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Brester1

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My grandmother was just diagnosed with stage IV Lung Cancer Squamos Cell, on July 21, 2018.  A little background...she’s 80 years old, smoked for a good 65 years, has COPD as well as other issues, on oxygen 24/7...currently in a nursing home...May 15th 2018 her Pulmonologist saw a mass on her upper right lung that was 2.5 x 2 cm, she didn’t want to have it tested...July 15th she goes to hospital for pain urinating that she’d had before, they did a CT scan for that and found:

 Interval increase in the size of right upper lobe lung mass with surrounding groundglass and interval development of new adjacent pulmonary nodules in the right upper lobe. There is also additional development of pleural-based mass just inferior to the index mass. Overall size is approx 7 x 5 cm of the index mass. There are adjacent pulmonary nodules with the largest 2 measuring 2cm x 2cm and 2.5cm x 3.5 cm. The pleural-based mass measures approx 3.3 x 7.5 x 6.5 cm. There is interval consolidated lung in the right lower lobe with minimal volume loss adjacent to its new small pleural effusion. Tracheobronchial airways are patent.

Don’t really know wat all of this means, she doesn’t want treatment and they recommended no treatment anyways..told her she has maybe 6 months..because she doesn’t want any treatment we didn’t talk with an oncologist at all, received this info from hospital and her Pulmonologist...just really don’t know what to think or do...😩😩😩

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Hi, Brester, and welcome.

I'm sorry to hear about your grandma.  Without a biopsy it's impossible to know for sure, but it sure sounds like lung cancer.  At her age, and with her COPD, not aggressively treating the cancer might be the most reasonable thing to do--conventional cancer treatment can be very hard on even the young and relatively healthy.  I can understand her not wanting to put herself through that.  

One thing to consider, though, is getting palliative care for her.  Palliative care focuses on relieving pain and other symptoms that impact the quality of life.  However long she does have, you don't want her to be in pain.  I'd suggest asking for a referral for a palliative care specialist.  Here's a link about palliative care: https://lungevity.org/for-patients-caregivers/lung-cancer-101/treatment-options/palliative-care.

As she approaches the end of her life, hospice care can help provide additional comfort for her.  Here's a link about hospice: https://lungevity.org/for-patients-caregivers/lung-cancer-101/treatment-options/hospice-care.  The hospital or nursing home should have information about both types of care.

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Thank you for your response, she did have a needle biopsy that confirmed the lung cancer...she’s now on hospice....she coughs up blood, but she’s not really having any “bad” symptoms yet...she’s still taking Oxycodone, but hospice is prepared to give her whatever she needs for pain as it worsens...I guess I figured she’d be in more pain because there’s no treatment...our family is spending more time with her because we don’t know how long she has left...the day after she was told it was cancer, she lost her cousin who she grew up with and she’s taking that worse than her diagnoses...She signed a DNR just yesterday which kinda freaked me out, but I know it’s best for her, she’s only 113lbs and frail and weak...I just don’t want her to suffer and I wonder if she’s being upfront with her pain or not, or if it’ll hit her all of a sudden. The Dr’s notes says “Squamous Cell NSC size(T4), pleural mass, effusion(M1), lymph nodes(N1?) stage IV...

 

 

 

 

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Well, it's the sort of thing that an aggressive plan of attack might be able to beat back.  The question always is, when you have someone quite elderly and whose health is frail to begin with, whether the potential additional time acquired from treatment would be worth it, in terms of treatment-related discomfort and the impact on quality of life.  

I just lost my dad at 88 to non-cancer-related causes, but his health had been declining for some time.  Nothing life-threatening, but he was progressively losing his eyesight, hearing, and sense of balance.  He was unable to enjoy many activities--even TV or reading had become a struggle.  When I visited, about a month before he passed, I learned from his assisted living facility he had never signed paperwork on life-sustaining measures.  They told me that CPR on an elderly person can be very rough and result in broken bones, even if they manage to revive someone.  My dad had seen my mom die over 30 years ago of metastatic breast cancer, and she was on a ventilator for the last three months--he knew he didn't want that.  So he signed the DNR documents, also declining other life-sustaining treatment, and when he died a month later after aspirating in his sleep, all of us (my brother and I, and my stepmom) were glad for his sake that he went so quickly.

It's always hard to lose a beloved family member.  But people often do have a sense of when they feel like they are ready to go.

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Thanks Lexi for your quick responses...I appreciate the info...Hospice talked to us about the DNR, and my grandma finally accepted that it would be best. I read this board constantly and I’m so glad I found it...it’s been a blessing. I guess I’d just like to know more, I read stories where people find out that it has metastasized to different areas of the body and I guess I just want to know how bad it’s getting and when. She doesn’t care to know, I’m her power of attorney and I don’t want to go against what she wants, it’s just hard to deal with...it baffles me that since the diagnosis there doesn’t seem to be that much change, at least not yet...you guys are great here...thank you so much😇😇😇

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Without testing, it's probably impossible to know where the cancer will go next and how quickly it will progress.  I'm not sure whether there's any point in monitoring it if she doesn't want treatment.  Those might be questions for the hospice professionals.  

