• Try to do some gentle physical activity daily. This will help you sleep better. Talk to a physiotherapist or exercise physiologist, who can tailor an exercise program, and an occupational therapist, who can suggest equipment to help you move safely.
• Limit or cut out the use of alcohol, caffeine, nicotine and spicy food.
• Avoid television or using computers or smartphones before bed, as the blue light may tell your body it’s time to wake up.
• Follow a regular routine before bed and set up a calm sleeping environment. Make sure that the room is dark, quiet and a cool, comfortable temperature.
• Try soothing music, a recording of rain sounds, or a relaxation recording. Listen to our " Sleep and Cancer" podcast episode and our Finding Calm During Cancer podcast series for more tips.

To prevent fluid building up again in the lining of the lungs, you may have a talc pleurodesis. Pleurodesis means closing the pleural cavity. 

Sterile talcum powder (talc slurry) is inserted into the pleural cavity, which causes an inflammation that helps fuse the two layers of the pleura together and closes the space.

A talc pleurodesis is best done during VATS by a thoracic surgeon, but is sometimes done by a respiratory physician.

After a talc pleurodesis, some people experience a burning pain in the chest for 24–48 hours. This pain can be eased with medicine and you will be able to have physiotherapy to improve lung expansion.

VATS with pleurectomy decortication

When fluid is drained and talc pleurodesis is done during VATS, part or all of the outer layer of the pleura (parietal pleura) is removed. This is known as pleurectomy decortication (PD).

This may be done when the parietal pleura, which lines the chest wall, has become thick and stiff.

Thoracotomy with pleurectomy decortication

Even after VATS and talc pleurodesis, the fluid may build up around the lungs again, causing breathlessness. The surgeon may suggest more extensive surgery called thoracotomy (open surgery) with pleurectomy decortication (PD).

This surgery may also be recommended as a first option if the cancer has grown in a way that makes it difficult to perform VATS successfully.

A thoracotomy helps to prevent fluid building up again in most cases. It also makes it easier for the lungs to expand and to transfer oxygen to the blood.

Pain after having a thoracotomy can last longer than after having VATS, but the improvement in symptoms may make open surgery a worthwhile option if VATS has been unsuccessful or if it isn’t possible.

Indwelling pleural catheter

Some people cannot have VATS or open surgery, either because they are too unwell or because the cancer has grown in a way that makes the surgery too difficult.

Instead, you may be offered an indwelling pleural catheter (also known as a drain) to remove the fluid and improve your breathing.

This can also be used if the pleural fluid builds up again after pleurodesis.

Under local anaesthetic, the specialist inserts a thin tube (the catheter) through the chest wall into the pleural cavity. You can manage the drain at home with the help of a community nurse, family member or friend.

When the fluid builds up and needs to be drained (usually once or twice a week), the end of the catheter is connected to a bottle.

Sometimes with an indwelling pleural catheter, the pleural cavity may close up over time and stop producing fluid. If this occurs, the drain will be removed.

In pleural mesothelioma, a pleural tap (also known as pleurocentesis or thoracentesis) drains fluid from around the lungs.

• Your doctor will numb the area with a local anaesthetic and insert a needle between your ribs into the fluid-filled pleural cavity.
• An ultrasound scan may guide the needle to the fluid. The needle is connected to a bag for the fluid to drain into.
• The process of draining the fluid usually takes anywhere between 30 and 60 minutes.
• You usually don’t have to stay overnight in hospital after having a pleural tap.

Fluid build-up around the lungs or abdomen may be drained before mesothelioma is diagnosed or at the same time as the biopsy.

• Peritoneal tap – In peritoneal mesothelioma, a peritoneal tap (also known as paracentesis) drains fluid from the abdomen. Your doctor will numb the area with a local anaesthetic and insert a needle through the skin into the peritoneal cavity. An ultrasound may guide the needle to the fluid. The needle is connected to a bag for the fluid to drain into over a few hours. A peritoneal tap may be done while you are still having tests. You usually don’t have to stay overnight in hospital after a peritoneal tap.
• Indwelling peritoneal catheter – If fluid keeps building up around the abdomen, a small tube can be inserted to allow fluid to flow into a bottle. This is known as an indwelling peritoneal catheter or drain. Under local anaesthetic, the specialist inserts a thin tube (catheter) into the abdomen. You can manage the drain at home with the help of a community nurse, family member or friend. When the fluid builds up and needs to be drained (usually once or twice a week), the end of the catheter is connected to a bottle.
• Heated chemotherapy – To help prevent fluid building up again, you may have a single dose of heated chemotherapy directly into the abdomen (HIPEC) during a laparoscopy.

