we have never met, but we know a lot about them. We have been through life’s happy experiences including weddings, births, anniversaries, and birthdays. We have supported each other through personal hard times like the death of a parent, a divorce, illnesses and accidents.
We remember patients who have been gone for years, we remember funny stories and very sad stories. We support each other. We are a community of people bound by our jobs and a genuine caring for each other. Like the mesothelioma community we come from all different backgrounds, cultures, and have varied personalities and life experiences. Also, like the mesothelioma community, we might not know the lasting effect kindness and listening can have on a person dealing with a crisis.
As you or your loved one continue on this journey with mesothelioma, remember you do not have to go it alone. Reach out for support. As the Beatle’s song goes, “I get by with a little help from my friends.”
Know more about Mesothelioma and how you can deal with it.
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