Can a ‘Chemo Bath’ Be Used to Treat Mesothelioma?

Exploring how a targeted cancer treatment offers new hope for mesothelioma patients by delivering chemotherapy directly to the tumor.

Receiving a mesothelioma diagnosis is often overwhelming, stirring up a mix of shock, confusion, and worry about the future. For many, it raises urgent questions about the availability of treatment options and which approaches are most effective. As an aggressive cancer, mesothelioma is challenging to both diagnose and treat, leaving many patients wrestling with a late-stage diagnosis and scrambling to figure out next steps as quickly as possible.

While treatments are generally tied to the stage of the cancer, decreasing in effectiveness or being eliminated as an option altogether in later stages, there is hope in innovative treatments, such as in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), commonly known as a “chemo bath.”

This targeted therapy, involving surgery followed by heated chemotherapy directly applied to the abdomen, has demonstrated promising results specifically for certain cases of peritoneal mesothelioma.

This article will delve into what mesothelioma is, exploring its causes, diagnosis, and treatment options while highlighting how HIPEC is being used, the growing evidence of its effectiveness, and what patients need to know about this cutting-edge approach. HIPEC may prove to be more effective than traditional therapies and, thus, it’s not only important for patients and their families to be aware of what it entails, but to start conversation about HIPEC with their healthcare providers.

What is Mesothelioma?

Mesothelioma is a rare, aggressive cancer that originates in the mesothelium, the thin layer of tissue that lines and protects most internal organs. There were an estimated 2,803 new cases of the disease in the United States in 2021. While this is relatively low, incidences of mesothelioma nearly doubling over the last three decades, largely due to its primary cause and symptom latency, both of which will be covered in greater detail in the sections to follow.

The two primary areas affected by mesothelioma are the pleura, which lines the lungs and chest cavity, and the peritoneum, which lines the abdominal cavity and digestive organs. Pleural mesothelioma is the most common, while peritoneal mesothelioma is the second most frequent presentation. In rare cases, mesothelioma can also affect the pericardium (the lining around the heart) or the tunica vaginalis (lining surrounding the testes).

Symptoms of the disease vary based on the location of the cancer. Pleural mesothelioma generally leads to chest pain, shortness of breath, persistent cough, and unintentional weight loss, while peritoneal mesothelioma often causes abdominal pain, bloating, nausea, and changes in bowel habits. In general, early symptoms tend to be nonspecific and are commonly attributed to less severe conditions. Therefore, many mesothelioma diagnoses are delayed.

The cancerous tumors tend to spread in fragmented patterns, making treatment particularly challenging. However, advancements in cancer therapies over the years have brought more effective options, both advancing technologies tied to existing treatments as well as bringing new options, more targeted therapies like HIPEC to the market.

What Causes Mesothelioma?

The primary cause of mesothelioma is exposure to asbestos, a mineral once widely used in various industries for its fire-resistant and insulating properties. Asbestos fibers, when disturbed, can be inhaled or swallowed, lodging in the body’s tissues and causing cellular damage over time. Certain industries have historically placed workers at high risk of asbestos exposure, including shipbuilding, construction, textiles, automotive repair, and even the military. For example, shipyards and military vessels were heavily insulated with asbestos-containing materials (ACMs), while construction sites used asbestos in cement, insulation, and roofing.

The Latency of Asbestos Cancer: Symptoms may not appear for 20-50+ years after exposure.

Individuals in high-risk places of work often unknowingly ingested asbestos fibers, leading to a delayed onset of mesothelioma decades later. Family members of workers exposed to asbestos also faced secondhand exposure when fibers carried on their loved ones’ clothing or skin. These were frequently left behind in family vehicles or stirred into the air while clothing was washed.

In addition to industrial uses, asbestos was present in numerous household items, from floor and ceiling tiles, insultation, and roofing shingles to hairdryers, dental products, children’s toys and other everyday products.

Even today, despite restrictions imposed on use over the years, asbestos remains in older structures and products and is imported in goods brought into the U.S. from regions with lax or nonexistent restrictions. In these ways, the legacy of asbestos use continues and will pose an ongoing risk for many years to come.

