Managing Wound Care in The Mesothelioma Population

Although rare, mesothelioma causes specific challenges for patients. Wound care clinicians should have an understanding of the condition and its related treatments. 

A rare form of cancer that affects about 3,000 people in the United States annually,¹ mesothelioma can be severely compromising and lead to the development of pressure ulcers that require unique care planning due to the disease’s potential to affect one’s ability to breathe and/or ambulate. Caused by asbestos exposure, the condition typically develops in either the lining of the lungs, abdomen, heart, or testicles, with approximately 75% of cases forming around the lungs and roughly 20% around the abdomen. Attempting to heal chronic wounds amid ongoing cancer treatment is a challenging proposition, especially if the intake of chemotherapy is suppressing the immune system. Treating wounds properly among those in this cohort could speed healing and reduce associated pain and discomfort that’s notorious with mesothelioma. This article will educate providers on this patient population, discuss the type of care they’re likely to require as an adjunct to wound management, and offer advice that could impact wound healing.

DIAGNOSIS & TREATMENT 

Treatment of mesothelioma involves surgery, chemotherapy, and radiation therapy, and may require prolonged hospital stays. The diagnostic process begins when troublesome symptoms such as breathing difficulty, coughing, and chest pain lead the patient to seek medical attention (pleural mesothelioma). Abdominal bloating, weight loss, and digestive issues also precede diagnosis of peritoneal mesothelioma, which develops around the abdomen. Pericardial mesothelioma develops in the thin membrane surrounding the heart. 

Mesothelioma has four stages of growth. During stage I, the tumors are small, localized, and found on one side of the body. Stage II tumors have spread beyond the original location and into the lung(s) and/or diaphragm. Stage III cancers will remain limited to one side of the body, but will also have spread to nearby organs and/or lymph nodes, while stage IV sees the cancer being found throughout the body. Early-stage patients will often qualify for surgery while late-stage patients qualify for chemotherapy, radiation therapy, and immunotherapy clinical trials. To treat peritoneal mesothelioma, surgeons may perform a peritonectomy to remove cancerous growths from the peritoneum, the lining of the abdomen where the cancer forms. However, surgery isn’t always the ideal treatment choice, especially for patients not healthy enough to endure the toll of invasive procedures.¹ Doctors primarily use two different tumor-removing surgeries for pleural mesothelioma: extrapleural pneumonectomy and pleurectomy/decortication. Palliative surgeries include thoracentesis and pleurodesis, both of which aim to control fluid buildup.² The only tumor-removing surgery available for pericardial mesothelioma is a pericardiectomy, according to the Mesothelioma Center. This procedure removes as much cancerous tissue as possible from the heart lining, and can help improve breathing and reduce chest pain, heart palpitations, and fatigue. The surgery can also relieve pericarditis and pericardial effusion, the buildup of fluid in the pericardium. A pericardiocentesis is a palliative procedure that can effectively remove fluid buildup to relieve these symptoms as well. While many patients living with mesothelioma may attempt to avoid lying down for long intervals, as doing so can trigger coughing (some individuals must sleep upright if their coughing is intense enough) and prolonged sitting, the development of pressure ulcers to the pelvic and tailbone regions can occur. Other types of chronic wounds that are common among this patient population include venous stasis ulcers and diabetic foot ulcers (DFUs). Venous ulcers may develop due to sedentary habits and most often appear on the sides of the lower leg between the calf and ankle. Approximately 15% of patients living with diabetes will develop DFUs,³ and assistance will more likely be needed among those living with mesothelioma to provide self-care for wounds located in hard-to-reach areas.

WOUND & ULCER CARE

Wound care patients who live with comorbid mesothelioma should be recommended for an adjustable bed that allows them to reposition every hour and for the use of seat cushions and/or pillows to reduce surface pressure when sitting. Seat cushions that feature a cutout for the tailbone are advised, and it’s suggested that patients avoid donut-shaped devices because they increase edema and congestion of veins. For self-care while at home, patients should be taught to cleanse their wound(s) using sterile saline or water with mild, hypoallergenic soap. Debridement may be required, depending on ulcer severity,⁴ and compression may be prescribed for patients living with venous ulcers (and perhaps debridement, skin grafting, and/or surgery). Although proper wound management may be time-consuming, the healing process may help this patient population cope with the physical pain and discomfort while helping to reduce emotional factors such as stress and anxiety. 

Michelle Whitmer is a medical writer and editor with the Mesothelioma Center, Orlando, FL. Focused on the benefits of integrative medicine for cancer patients, she is a certified yoga instructor, a member of the Academy of Integrative Health & Medicine, and a graduate of Rollins College. (The Mesothelioma Center and its website are sponsored by Weitz & Luxenberg, a law firm with multiple locations nationally that focuses on asbestos injury litigation.)

References

1. How Mesothelioma Affects Your Body. Mesothelioma Prognosis Network. Accessed online: www.mesotheliomaprognosis.com/mesothelioma

2. Whitmer M. Mesothelioma Surgery. Mesothelioma Center. Accessed online: www.asbestos.com/treatment/surgery

3. Reiber GE, Ledous WE. Epidemiology of diabetic foot ulcers and amputations: evidence for prevention. In: Herman W, Kinmonth AL, Wareham N, Williams R. The evidence base for diabetes care. 2nd ed. London, UK. John Wiley & Sons;2002;641–65.

4. Carpenter S, Shaffett TP. Choosing the best debridement modality to 'battle' necrotic tissue: pros & cons. TWC. 2017;11(7):10-8.