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Suggest treatment for Stage 4 Lung Cancer

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Practicing since : 2002
Answered : 2565 Questions
Mother just diagnosed with Stg 4 Lung Cancer, been treated with Lymphoma since December, internal bleeding, heart has STV, pet scan this past fri, going to do camera scope on wed, she is 72 yrs old, we are wondering if there is anything different that your facility might be able to do for her. She is a medicare patient and currently goes to OHC - Mercy at Jewish Hospital in Kenwood. She is hospitalized every time she has chemo treatments, also she has blood clots in her lungs. Gets daily shots in her stomach. Dr. Ward (her lung cancer dr) we just met last week, thinks that the cancer has spread to other organs and that she is in a much more advanced stage. At this point, we are looking for options that maybe could help her. Tumors in lungs, 1 is 1.7 cm, 0.4, 0.3. On 1-2-14, she was in ICU for 7 days, GI bleed (very serious). 9.5 hemoglobin, but is down from 10 something, believes that she is still bleeding internally even though we don\\\'t see it outside like before. Her last chemo was 12-24-13. Any help/suggestions? Could your facility potentially help her cancer? Also, separately, from my mom, Dr. Ward told us we might want to think about getting hospice involved, b/c apparently with internal bleeding, they really can\\\'t treat her unless it is possible to stop that. Your help/comments are appreciated. Thank you for your time.
Posted Tue, 4 Mar 2014 in Cancer
Answered by Dr. Robert Galamaga 21 hours later
Brief Answer: Goals of care Detailed Answer: Hello and thank you for sending the question. I think one of the most important things to establish at this time would be the appropriate goals of care. This concept basically incorporates your mothers wishes into the treatment plan. I agree that she is very debilitated and has encountered significant complications of treatment. at this time continued chemotherapy may contribute to a further decline in overall health. This is a constant struggle in the field of oncology in the case of advanced cancers and in the case of patients web encountered significant issues including pulmonary embolism and gastrointestinal bleeding. I realize this is an extremely difficult decision but I do feel that the entire family should sit down and talk about these decisions with your mother to gather what exactly she would like to be done at this time. experimental therapy and clinical trials is usually reserved for patients who are relatively fit. At this time it is a situation where her level of fitness is very very limited. I am speaking in a general sense here but it sounds like at least a consultation with a palliative care service or possibly hospice would be reasonable. I discussion does not mean that you are actually signing up for the service and it might provide you with some information to help you make further decisions. I do not see an indication for further systemic chemotherapy right now for her. This is especially the case in the setting of gastrointestinal bleeding and relative instability and an overall debilitated state. thanks again for sharing your health care concerns, Sincerely, Dr Galamaga
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Follow-up: Suggest treatment for Stage 4 Lung Cancer 6 minutes later
Overall, outside appearance, she is moving around, and looks great on the outside, other than she has the most pain in both her arms. The plan is start chemotherapy again more dedicated for lung cancer versus lymphoma; however, the lung cancer dr did the petscan last friday and is having the camera scope done this wed. How long does it usually take for the dr to get those results? Will a dr want to meet with us again after the 1st test or after he gets all the test results; or does it depend upon what the petscan shows. Mom goes daily for her stomach shots. I'm not sure what the dr meant by that she needs more supervision; since she appears to be relatively well looking externally. There is no outward signs of internal bleeding. My mom tends to want to sneak off and not let me/nor my daughter know about these appointments. I believe as your medical POA I should be present to understand exactly where we are. Is internal bleeding a strong indication that the cancer has already metasticized (sp) elsewhere? For myself, I have scheduled some counseling appts to help me deal with everything. Mom and I have faith that God still can do miracles; if he chooses so, but we are also being practical. A few questions imbedded in here as follow. I know you have not seen her file or anything; but since this started last spring with a GI ulcer and the lymphoma was discovered, they believe now that it was probably the lung cancer all along, this were just side notes, what generally is a prognosis of life expectancy after these results and the ones mentioned above were stated, on average anyway? Would even like the mayo clinic or cancer centers of XXXXXXX be able to provide more/different treatment that might change the outcome?
Answered by Dr. Robert Galamaga 2 days later
Brief Answer: Followup Detailed Answer: Thanks for the followup. It usually takes 3 to 5 days to get results of imaging and biopsy. Its usually a better idea to wait until all results are in before proceeding with decision making and discussions. I think the doctor is concerned that she is deconditioned and at risk for falls and such. Internal bleeding is difficult to interpret and we cannot draw alot of conculsions about it in general - it is an individual aspect of a patients case. The counseling is a good idea for you. It is tremendously mentally and physically taxing to take care of a loved one who is very ill. The counselor will help you focus on needs of coping and will also help with strategies in taking care of your mom. I almost never provide prognosis in form of days, weeks, months or years. My focus is on quality of life for all patients. If quality of life is declining then I usually have another discussion to help establish goals of care with a patient and his or her family. May or CTCA may provide some options for you but these institutions are not always much better than a good community physician in many cases. You could always call them and discusss the case with a nurse navigator. Bottom line is to do what your mom wants. Sincerely, Dr. G
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