Background: Pleural mesothelioma (PM) is a rare, incurable cancer. One of the most common symptoms experienced is dyspnea. Lung-sparing surgery for PM is investigational and offered to select patients. Despite being fit for surgery, some patients continue to experience dyspnea after surgery and do not return to baseline quality of life (QOL).

Purpose: The purpose of this dissertation was to (1) review and synthesize the existing scientific literature of physical, psychological and situational factors influencing QOL before and after lung-sparing surgery for PM, (2) describe factors influencing perceptions of dyspnea and QOL before and after lung-sparing surgery for PM, and (3) compare and integrate qualitatively derived themes with QOL and dyspnea measures, before and after lung-sparing surgery for PM.

Methods: Guided by the Theory of Unpleasant Symptoms, the first manuscript is a synthesis of the current state of evidence of factors influencing QOL before and after lung-sparing surgery for PM. The second manuscript is the results of a qualitative study of perceptions of dyspnea and QOL before and after lung-sparing surgery for PM. The third manuscript is the results of the pilot mixed methods study comparing qualitatively derived themes and quantitative data (Dyspnea-12 scores, McGill Quality of Life Questionnaire) to identify areas of convergence and divergence.

Results: The scoping review identified 15 studies. Dyspnea was quantified in 78% and individually measured in 14% of the studies. Physiological and psychological concepts were identified. The Interpretive Phenomenological Analysis identified Group Experiential Themes, Mind supports body in the world; Body fighting, enduring, adjusting, and adapting in the world; Others sharing and supporting body in the world; Facing an uncertain future of body living in the world. During the mixed methods analysis, convergence occurred with physical and psychological distress corresponding to lower QOL scores and higher Dyspnea-12 scores. Divergence occurred in the psychological domain, where improvements in scores did not reflect continued mental burden after surgery.

Conclusions: This study identifies interconnections between physical, psychological, social, and existential perceptions of dyspnea and QOL. It highlights how a symptom, like dyspnea, can have broad-reaching effects on multiple aspects of QOL before and after lung sparing surgery.