Understanding Palliative Care
Palliative care focuses on relieving symptoms and improving quality of life, and can be provided alongside active treatments like chemotherapy, immunotherapy, or surgery.
Palliative care is NOT the same as hospice care. You can receive palliative care while still pursuing curative treatment. It focuses on symptom relief and quality of life at any stage of illness.
Palliative Care vs. Hospice Care
| Aspect | Palliative Care | Hospice Care |
|---|---|---|
| When started | Any time after diagnosis | Life expectancy 6 months or less |
| Treatment goal | Symptom relief + active treatment | Comfort only, no curative treatment |
| Setting | Hospital, clinic, or home | Usually home or hospice facility |
| Duration | Throughout illness | End of life |
Both approaches prioritize comfort, dignity, and quality of life, but palliative care can accompany aggressive treatment.
Symptoms Addressed by Palliative Care
A 2010 New England Journal of Medicine study led by Dr. Jennifer Temel at Massachusetts General Hospital found that patients who received early palliative care integrated with oncology care reported better quality of life and lived about 2.7 months longer than those receiving standard care alone. That study shaped current practice at cancer centers including Memorial Sloan Kettering, MD Anderson, and Dana-Farber.
Breathing and Pleural Effusion
Shortness of breath is often the symptom that limits daily life most. It stems from tumor growth, pleural effusion, or reduced lung capacity, and is managed through a combination of medications, supplemental oxygen, and positioning techniques. When fluid accumulates in the pleural space, three procedures address it.
| Procedure | What it does | Typical setting |
|---|---|---|
| Thoracentesis | Drains 1-2 liters of pleural fluid for immediate relief | Outpatient, may be repeated |
| Pleurodesis | Seals the pleural space with talc or another agent to prevent reaccumulation | Often via VATS |
| Indwelling pleural catheter | Allows ongoing drainage at home by patient or caregiver | Placed outpatient |
Pain Control
Pain from mesothelioma is managed through layered approaches. Over-the-counter and prescription medications (including opioids where appropriate) form the backbone. Nerve blocks offer targeted relief for chest wall or abdominal pain, low-dose radiation can shrink tumors that compress nerves or bone, and physical therapy helps maintain mobility and reduce stiffness-related pain.
Non-Respiratory Symptoms
| Symptom | Management Approaches |
|---|---|
| Fatigue | Energy conservation, activity planning, nutrition support |
| Nausea | Anti-nausea medications, dietary modifications |
| Appetite loss | Nutritional counseling, appetite stimulants |
| Anxiety/Depression | Counseling, medication, support groups |
| Sleep problems | Sleep hygiene, medication when needed |
The Palliative Care Team
A palliative care team typically includes a palliative medicine physician who coordinates care, nurse practitioners handling day-to-day symptom management, and social workers providing emotional support and practical assistance. Most teams also include chaplains for spiritual care, pharmacists for medication management, physical and occupational therapists working to maintain function, and dietitians addressing nutritional needs.
When to Consider Palliative Care
Research shows patients who receive palliative care alongside standard treatment report better quality of life, have improved symptom control, experience less depression and anxiety, and may even have better survival outcomes.
- Report better quality of life
- Have improved symptom control
- May even have better survival outcomes
- Experience less depression and anxiety
Consider palliative care when:
- You’re diagnosed with mesothelioma (at any stage)
- Symptoms are affecting your quality of life
- Treatment side effects are difficult to manage
- You need help making treatment decisions
- You want comprehensive support for you and your family
Hospice Care
Hospice is appropriate when:
- Life expectancy is 6 months or less
- Curative treatments have been stopped
- The focus shifts to comfort and quality of remaining time
Hospice Eligibility Criteria
Patients typically qualify when experiencing:
- Rapid physical decline
- Severe symptoms reducing quality of life
- Choice to focus on comfort over aggressive treatment
- Disease progression despite treatment
Levels of Hospice Care
| Level | Description |
|---|---|
| Routine home care | Regular visits from hospice team |
| Continuous home care | 24-hour care during crisis periods |
| Inpatient care | Short-term facility care for symptom management |
| Respite care | Temporary relief for caregivers |
Hospice Services
For patients:
- Symptom management and pain control
- Emotional and spiritual support
- Assistance with daily activities
- 24/7 on-call nursing support
- Medical equipment and supplies
For families:
- Caregiver education and support
- Respite care (breaks for caregivers)
- Bereavement counseling
- Support groups
How Fluid-Drainage Procedures Work
Thoracentesis drains pleural fluid causing shortness of breath. A needle is inserted through the chest wall and fluid (often 1-2 liters) is drawn off as an outpatient procedure. It may need to be repeated as fluid reaccumulates.
Pleurodesis aims to prevent that reaccumulation. Talc or another sclerosing agent is inserted into the pleural space, creating an adhesion between the lung and chest wall. It is a more durable solution than repeated thoracentesis and can be done via video-assisted thoracic surgery (VATS).
An indwelling pleural catheter allows ongoing drainage at home. A small catheter placed in the chest wall lets the person or a caregiver drain fluid as needed, avoiding repeated hospital visits. It is often chosen for recurrent effusions when pleurodesis is not an option.
Quality of Life Considerations
Quality of life with mesothelioma cuts across three areas. Physically, people do best when they stay active within their tolerance, conserve energy for the activities that matter most, and accept help with tasks that drain them. Emotionally, the work is giving space to all emotions rather than suppressing them, staying connected to loved ones, and using counseling, support groups, or spiritual care where helpful. Practically, advance directives, clear conversations with family about wishes, and attention to financial and legal matters all ease pressure later.
Caregiver Support
Caregivers need care too. Respite services provide breaks, support groups connect caregivers with others in similar situations, counseling offers a space to process difficult emotions, and practical assistance covers tasks, transportation, and meals. Under the Medicare hospice benefit, bereavement counseling continues for family members for 13 months after a death.
Can I receive palliative care while continuing treatment?▼
Yes. Unlike hospice, palliative care can be integrated with active cancer treatment. Chemotherapy, immunotherapy, even surgery. It focuses on symptom management and quality of life at any stage.
What symptoms can palliative care help manage?▼
Palliative care addresses shortness of breath, pain, pleural effusions (fluid buildup), fatigue, nausea, anxiety, depression, and sleep problems. The team coordinates multiple approaches for each symptom.
What support is available for my family?▼
Palliative care includes caregiver support: education, respite services, counseling, and practical assistance. When transitioning to hospice, bereavement counseling continues for 13 months.
When should I consider hospice care?▼
Hospice is appropriate when life expectancy is 6 months or less and the focus shifts from curative treatment to comfort care. Your medical team can help determine when this transition is appropriate.
Finding Palliative Care
Referrals usually come through the oncology team. Most cancer centers (including Memorial Sloan Kettering, MD Anderson, Mayo Clinic, and Dana-Farber) have inpatient and outpatient palliative care services, and many community hospice organizations offer palliative care too. The Center to Advance Palliative Care maintains a provider directory at getpalliativecare.org.
References
New England Journal of Medicine. (2010). Early Palliative Care for Patients with Metastatic Non-Small-Cell Lung Cancer.
https://pubmed.ncbi.nlm.nih.gov/20818875/
Journal of Clinical Oncology. (2017). Integration of Palliative Care into Standard Oncology Care.
https://pubmed.ncbi.nlm.nih.gov/27069075/
Center to Advance Palliative Care. (2024). Get Palliative Care Provider Directory.
https://getpalliativecare.org/whatis/