Palliative Care- is chemo a necessary evil?

Bob's oesophagectomy was abandoned after two carcinogenic tumours were found in each lobe of his liver. The Consultant has told us that radiotherapy isn't appropriate and they may have a problem with which chemo regimen to offer as Bob developed saddle PEs and neutropenia after ECF and the adenocarcinoma is aggressive. We will have to wait for 3/4 weeks anyway before chemo can start as Bob has to recover from this recent surgery. Palliative care for the remaining months - quality not quantity- seems to be Bob's only option.

We trust the judgement of Mr Beardsmore and his superb MDT but are unsure what the palliative options include. We have decided to plan for the quality but even this is a little limited by the jejunostomy feeding and Bob's fatigue.

All advice and experience welcome.

2 Replies

  • I am sorry to hear about Bob's operation; this sometimes happens and although it sounds dramatic to abandon the surgery, it is often the best thing for the patient's best interests.

    The reactions to chemotherapy vary enormously. Some people have a dreadful time; for others there is a positive improvement, and there does not seem to be any reasonable way of predicting how any one patient will tolerate it. But it is not compulsory to have to go through it because all medical treatment is based on the patient's consent. Even in the best of circumstances chemotherapy can tend to feel like the patient is being all but killed in order to destroy the cells that are causing the trouble.

    I think in your position I would agree that quality of life, reasonable comfort and certainly freedom from pain are the priorities, rather than length of life as such. You might ask how much of any treatment will require visits to, or stays in the hospital, for instance. You might ask about local hospice care, not least because they tend to be the best at controlling pain.

    It is a lot to get your heads around isn't it. But it sounds like you have made a good start by talking things through. You have to make the most of what time you will have together. That is probably true for life generally but we tend to take things for granted unless you are faced with the situation that you and Bob are looking at. So there may be counsellors in the local cancer centre / Maggie's Centre that can help you through the difficult bits. You will also find unexpected reserves of strength that you never knew you had; and hopefully friends from unexpected places.

  • A situation we all dread and I'm sorry you are both now facing all these difficult decisions.

    As always Alan has got it right, quality is usually the best option.

    What else can I offer except to say it is worth exploring services which vary in each locality,

    some being run on a voluntary basis. macmillan, day centres specifically for cancer patients, hospices all are there to offer you help and advice to make life easier.

    Support will come from some unexpected places to help you through this quite often from the voluntary sector.

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