Chemo vs. Hospice .... time sensitive

DBrew99 · New User Joined: 09 Aug 2007 Posts: 2

Hi, all --

Please forgive the length; I (like so many others I have read on these forums) don't know where to turn and could use some advice.

My father, age 77, has been diagnosed with adenocarcinoma of unknown primary (ACUP). It showed up in his lymph nodes about three months ago and, after numerous delays and exhaustive tests, etc., his team of oncologists arrived at the above conclusion. He has been given an outlook of 6-8 months with no treatment and hospice, or perhaps 12-18 months with chemotherapy.

There are complications, as ever. He has had a checkered medical past, starting with a quintuple bypass twenty years ago, a couple of mild heart attacks, and a mechanical heart valve replacement. He has been in fairly good health until the last two years, where his age has started to take its toll. He was in the hospital with pneumonia last fall, and at one point it looked like he had congestive heart failure. He (and my mom, by proxy) has weathered so much -- it seems so unfair that he has to fight yet another battle, but such is life.

His primary oncologist wants to start a treatment of the usual double cocktail of chemo these days: a dose of carboplatin now, and Taxol in three weeks. One cyle every six weeks for six months, then a break to reduce the toxicity in his system. Eight treatments in six months. Eight chances for an infection or bad reaction to the chemicals (and they talk oh-so-facilely about anti-nausea medication, but they really can't predict anything until they try it on him), eight chances for something to infect him near his heart valve and end everything right there. Moreover, they give only a 36% chance of the treatment doing any good. And, he could die soon afterwards, having spent the last six months of his life feeling like s***.

Our other option is no less bleak: set up for hospice and try to give him 6-8 months of "quality of life" (how many worthless euphemisms we turn to in our grief) before he goes. Radiation is not an option at his age and health. Surgery wouldn't get all the affected cells, and with the unkown primary .....

The doctors are pretty sure that the tumor is somewhere in his lungs, and they asked if he were a smoker. He was back in the day, although he quit over 30 years ago. The affected lymph nodes are in the center of his body near his trachea, so we think that could reinforce their hypothesis.

The challenge: my dad is in enough discomfort now as it is. He is having a hard time sleeping -- they gave him a pain medication to help him sleep, but while that works he is nauseous and unable to keep food or drink down, not that he has much of an appetite. I don't know that a second opinion is worthwhile at this point -- so many people have seen his CT and PET scans that the possibility of misdiagnosis seems thin. My parents are meeting with his GP after he has a chance to talk to the oncologist personally, and he may have some better light to shed on the solution.

My dad is leaning towards hospice, and forgoing the treatment. He is not ready to take a 34% chance of prolonging his life if the treatment has a chance of simply making him miserable for the duration. (He's a very astute poker player, and said that if this were a hand he would fold) My three sisters (I am 41 and they are all also fullgrown adults) and I support him in whatever he decides but we are musicians, teachers, administrators, and librarians -- not oncologists. We feel that we are not dealing with all of the information and wish we could do more to help with this decision. Moreover, the feeling of helplessness is crippling.

We meet with the oncologist on Tuesday morning, August 14th and my father will have to make a decision at that time. If there are any questions we should be asking or if anyone here has any insight, I and my family would be grateful.

Thank you for reading this.

Dan

brainman · Last edited by brainman on Sat Aug 11, 2007 11:12 am; edited 1 time in total

Dan, I am very sorry about your father's diagnosis of ACUP and his very poor options! The choice is his and it is a very difficult choice. It does sound like you are a well informed family and will make the right decision (whatever that is).

"Quality of Life" can indeed be a "worthless euphemism" or it can be a term used to describe an effort to bring wholeness and meaning to life. My father died in September 2006 of Leukemia. One of the things we did prior to his death was listen to the Saturday afternoon broadcast of the Opera on PBS. That time together means so much to me now. It did not diminish my grief over his death, but it does bring some kind of meaning to part of our relationship.

I will be thinking about and praying for you and your father as he tries to make this extremely difficult decision.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

DBrew99 · New User Joined: 09 Aug 2007 Posts: 2

Hi, Jim, and thank you for your kind words. Your own story is quite remarkable; you must have a lot of courage.

I and my family are prepared to face what we have to face -- but we don't want to overlook anything. Maybe the hope that there is something to overlook is magical thinking on our part --- I know my dad will do what he feels is right.

Be well.

Dan

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