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FEATURE ARTICLE
Diffuse Malignant Pleural Mesothelioma:
Part II. Symptom Management
Mary Ellen Cordes, RN, MS, APRN-BC, and Carol Brueggen, RN, MS, APRN-BC, AOCN ®
Therapy Impact Questionnaire
iffuse malignant pleufor Quality of Life. Self-report
ral
mesothelioma
Patients with diffuse malignant pleural mesothelioma
measures, such as the Medical
(DMPM) is a rare dis(DMPM) experience multiple symptoms from their disResearch Council Dyspnea
ease that forms on the lining of
ease and treatment, which can affect all aspects of their
Scale, Dyspnea Interview
the lungs. DMPM usually is aslives. Dyspnea, cough, pain, fatigue, depression, weight
Schedule, Oxygen Cost Diasociated with asbestos exposure
gram, Modified Borg Scale,
and accounts for approximately
loss, anorexia, and cachexia are the most common
Cancer Dyspnea Scale, and Vi1% of all cancer deaths in the
symptoms. Early, ongoing assessment and management
sual Analog Scale, also are
world (Peto, Decarli, LaVecchia,
of these symptoms are imperative to maximize quality of
available (Mancini & Body,
Levi, & Negri, 1999). The diaglife for patients with DMPM.
1999; Tanaka, Akechi, Okunosis of DMPM often is delayed
yama, Nishiwaki, & Uchitomi,
because of nonspecific sympKey Words: dyspnea, pain, fatigue, depression, anorexia
2002c; Wickham, 2002). The
toms. Approximately 60%–90%
most commonly used tool is the
of patients present with symptoms of dyspnea and chest pain (Grondin & in patients with lung cancer and patients visual analog scale, where patients rate
Sugarbaker, 1999; Martin-Ucar, Edwards, with cancer in general are useful in identify- their dyspnea on a horizontal or vertical
Rengajaran, Muller, & Waller, 2001). Other ing and describing possible interventions for line from no breathlessness to worst possible breathlessness (Ripamonti & Bruera,
common complaints at presentation include patients with DMPM.
1997).
cough, fatigue, and weight loss, which can
Ideally, treating the underlying cause of
lead to anorexia or cachexia (Aisner, 1995;
Dyspnea
dyspnea would eliminate this symptom;
Grondin & Sugarbaker). Symptoms of
DMPM can be present up to five months
Dyspnea, as defined by the American however, this is difficult to do in advancedbefore a diagnosis is established (Merritt et Thoracic Society (ATS) (1999), is “a sub- stage lung cancers (Gift, 1990). Dyspnea
al., 2001).
jective experience of breathing discomfort may be an indication of a phase in the illPatients diagnosed with DMPM have consisting of qualitatively distinct sensations ness in which resources should be shifted
multiple disease- and treatment-related that vary in intensity” (p. 322). Physiologic, from acute intervention to palliative and
symptoms. The majority of patients with psychological, cultural, and environmental supportive care measures (Ripamonti &
DMPM are diagnosed with advanced dis- factors contribute to patients’ experience of Fusco, 2002). Goals of treatment are based
ease. Currently, no cure for DMPM exists dyspnea (ATS, 1999; Gift, 1990; Ripamonti on an assessment of subjective complaints
and life expectancy usually is very limited. & Bruera, 1997; West & Popkess-Vawter, and the limitations created for each patient.
The presence of pleural effusions and pleuAggressive multimodal therapy consisting 1994). Dyspnea was reported to be the numof surgery, chemotherapy, and radiotherapy ber one presenting symptom in 46 of 101 ral thickening in DMPM contributes to dyspis used to treat DMPM. Supportive care is patients with DMPM in a retrospective re- nea in this patient population. The prognosis
recommended for patients who are debili- view (Merritt et al., 2001). In a study by
tated at diagnosis because they would not Herndon and colleagues (1998), 70% of paSubmitted April 2003. Accepted for publicabe able to tolerate aggressive therapy. The tients with DMPM (n = 337) reported that
tion May 13, 2003. Part I. An Overview of Diseverity of symptoms increases as the dis- dyspnea was their chief complaint.
agnosis, Staging, and Treatment Options apease progresses, putting patients at risk for
The subjective nature and multiple conpeared in the July/August 2003 issue of the
anxiety and depression. Effective symptom tributing factors make dyspnea a difficult
Clinical Journal of Oncology Nursing. (Menmanagement must be initiated early to as- symptom to assess. A variety of assessment
tion of specific products and opinions related
sist in improving the quality of life for these tools for evaluation of dyspnea and intervento those products do not indicate or imply enpatients.
tions for relief exists. Available assessment
dorsement by the Clinical Journal of OncolSpecific research about managing symp- tools include activity scales, such as the Pulogy Nursing or the Oncology Nursing Socitoms experienced by patients with DMPM monary Function Status Scale, American
ety.)
is minimal. However, research findings Thoracic Standardized Questionnaire, Baseabout symptoms and symptom management line and Transitional Dyspnea Indexes, and Digital Object Identifier: 10.1188/03.CJON.545-552
D
CLINICAL JOURNAL OF ONCOLOGY NURSING • VOLUME 7, NUMBER 5 • DIFFUSE MALIGNANT PLEURAL MESOTHELIOMA: PART II. SYMPTOM MANAGEMENT
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