It is my privilege to bring to you the next edition of Conquering the Cancer Care Continuum series. This issue, which focuses specifically on hospice options, is one I believe to be vitally important to read. Hopefully, concepts addressed here will be adopted as new and better ways of supporting our terminally ill cancer patients and their families.
HW is a 71-year-old male diagnosed with a recurrence of colorectal cancer in the spring of 2012 with radiographically confirmed metastases bilaterally in his lungs and throughout his liver. Palliative chemotherapy was undertaken at that time with initial response documented by CT scan and serum CEA monitoring. However, within the past 2 months HW has experienced progressively worsening pain (rated 8/10 on a numeric pain scale) in his right side (consistent with progressive liver metastases) and today is severely jaundiced (total bilirubin has increased from 8 mg/dL to 26 mg/dL in the past 2 weeks). The decision is made to transition HW to hospice care.
Linda is a 62-year-old nonsmoker who eats a vegetarian diet and walks 3 miles 3 days a week. Despite her healthy lifestyle, Linda developed a nonproductive cough in May 2012 that kept her up at night. The coughing became progressively worse, so she was evaluated by her primary care provider. A chest x-ray was performed that showed a suspicious right upper lobe mass. A positron emission tomography/computed tomography (PET/CT) test was performed that showed “a hypermetabolic (SUV max 27), 6-cm right upper lobe lung mass consistent with malignancy and abuts the mediastinal pleura.” Metastases to left upper lobe and right adrenal gland were also noted. A biopsy was positive for non–small cell lung carcinoma (NSCLC). Linda was referred to a local medical oncologist for evaluation and staging. She was diagnosed with T3 N2 M1/stage IV metastatic lung cancer.
Each year in the United States, over 1.5 million people are diagnosed with cancer and nearly 600,000 will die of cancer. While cure rates for certain cancers have increased over the decades and survival has lengthened for many incurable cancers, ultimately the vast majority of patients with metastatic disease from most solid tumors and some hematological malignancies will not survive their cancer.
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