Some Hospitalizations for Mesothelioma Patients May Be Avoidable

Nearly every mesothelioma patient will be hospitalized at some point during their care. The cancer and treatments often leave patients with debilitating symptoms that require medical intervention to help manage the issues. However, new research reports that a significant number of cancer patients’ hospital visits could be avoidable.

Researchers at the University of Chicago looked at 72 terminal cancer patients’ ICU admission records and found “nearly half of terminal oncology ICU hospitalizations in our study population were potentially avoidable,” according to an Oct. 13 article in Oncology Practice.

http://www.mdedge.com/oncologypractice/article/115520/hospice-palliative-medicine/almost-half-terminal-cancer-patient

This “high-intensity end-of-life care,” according to the colleagues, “does not improve survival or quality of life for terminal cancer patients.” The researchers noted that the National Quality Forum, a non-profit organization that works to catalyze improvements in healthcare through measures and standards, referred to “ICU admissions in the last 30 days of life as a marker of poor-quality cancer care.”

Mesothelioma is a rare form of cancer typically affecting the lining of the lungs. Primarily caused by exposure to airborne asbestos fibers, mesothelioma has an extended latency period – symptoms can sometimes take decades to appear. However, once symptoms become apparent, mesothelioma may rapidly progress to cause life-threatening complications. The treatment at this point is no longer curative, rather palliative, and is aimed at relieving the symptoms and improving the patient’s quality of life. For many mesothelioma patients, palliative care offers them an opportunity to stay out of the hospital and spend more time with their loved ones.

Upon reviewing the data, the Chicago researchers identified the following factors associated with avoidable hospitalizations in the terminal cancer patients:

Likely to be residing in an institutional setting;
Worse performance status prior to admission;
Most recent treatment of chemotherapy;
Fewer days since diagnosis;
Cancer symptom care;
Recent palliative care consultation, potentially indicating the severity of illness.

Sadly, the researchers found that many of these patients would pass away in the ICU setting. This, they said, leaves the family with more stress. A separate UK study found that patients who die at home do so more peacefully than hospitalized patients but suffer no more than patients in a hospital. In addition, family members experience less intense grief with their loved one at home.

“ICU deaths often create a traumatic experience for patients and families,” the researchers note. “Health care leaders should test strategies to prospectively identify patients at high risk for avoidable terminal hospitalizations and formulate interventions to improve end-of-life planning and care.”

Many medical professionals advocate for terminal mesothelioma patients to look more closely at hospice care as their cancer becomes more aggressive and symptoms become more acute. According to the Hospice Foundation of America, hospice is designed to improve the quality of a patient’s last days by offering comfort and dignity. Hospice care neither prolongs life nor hastens death, reports the organization, however, it does allow for patients to remain in their own home surrounded by their loved ones.

“This study serves to highlight terminal ICU hospitalizations as an area of focus to improve the quality and value of cancer care,” concluded the researchers.

See “No Exit: Identifying Avoidable Terminal Oncology Intensive Care Unit Hospitalizations” for the full report.

http://ascopubs.org/doi/abs/10.1200/jop.2016.012823

When a mesothelioma patient no longer responds to a prescribed treatment plan, and the primary caregiver needs support caring for their loved one, turning to a hospice program is one option to explore. Visit the Hospice Foundation of America to find out more about hospice care.

Biomarker May Help With Diagnosis and Prognosis of Mesothelioma

The search for a reliable biomarker to help diagnose mesothelioma, serve as a prognostic indicator or even to assess the efficacy of treatment in mesothelioma patients is critical for patient survival. Recently Mesothelioma Help reported that uPAR overexpression (a protein normally found in the colon and kidneys) could help identify prognosis in mesothelioma patients and may lead to a new treatment. Now, researchers report that glycodelin could indicate improved prognosis, and could also be used to diagnose the asbestos-caused cancer.

Researchers from Germany at the University Hospital Heidelberg and the Translational Lung Research Center Heidelberg report when they measured glycodelin serum concentrations in pleural mesothelioma patients after receiving an initial treatment of chemotherapy and/or surgery and radiotherapy, the team found a “strong correlation between the serum levels and the tumor response to treatment. “Gylcodelin,” according to the researchers, “seems to be a new potential biomarker for the aggressive malignant pleural mesothelioma.”

The researchers then set out to assess whether glycodelin might be useful as a novel biomarker for early diagnosis of pleural mesothelioma, and found that “most patients with benign or malignant lung diseases did not show increased glycodelin serum concentrations except patients with pleural mesothelioma.” This, according to the researchers, points to the potential diagnostic use of glycodelin for early detection of pleural mesothelioma.

