Mesothelioma is a relatively rare cancer that affects the pleura around the lung or around the abdominal cavity. According to Cancer Research UK, there are approximately 2,700 patients diagnosed with mesothelioma each year. Most patients (56%) diagnosed with mesothelioma are over 75 years old, however there are many cases where patients are much younger. For example, I cared for one patient who was 29 years old at diagnosis.
Peritoneal mesothelioma accounts for approximately 250 new diagnoses of mesothelioma a year. It is often diagnosed at a late stage due to patients having multiple investigations for other causes before a biopsy is taken and mesothelioma is confirmed as the diagnosis. Treatment options are limited for mesothelioma and the prognosis remains poor with most patients surviving approximately 18 months from diagnosis.
There is limited research around the prevalence of symptoms for mesothelioma patients, but many patients will experience one or more of the following symptoms: pain, shortness of breath, fatigue, weight loss, night sweats and cough.
In contrast, there have been several research studies examining the link between cancer and anxiety and depression. Grassi et al (2023) highlighted that anxiety and depression are the most common psychological symptoms in patients with cancer. This is irrespective of disease stage, type of cancer or phase of treatment.
It would be realistic to expect that many patients will experience anxiety and low mood at diagnosis and when treatment fails and their cancer progresses. But these may be short lived emotional responses to trauma or a life challenge. As clinicians, we need to be able to assess patients for psychopathological conditions such as anxiety and depression and ensure patients are signposted to the appropriate treatment if they are found to be experiencing one or more of these conditions.
The Minnow Study (Sherborne et al, 2023) looked at the mental health and wellbeing of mesothelioma patients and their carers. Of the 96 people interviewed, 29 showed a clinical level of depression and half the participants had clinical levels of anxiety. One third of participants also scored 44 or more on the PTSD scale, indicating a clinical level of post-traumatic stress disorder.
It has been shown that patients with anxiety and depression are less likely to adhere to treatment and have a poorer prognosis. Yet in the hospital setting, patients are not routinely assessed or screened for anxiety or depression. Many patients will have a Holistic Needs Assessment undertaken at the point of diagnosis, and if they score highly for anxiety or depression, they may go on to have a referral for counselling. But due to pressures in the NHS, they may have to wait several weeks to be seen. Patients are not screened for past mental health problems, and there is limited understanding about the complexity of anxiety and depression.
I work for a charity called HASAG which specialises in providing support and assistance to patients and families who have been affected by mesothelioma, asbestosis or pleural thickening. In my role as a Community Mesothelioma Nurse Specialist, I’m able to visit patients an