Chemotherapy or not

[MVin]

My dad (68 years old, 41 kg weight) has been diagnosed with Metastatic Adenocarcinoma of the lung (stage 4) as per the biopsy. The PET CT shows that it has spread to the liver, bone and lymph nodes. The oncologist here has suggested that we start chemotherapy (Pemetrexed + Carboplatin) right away. Once every 3 weeks - 6 cycles to start off with. We are extremely worried about quality of life, and unsure what to do.

Dad has breathlessness, cough and pain. The palliative care expert has put him on Morphine and other medicines to keep him comfortable.

I would be extremely grateful if you could tell us what you think we should do please. Our goal, is to keep him comfortable and have a decent quality of life. But when the oncologist tells you that its 4-5 months without chemotherapy and 7-9 months with chemotherapy; one is completely thrown off! 

One week has changed our lives forever. Shattered :(

[LexieCat]

Hi, MVin, and welcome.  I'm sorry to hear about your dad's diagnosis--this stuff is always upsetting for everyone involved.

First of all, doctors cannot predict how long someone will live--nor can they make more than a well-educated guess, most of the time, as to how any particular person will respond to treatment.  We have some long-term Stage IV survivors here.  Have they tested the tumor for genetic markers to see whether targeted therapy might be effective?  Some people also have done well on immunotherapy (with or without chemo) and/or radiation.  If your dad isn't being treated at a major cancer center, a second opinion from a place like that might be worthwhile.  

Does your dad have other health problems?  Sixty-eight isn't that old--many people that age are able to tolerate treatment.  (I'm 62, and 68 is looking younger to me every day!)

There are times when it really does make sense to forego treatment.  But if he has JUST been diagnosed, there might not be enough information yet to make a truly informed decision about it.  And you haven't mentioned how your dad feels about the situation.  The cancer might not be curable, but maybe it's treatable in a way that would give him significantly more time with good quality of life.  

[suecris]

Hi MVin - just a question. As an American, I had to plug in your Dad's 41 kg into a conversion app, and it comes to 90 pounds. Has your Dad lost a lot of weight recently, or is this normal for him? Is he able to eat enough?

[bacchus]

Yeah I would ask about testing the cancer for genetic markers that allow targeted or immunotherapies.  Also, ask if radiation is appropriate.  Just my opinion here but if your dad is newly diagnosed and hasn't had any treatments you have to try something.  You just never know how well they might respond.

[Robert Macaulay]

Looks like the are intending to use a full dose. Chemo reacts very different in every individual and they will know this in the first fifteen minutes of starting the infusion. Also they would not start chemo is if blood tests were a problem. Side effects if they are serious you will then have to make a decision and the doctors will respect your choice.

Bob

[Tom Galli]

MVin,

Welcome here.

In answering your question of what to do, I am thinking about your dad's weight 41 kg (90 lb), distant metastasis in the liver and bones, and pain requiring morphine likely attributed to bone involvement.  Keep in mind, this is not a lot of information to suggest an answer.  His very low body weight is of concern; does he have complicating medical conditions besides lung cancer? 

I'm thinking your dad's oncologist is trying to arrest further spreading of cancer with Pemetrexed and Carboplatin and perhaps shrink tumors, particularly in the bone to reduce pain.  Can this approach alone resolve his cancer? Not likely I'm thinking.  However, you mentioned adenocarcinoma diagnosed by biopsy.  If the biopsy is being tested for targeted therapy biomarkers, and if certain biomarkers are present, then a whole new approach opens to treatment.  Do you know if his biopsy sample is being tested for targeted therapy treatment?

His oncologist projection of 4 to 5 months without and 7 to 9 months with is telling.  I once had a less than 6 month projection of remaining life and my lung cancer and surgical mayhem deserved such a projection.  But, these are projections and in my case, I've lived nearly 15 years after receiving my 6 month projection.  All in, I'm thinking your goal statement of making your dad comfortable and creating opportunity for good quality of life for whatever remaining period is a good one.  If targeted therapy is not warranted, then you should pay close attention to how he handles the Pemetrexed and Carboplatin.  If well tolerated and if it is having an effect, I'd continue it.  Obviously, I'd continue his concurrent palliative treatment.  If the chemo is not having an effect and mindful of your goal, I'd consider hospice care.

Please bear in mind that I am not a doctor and you've not revealed a lot of information about your dad's state of health.  But I believe the purpose of this forum is to answer the hard questions and your's resolves to three future state outcomes: does Pemetrexed and Carboplatin have an effect; is the chemotherapy well tolerated ; and is targeted therapy available.  Answers to these will guide you in deciding on continuing treatment.

More questions?  This is the place.

Stay the course.

Tom

 

[BridgetO]

Hello MVin and welcome. 

I'm sorry to hear about your dad's diagnosis. Those who responded to you above have given some excellent suggestions. Here's a quick summary of some things are important:

1. Testing for biomarkers to see if he's a candidate for targeted therapy or immunotherapy. 

2. Being sure he's getting enough to eat.

3. Is your dad's goal the same as yours?

4. Predicting life expetancy is not an exact science. Many live much longer than predicted and have good quality of life.

All that being said, I think that how your dad tolerates the chemo (or any other treatment) . is crucial. I don't think you'll necessarily know during the actual infusion. Side effects occur days  later and can get worse over time. My mom had stage 4 breast can and had  radiation to bone mets, which helped a lot with her pain. She also had long term chemo, which did keep her cancer in check, but the side effect of neuropathy gradually got worse and when it became intorlerable to her, she chose to discontinue treatment. Some people do fine with long term treatment, though, so if your father choses to have chemo, it's a matter of how he feels from it and whether it's working.

Best wishes to you both,

Bridget O