Making matters worse, there tends to be a long latency period (20 to 50 years) between exposure and the onset of symptoms. In other words, when fibers are ingested, they cling permanently to internal organ issues, causing inflammation that gradually progresses over time. Most individuals are unaware of their presence, and only become concerned when symptoms develop and, eventually, become severe enough to seek medical advice.

Diagnosis and Treatment

Due to the long latency period between asbestos exposure and mesothelioma symptom onset, diagnosis often comes years after initial contact with the substance. This process usually involves imaging tests, biopsies, and tissue analysis to confirm mesothelioma and its type. Oftentimes, these procedures are only performed after a period of misdiagnosis with more benign conditions.

Because of this, anyone who worked in a high-risk industry, had a loved one who did, or were otherwise frequently exposed to asbestos, should consider inquiring about screenings. Early screening is critical for those with known asbestos exposure history, and early intervention can significantly improve treatment outcomes.

Treatments available for a mesothelioma diagnosis

Once diagnosed, traditional treatment options include surgery, chemotherapy, radiation, and immunotherapy. Each treatment has unique roles in managing mesothelioma, often customized based on tumor location, disease stage, and patient health. Surgery, which is usually reserved for earlier stages of the cancer, before it has spread, focused on removing visible tumors. Chemotherapy targets residual cancer cells, radiation applies high-energy beams to destroy remaining malignant cells, and immunotherapy engages the body’s own immune system to combat the cancer.

Most providers will lean on these options and discuss the availability of each with patients depending on their unique situation. Another promising approach, however, especially for peritoneal mesothelioma, is HIPEC.

Hyperthermic Intraperitoneal Chemotherapy, commonly referred to as HIPEC or a ‘chemo bath,’ has gained attention as an innovative option that combines cytoreductive surgery with heated chemotherapy. This two-step process begins with surgery to remove visible tumors in the abdominal cavity, followed by heated chemotherapy circulated within the cavity to target any remaining cancerous cells, many of which are microscopic and difficult to detect.

HIPEC is especially beneficial for cancers confined to the abdominal area, such as peritoneal mesothelioma, as it allows high concentrations of chemotherapy to reach the affected tissues without as many side effects as seen with systemic chemotherapy.

Research on HIPEC shows encouraging results. A study in JAMA Network Open noted that patients with peritoneal mesothelioma who underwent HIPEC had a five-year survival rate of around 50%, a significant improvement over standard chemotherapy alone. Another study published in the Annals of Surgical Oncology reported that some patients had a median survival rate of up to 60 months following HIPEC.

As a relatively new treatment, HIPEC continues to be researched, with institutions like the National Cancer Institute and prominent cancer hospitals exploring its long-term impact on mesothelioma outcomes. However, it’s clear that for individuals with peritoneal mesothelioma, HIPEC presents a viable treatment option, offering improved quality of life and extended survival time for patients who meet the criteria for this procedure.

How to Inquire about HIPEC and Next Steps

For mesothelioma patients considering HIPEC as a treatment option, discussing it with a healthcare provider is an important step that involves understanding candidacy, potential benefits, and risks. Because HIPEC is still relatively new and specialized, it’s helpful to come prepared with questions and have a general understanding of what the therapy entails. Here’s what these may look like:

Initial Consultation: 

Patients should start by asking their oncologist if they are a candidate for HIPEC. Since HIPEC is often most beneficial for cancers limited to the abdominal cavity, such as peritoneal mesothelioma, doctors will assess factors like the cancer’s stage, the patient’s overall health, and previous treatment history. If the current oncologist doesn’t perform HIPEC, they might provide referrals to specialists at larger cancer centers that offer the procedure.

Benefits and Risks: 

It’s essential to have a conversation about how HIPEC may compare to other treatments, particularly in terms of efficacy and side effects. HIPEC enables high-dose chemotherapy directly at the tumor site, minimizing systemic exposure and potentially reducing side effects common with traditional chemotherapy. Despite this, pursuing any treatment should involve an informed discussion about both benefits and risks.