Lung cancer is very tricky, and it doesn't follow a predictable path.  Every case of lung cancer is a bit different.  A palliative care specialist might know whether it's worthwhile to do testing to plan for any treatments that will make her more comfortable (without compromising her quality of life).  

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Brester1,

Given all the information you’ve provided on your grandmother, if it were me with her symptoms and health complications I’d be in hospice with an executed DNR. 

Your objective now is to ensure she feels no pain. End stage cancer can be very painful so the objective is to administer opioid medication so she experiences no pain. Therefore, she will likely be in and out of sleep. I had a good friend who passed with end stage cancer in hospice. Sometimes during my visit he’d waken and was remarkably lucid. Mostly, he slept peacefully. 

Time now to gather the family around your grandmother and tell her of those wonderful family experiences. 

Stay the course. 

Tom

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Thank you Tom, that’s what we’re doing...I appreciate you guys responding...it truly helps a lot...reading your story is truly inspirational, keep fighting the good fight!!!

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Hi Breste1 and welcome. 

I'm so sorry to hear about your grandmother' illness. I agree with Tom that, given the state of her health generally, the decision to go with hospice and no treatment is a good one. Hospice should be abl e to keep  her pain free. My mother had metastatic breast cancer. She decided at age 86 to discontinue treatment because it was so debilitatating.  She developed a major blood clot and wasn't a candidate for surgery because of her poor health. She went into hospice, and although the doctors said her death from the blood clot would be painful, it didn't seem to be. The hospice nurses kept  her comfortable with opiate medications and she died peacefully.  I had her health care power of attorney and I was completely satisfied with her care. 

I  hope for peace and comfort for your grandma and for you.

Bridget O

 

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Thank you Bridget, I totally agree with you guys and that’s what I’m doing...just left seeing her and she’s lost 5lbs since last Sunday...she doesn’t want to go on too strong of pain medication because she doesn’t want to sleep a lot and miss her family...I’m trying to explain to her that she needs to be comfortable....just staying strong for her....thanks again for your response 

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Hi Brester1,

I am a bit late to the conversation, but after reading the discussion, I can understand your fear and concern.  My grandmother died of lung cancer about 10 years ago, she was in her 80's.  She lived out her remaining days in my parents home, I was living there too.  She too chose not to look into any treatment or even know what kind of lung cancer she had.  She had survived breast and bladder cancer and wasn't interested in going on any further with treatments for lung cancer.  We all struggled with that decision, but it was hers to make.  She had refused hospice in the beginning, but then didn't have much choice toward the end.  (She was an ornery one!). My grandpa was with us too, but had to be moved to a rest home because he started to wander in the middle of the night (and maybe he didn't want to deal with my grandma's orneriness!). 

With having gone through something similar to you, the best advice I can give is to let her do what she needs to do.  If she doesn't want to take opioid meds and is not suffering, let her be. Let her have time with her family.  My grandma refused opioids until her last day.  She was lucid and ornery as ever prior to her death.  And honestly, she may have gone on for a bit longer, but when my grandpa died, she was gone within 24 hours - a great love story.  

I am so very sorry that you are having to deal with all of this.  It's such a stressful and hard time for everyone.  I really do cherish the final few months I had with my grandparents and I hope you have the same experience - lots of laughs and some tears.  

Take Care,

Steff

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Wow, tks Steff... your grandmother sounds like mine....sorry for your loss...she’s doing what she wants....I guess I’m just not understanding her not being in pain...for instance I go see her today and after visiting I speak with the nurse and she hasn’t head any pain medication since 1pm yesterday...she’s not even asking for her normal pain meds....I guess I just need to truly let her be and when she wants it, it’s there...it’s hard though, because I just feel she’s in pain and just doesn’t want to say it...she’s ornery as well....thanks for taking the time to respond and the info...Knowing someone else’s loved one went thru similar experience helps me allow her to make the decision 

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My grandmother had SCLC and tried chemo, but it didn't work.  She never had any pain - and she was as ornery as they come.  When her docs told her there was nothing else they could do, we requested hospice.  We don't know where, if anywhere, the cancer had spread beyond her lungs.  We kept her comfortable and she left peacefully.

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Susan, tks for responding...I have a question if you don’t mind...how long did your grandmother live after being diagnosed?

Barbara

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Barbara, my grandmother lived 13 months from the date of her diagnosis.  She took chemo, but they stopped it because her tumors came back DURING chemo.  She was 83 when she died.

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just wanted to update you on my grandmother....she went to heaven today...3 weeks after diagnosis...she didn’t suffer at all, was very comfortable with hospice...just doesn’t seem real. This board is wonderful and I thank you guys for info and compassion 

Barbara

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Barbara, I am so sorry for your loss.  My prayers are with you today.

Donna G

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I'm so sorry, Barbara.  I'm glad she was comfortable in her final days and that her family had a chance to show her how much they loved her.

Warm thoughts,

Teri

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