It can be distressing to feel short of breath, but several simple strategies can help provide some relief from breathlessness at home.

• Treating other conditions  – Let your doctor know if you feel breathless. Conditions such as anaemia, a lung infection or chronic obstructive pulmonary disease may also make you feel short of breath and these can often be treated.
• Sleep more upright – Use a recliner chair or prop yourself up in bed to help you sleep in a more upright position. An occupational therapist may be able to recommend a special pillow for sleeping.
• Check if equipment could help – Ask your health care team about equipment to manage breathlessness. You may be able to use an oxygen concentrator at home to deliver oxygen to your lungs. For social outings and medical appointments, you can use a portable oxygen cylinder. If you have a cough or wheeze, you may benefit from a nebuliser, a device that delivers medicine into your lungs.
• Relax on a pillow – Rest your head and upper chest on a table with a pillow. Bend from your hips and keep your back straight. This helps to relax your breathing muscles.
• Ask about medicines – Talk to your doctor about medicines, such as a low dose of morphine, to ease breathlessness. It is also important to keep any chest pain well controlled because pain may prevent you from breathing deeply.  
• Modify your movement – Some types of gentle exercise can help but check with your doctor first. An exercise physiologist, physiotherapist or occupational therapist from your treatment centre can explain how to modify your activities to improve breathlessness.
• Create a breeze – Use a handheld fan to direct a cool stream of air across your face if you feel short of breath when not exerting yourself. You may also find it helpful to sit by an open window.
• Find ways to relax – Listen to a  relaxation recording or learn other ways to relax. This can help you control anxiety and breathe more easily. Some people find  breathing exercises, acupuncture and meditation helpful. 

Different types and strengths may be used:

• mild, like paracetamol
• moderate, like codeine
• strong and opioid-based, like morphine.

Pain medicines may come as tablets, oral liquids, patches, injections or intravenous infusions. Non-steroidal anti-inflammatory drugs (NSAIDs) or drugs for nerve pain may also be prescribed.

Many people need a combination of medicines for good pain control. Opioids, such as morphine or oxycodone, are the most common drugs used for moderate-to-severe mesothelioma pain (and may be used for breathlessness).

Morphine is available in quick-acting and long-acting forms. Some people worry they might get addicted to morphine. Pain specialists believe this is unlikely if you take it as prescribed to relieve acute pain or for palliative care.

Morphine can be taken for a long time and in increasing doses, if needed. It doesn’t have to be saved for when pain is very bad. There are many strong pain medicines similar to morphine, so if one doesn’t work, ask your doctor for other options.

A small number of people have difficulty controlling their pain, and a pain management specialist may help find a solution.

Aside from breathlessness, fluid build-up around the lungs or abdomen can cause pain. Various treatments can help drain the fluid and try to prevent it building up again.

This may be used to shrink mesothelioma that is pressing on nerves, bones or major blood vessels and causing pain.

Sometimes the mesothelioma can grow through the scar from VATS surgery and produce a lump in the skin.

Radiation therapy can reduce the size of the lump and ease any associated pain.

Chemotherapy can reduce the size of the mesothelioma that is causing the pain.

If you are well enough and it is technically possible, surgery may be used to remove the part of the mesothelioma causing pain and other symptoms.

This is known as debulking surgery. Talk to your doctor for more information

• Drink plenty of fluids.
• Eat fresh fruit and vegetables and fibre-rich foods (e.g. prunes, apples with skin on), unless your doctor advises otherwise.
• Try to be physically active every day. Talk to your doctor or physiotherapist to find the exercise that is right for you.
• Ask your doctor how to manage constipation. You may be prescribed medicines to help stimulate bowel movements.
• Try over-the-counter laxatives such as Coloxyl with senna, Duphalac or Movicol. Check the dose with the pharmacist and let your doctor know. Don’t wait too long before starting laxatives.
• Talk to your treatment team about how to manage bowel obstruction (described above). If your stomach is swollen and you are in pain, call Triple Zero (000) as it may be an emergency.

• Have small meals and snacks regularly. A large, full plate may put you off eating – try using a smaller plate with smaller portions. Likewise, drink from a half-full glass.
• Eat moist food such as scrambled eggs. Moist food tends to be easier to eat and will cause less irritation if you have a sore mouth.
• Avoid fatty or sugary foods if these make you feel sick.
• Use lemon juice and herbs to add flavour to bland foods. • Eat more of your favourite foods – follow your cravings.
• Carry snacks so you can eat any time you feel like it. Try muesli bars, dried fruit and nuts, crackers or fruit buns.
• If solid food doesn’t appeal, ask a dietitian about protein drinks or other supplements.