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Suggest Treatment For Cancer Patient On Ventilatory Support

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Posted on Fri, 30 May 2014
Question: My 78 year old mother was diagnosed with squamous cell NSCLC in XXXXXXX of 2012. She had a good size tumor in her left lung and after 7 weeks or radiation and 8 sessions of two chemo agents. It bothers me greatly that I cannot recall the name of them both, but at any rate my mom's oncologist thought that my mom was in the clear and a pet scan in late November proved that the tumor had shrunk from an SUV of 17 down to about 5. Well, in February of 13 some persistent neck pain that my mom was experience turned out to be from a metastasis on C-1 of her spine. We would learn a week or so that there was also evidence of smaller lesions on one of her ribs and I. Her lower spine. Well, my mom had some radiation on the c-1 lesion but had a hard time tolerating the 30 low does treatments that she was to receive for this so she had enough after about 13 treatments---anxiety.
Well, my mom opted to check in as an inpatient t at a local rehabilitation center and after about 6?weeks of physical therapy she felt brand new. One of the doctors at this facility convinced her to go to a new oncologist to continue her treatment and I thank my lucky stars he was able to do this because I wanted my mom to continue on badly. Well, in July of 2013, she started all over again. Now, her last chemo treatment was on October 31st so it had been some months since she had received any treatment. While a pet scan she had in July did indicate some progression, she would endure 6 cycles on Gem/Cis and then have a pet scan in October that, according to her oncologist was almost like a normal pet scan. But for a small light up on C-1, there was no other evidence detected. My mom continued with the gem/Cis and had another pet scan in December. while we had our fingers crossed for NEDS, there was some progression--her original tumor in her left lung and a small area of her lower spine. Well we traveled and celebrated the holidays before my mom started treatment with alimta in January and after receiving her second treatment on January 31st do this year, my mom started feeling a little congested in the beginning of February and then was admitted to the hospital to be treated for a minor cold or infection that was not getting any better on February 24th. Five days later, my mom could no longer breathe on her own and required intubation a tracke and almost seven weeks in intensive care. The origin of the pneumonia was never discovered despite two Bronchs and my mother is currently in a sub acute facility and hopefully in the process of being weened off of the vent.
Now, as much as I wish the nsclc would call a time out during all of this, I know that is not very likely. At the end of this moth, it will 4 months since my mom has received any treatment for cancer. My fear is that the cancer will kill her before she ever gets off of the vent.
doctor
Answered by Dr. omz (33 hours later)
Brief Answer:
Need to know EDGF and ALK status?

Detailed Answer:
Hello

I am Dr.Omer and I am here to help you with your query.

I am really sorry to hear about your mother problem as she is on ventilatory support.

She is a case of NSCLC the type is squamous cell with metastasis to cervical vertebras/ribs.

The two chemotherapy agent given to your mother should be gemicitabine / cisplatin with palliative radiotherapy to ribs and cervical vertebras.

Can you tell me the status of ALK oncogene and EGFR on your mother histology of the lung mass?

Pemetrexed is not advised in patients with squamous cellcarcinoma as it has low efficacy.

So the side effect of pemetrexed /gemcitabine/cisplatin is immunosuppression and usually people have severe kind of pneumonia or any infection affecting specifically brain that will be severe.When any cancer patient is on ventilatory support or have severe infection that requires ventilator or ICU admission no chemotherapy is given as she will get more immunocompromised and in return the infection will ncrease .Her blood complete picture test will not allow any oncologist to start chemotherapy with any of the agent.

You just have to wait IF she comes out of this severe infection gets stabilized only then chemotherapy can be started.I know during the last four months no chemotherapy is given the cancer must have progressed.Usually its the end stage where cancer keeps on increasing and severe infection is there and we cannot give any other chemtherapy , now doctors hands are tied.

The best plan of action now will be an aggessive antibiotic coverage with steroids and fluids to take her off the ventilator as soon as possible , check her blood and immune status and when stabilized only then we can start chemo.

I know its depressing but dont let your hope down as miracles usually occur in cancer patients.

Feel free to ask me any further questions , praying for your mother Take care

Note: For further queries related to kidney problems Click here.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Answered by
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Dr. omz

Internal Medicine Specialist

Practicing since :2005

Answered : 508 Questions

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Suggest Treatment For Cancer Patient On Ventilatory Support

Brief Answer: Need to know EDGF and ALK status? Detailed Answer: Hello I am Dr.Omer and I am here to help you with your query. I am really sorry to hear about your mother problem as she is on ventilatory support. She is a case of NSCLC the type is squamous cell with metastasis to cervical vertebras/ribs. The two chemotherapy agent given to your mother should be gemicitabine / cisplatin with palliative radiotherapy to ribs and cervical vertebras. Can you tell me the status of ALK oncogene and EGFR on your mother histology of the lung mass? Pemetrexed is not advised in patients with squamous cellcarcinoma as it has low efficacy. So the side effect of pemetrexed /gemcitabine/cisplatin is immunosuppression and usually people have severe kind of pneumonia or any infection affecting specifically brain that will be severe.When any cancer patient is on ventilatory support or have severe infection that requires ventilator or ICU admission no chemotherapy is given as she will get more immunocompromised and in return the infection will ncrease .Her blood complete picture test will not allow any oncologist to start chemotherapy with any of the agent. You just have to wait IF she comes out of this severe infection gets stabilized only then chemotherapy can be started.I know during the last four months no chemotherapy is given the cancer must have progressed.Usually its the end stage where cancer keeps on increasing and severe infection is there and we cannot give any other chemtherapy , now doctors hands are tied. The best plan of action now will be an aggessive antibiotic coverage with steroids and fluids to take her off the ventilator as soon as possible , check her blood and immune status and when stabilized only then we can start chemo. I know its depressing but dont let your hope down as miracles usually occur in cancer patients. Feel free to ask me any further questions , praying for your mother Take care