Mesothelioma often has symptoms such as a persistent cough, shortness of breath, fatigue and wheezing, that are similar to many other respiratory illnesses. When a patient presents with these symptoms, doctors often first treat the patient for a respiratory infection before turning to testing for cancer. However, the key to increasing survival for mesothelioma and lung cancer is through early detection.

“Our data strongly suggest that glycodelin might be a feasible serum marker for the diagnosis of MPM [malignant pleural mesothelioma] and the monitoring of tumor response to treatment during the follow-up of MPM patients,” concluded the researchers in the study.

Nearly 3,000 Americans are diagnosed with mesothelioma each year. There is no cure for the disease.

Find the full report in Oncotarget.

Lung Cancer Awareness Month - Mesothelioma

Focus on Mesothelioma Education During Lung Cancer Awareness Month

For many people, November means apple cider, pumpkin pie, and Thanksgiving. In the health and medical fields, November is Lung Cancer Awareness Month, which emphasizes education and awareness of all things about lung cancer and other cancers affecting the respiratory system – such as mesothelioma.

This year, help out by making November a month to educate others about mesothelioma and lung cancer by taking part in Lung Cancer Awareness Month. Teaching the facts about mesothelioma, its symptoms, and its causes can help patients, family members, and friends better understand the disease and help advocate for the community.

Pleural mesothelioma is caused by inhalation or ingestion of airborne asbestos fibers. The fibers then become lodged in the lining of the chest, where, over the years, they begin to irritate the tissue leading to cancer. Not everyone exposed to asbestos will develop mesothelioma, but those who do often are not diagnosed until decades after exposure. The treatment protocol for pleural mesothelioma is similar to that of lung cancer.

People who live with pleural mesothelioma, or who care for someone with the cancer, know that educating the public about the struggles facing rare disease sufferers often takes a focused effort from organizations, the government, the medical community and many volunteers.

Early Detection of Mesothelioma is Important

With a vision of “a world where no one dies of lung cancer,” LUNGevity is 100% focused on increasing and improving lung cancer survivorship. In addition, the 501(c)(3) charity focuses on building and sustaining a community for all those affected by lung cancer and through “accelerating research into early detection and more effective treatments” the organization aims to make an immediate impact on quality of life and survivorship in lung cancer patients.

The key to increased life expectancy when battling mesothelioma is early detection. When treating mesothelioma patients, the best outcome is achieved with early detection of the disease by increasing treatment options and improving the patients‘ quality of life while battling the cancer.

“LUNGevity believes strongly that everyone can drive progress and change for people affected by the disease, whether through research funding, mentoring a fellow lung cancer patient, or organizing and participating in events and activities to raise funds and awareness,” as stated in the 2016 press release kicking off the awareness month.

Know What Questions to Ask Your Mesothelioma Doctor

According to the American Lung Association, “The diagnosis of mesothelioma is very serious and may be overwhelming and affects all aspects of life in a profound way.” The ALA recommends being actively prepared for each healthcare visit by writing down questions to ensure you get everything you need in the short visit, and that your family and caregivers are thoroughly informed about your wants and needs.

What is the goal of the treatment you are proposing? Is the intent to cure me from the disease or manage its symptoms?
What are the side effects of the proposed treatment and how will they affect my quality of life?
Am I a candidate for any clinical trial?
What are my options for palliative care to address management of my shortness of breath and pain?
Can you help me and my family make decisions about how I will be treated at the end of my life?

Lung cancer is the leading cause of cancer death in men and women with an estimated 222,500 new diagnoses and 155,870 deaths in 2017, according to the National Cancer Institute. Nearly 3,000 Americans are diagnosed with mesothelioma each year.

DOD Continues to Allocate Millions to Mesothelioma Research

The U.S. House of Representatives recently passed the fiscal year 2017 Defense Appropriations bill and kept mesothelioma-eligible funding for 2017. Mesothelioma was first funded through the bill in 2011 and has been on the list every year since then.

The funding is available as part of the DOD’s Peer Reviewed Cancer Research Program (PRCRP). The DOD Appropriations Bill, 2017, which was submitted on May 19, allocates $30 million for distribution among eligible cancers through the PRCRP. In addition to mesothelioma, other cancers sharing in these research funds include: bladder cancer, brain cancer, colorectal cancer, listeria vaccine for cancer, liver cancer, lymphoma, melanoma and other skin cancers, pancreatic cancer, stomach cancer, and cancer in children, adolescents, and young adults.