Procedure Specifics: 

Patients who qualify can ask their provider to outline the HIPEC procedure in detail, including the surgery to remove visible tumors and the heated chemotherapy that targets microscopic cancer cells. Discussing how long the recovery might take and what follow-up care involves can help patients and their families feel better prepared for this process.

Available Institutions and Clinical Trials: 

Because HIPEC is available at select institutions, patients may ask for referrals to hospitals or specialists who perform the procedure regularly. The National Cancer Institute and prominent hospitals such as MD Anderson and Memorial Sloan Kettering are involved in research and may also offer access to clinical trials examining HIPEC’s long-term efficacy, which can offset treatment costs.

By approaching these discussions openly, mesothelioma patients can work with their healthcare team to determine if HIPEC aligns with their treatment goals and get connected with resources that could support them throughout their journey.

Legal and Financial Options to Offset Treatment Costs

Mesothelioma treatment, especially with advanced techniques like HIPEC, can place a significant financial burden on patients and families. However, there are various legal and financial assistance programs that can help to offset these costs. Here are a few to consider:

· Veterans’ Benefits through the Department of Veterans Affairs (VA): 

Veterans exposed to asbestos during military service may qualify for VA benefits, as many service members were exposed to asbestos, particularly those in Navy or in construction roles. Benefits can cover medical treatment, monthly disability compensation, and other mesothelioma-specific costs if veteran’s are able to prove their diagnosis resulted from their time in the service. 

·  Social Security Disability Insurance (SSDI): 

SSDI can offer financial support if a disease prevents a person from working, and mesothelioma generally qualifies as a disability under SSDI guidelines. Applications for SSDI often benefit from medical documentation that outlines the diagnosis and its impact on daily functioning. 

·  Workers’ Compensation: 

For individuals exposed to asbestos on the job, workers’ compensation provides a way to recover lost wages and medical expenses without needing to prove fault. This option varies by state and may be limited to specific medical expenses, but it can ease the financial burden for those unable to work due to their diagnosis.

There are also two primary legal options available to mesothelioma patients who are able to prove they were exposed to asbestos—trust funds and traditional lawsuits:

·  Asbestos Trust Funds: 

Many companies responsible for asbestos exposure have set up trust funds to compensate those diagnosed with mesothelioma and related diseases. These funds were established during bankruptcy proceedings of asbestos-related companies to ensure resources were set aside for future claims. Patients with an asbestos-related diagnosis may submit claims to multiple trust funds, which can provide significant financial assistance to offset healthcare costs. 

·  Traditional Lawsuits: 

Some patients choose to file lawsuits directly against asbestos manufacturers to seek compensation for their diagnosis. While lawsuits can yield large payouts if successful, they tend to be time-consuming and are riskier than filing trust claims.

Regardless of the legal route chosen, working with a lawyer who specializes in mesothelioma and asbestos litigation is essential. These attorneys have the experience necessary to guide patients and their families down the right path, ensuring the burden of proof is met and all documentation is filed correctly and on time. Many also work on a contingency basis, meaning patients only pay legal fees if they win their case, reducing upfront costs.

Taking Control with HIPEC: A Targeted Approach to Combating Cancer

Although traditional treatments continue to be effective, HIPEC has emerged as an additional, targeted therapy for individuals facing abdominal cancers, including peritoneal mesothelioma.

This innovative procedure, also known as a “chemo bath,” combines surgery to remove visible tumors with a heated chemotherapy wash, targeting microscopic cancer cells directly within the abdomen. This method minimizes systemic exposure, reducing side effects and enhancing the treatment’s potency against remaining cancer cells.

If you or a loved one is exploring treatment options for abdominal cancer, HIPEC may be worth considering. Consult with a specialized oncology team to determine whether HIPEC could be an effective part of your cancer-fighting strategy.

To offset the costs of treatment, you might also consider meeting with an attorney experienced in asbestos litigation to discuss available options and seek the compensation you deserve.