An additional $12 million is set aside specifically for the lung cancer research program. The bill provides a total of $282 million for cancer research.

The Defense Appropriations bill funds critical national security needs, including military operations and readiness programs, as well as health and quality-of-life programs for U.S. troops and their military families. The PRCRP grants are offered with a goal to improve quality of life by decreasing the impact of mesothelioma cancer on service members, their families, and the American public. The entire bill provides $517.1 billion in funding.

“This bill fulfills the Congress’s most important responsibility – providing for the common defense. And it does so responsibly – funding those military needs that must be addressed now, planning and preparing for the future, and respecting the taxpayer by making commonsense budgeting decisions,” Chairman Hal Rogers said in the June 16th press release announcing the House’s passage of the bill.

http://appropriations.house.gov/news/documentsingle.aspx?DocumentID=394614

The DOD is responsible for funding and promoting research on diseases related to military service. Veterans account for nearly 30 percent of all cases of mesothelioma, a cancer of the lining of the lung or abdomen, caused by exposure to asbestos. Former military troops have a higher risk of contracting asbestos-related diseases because of the wide use of asbestos in thousands of buildings and Navy ships from World War II until the 1970s.

“The Committee commends the Department of Defense for ensuring that projects funded through the various peer-reviewed cancer research programs maintain a focus on issues of significance to military populations and the warfighter,” noted the Committee members in the bill report. “This includes promoting collaborative research proposals between Department of Defense researchers and non-military research institutions. These collaborations leverage the knowledge, infrastructure, and access to clinical populations that the partners bring to the research effort.”

Close to 3,000 Americans are diagnosed with mesothelioma each year. There is no cure for the cancer.

Sources:

Peer Reviewed Cancer Research Program
http://cdmrp.army.mil/prcrp
Committee members in the bill report
https://www.congress.gov/114/crpt/hrpt577/CRPT-114hrpt577.pdf

Blood Clots Awareness for Mesothelioma Patients

Simple Blood Pressure Drug to Increase Effectiveness of Therapy

In February, MesotheliomaHelp reported that patients who drink cola could increase the effectiveness of the anti-cancer treatment erlotinib, a drug used to treat lung cancer and mesothelioma. Now, researchers report that patients may also increase the effectiveness of the drug by taking a diuretic along with the therapy.

Researchers from Imperial College London and Fudan University in China collaborated in an effort to find a way to increase the effectiveness of treatment by erlotinib, a kinase inhibitor, by tackling the drug resistance lung cancer cells inevitably develop. In an in-lab study on mouse models with human cancer cells harboring the EGFR lung cancer mutation, the team found that by adding a simple diuretic found in blood pressure medicine to erlotinib they “reversed resistance to the drug, and enabled it to kill lung cancer cells.”

“Although these are very early-stage results, and are yet to be applied to patients in trials, they suggest the addition of a very cheap diuretic may extend the amount of time we can use the cancer drug erlotinib,” said Professor Michael Seckl, lead author from the Department of Surgery and Cancer at Imperial, in a Sept. 27 press release from Imperial College London. “This could potentially provide patients with more treatment options and save money in financially challenged health services.”

Malignant pleural mesothelioma is a cancer found in the outer lining of the lungs caused by inhaling asbestos fibers. Pleural mesothelioma is highly aggressive and does not always respond to cancer treatments. Both lung cancer and mesothelioma have proven to develop a resistance over time to the very drugs designed to kill the cancer cells. Finding a way to prevent this resistance can increase survival and improve the patients’ quality of life.

The researchers found that by raising glutahione levels, a natural antioxidant, the resistance to erlotinib was reversed. They then found that the “simple and cheap diuretic” ethacrynic acid, used to treat swelling caused by high blood pressure, raised gluhatione levels leading to increased sensitivity to erlotinib.

Erlotinib, or Tarceva® from Genentech Inc., is prescribed for some mesothelioma patients and in nearly 30 percent of non-small cell lung cancer patients, or 85 percent of all lung cancer cases, according to the researchers.

Various studies on mesothelioma have confirmed that developing an effective kinase inhibitor may be the key to developing drugs that kill mesothelioma cancer cells. Other kinase inhibitors used to treat mesothelioma include gefitinib and dasatinib.

“We urgently need new treatments for lung cancer patients, and this research suggests we can boost the effectiveness of an existing drug, rather than switch to another new expensive treatment,” said Seckl. “We are now seeking funding to enable patient trials within the next three years.”

Read the full report in the Sept. 27 issue of Cell Discovery.

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