Dad (93) was recently diagnosed with Stage 4a adenocarcinoma of the Lung. Chemo/Radiation suggested. How do we make this decision?

OP you have not come back to comment on what Dad wants.

Although at 93 I would question chemo and radiation, I am not a doctor, nor do I have any first hand experience with cancer.

I do know my Dad at 92 who has had many different skin cancers over the years continues to have them either removed or treated with a chemo cream.

My Uncle has cancer, he is 84 and decided to take treatment. Other than the cancer he is fitter than more 50 year olds. He had a scare in December and had to have emergency surgery, but is still kicking. He just sold his Harley, but still has his hot rod.

My Mum is 87 and I know she would refuse any treatment if she was given a cancer diagnosis. She still has most her marbles and lives completely independently.

My late grandmother in law, had a hysterectomy when she was 93, I do not know if she had any additional treatment.

I have a couple friends who had chemo and radiation and said if they got cancer again they would refuse treatment. It truly is an individual choice.

I’m sorry you’re going through this. We just brought my 86 year old mom home from the hospital after she learned she has a major bowel blockage. I’m grateful she was clear headed that day to make the decision on her own that she did not want the risky surgery so she chose to come home on hospice surrounded by her loved ones to care for her. If your dad is able to make the decision to go for it or not but if the decision falls to the family or health care proxy, I feel your concerns are definitely valid. At 93, that’s a big undertaking. My very athletic strong 54 year old sister had adenocarcinoma pancreatic cancer and chemo & radiation was brutal for her. Unfortunately, she didn’t make it. My 59 yr old dad also had cancer years ago & chemo was rough on him too. He didn’t make it either. I hope you can all come to a decision that you’re comfortable with. If he decides not to do it, hospice is a great alternative. I wish you strength

I am so sorry this is a hard decision for you and your family.

I'm sad that you haven't had the opportunity to discuss with your father what he would do in situations like this as he aged and health crises were going to arrise.

I am sorry you don't have a physician who understands health care must consider quality of life.

Given all of these hard-but-important components to aging care, it strikes me that your father may not have written a Living Will and established Powers of Attorney for his medical and financial needs which does clarify exactly these things. I realize this is already a hars time, but these document need to be thought through and completed right away.
The doctor is simply offering options. It is the patient who needs to be prepared for how they plan to live out their life. Perhaps the process of looking honestly at end of life care, your father and your family can get clarity on what steps to pursue.

My mother in law was diagnosed with lung, liver, brain and bladder cancer. She was 77 years old. Her doctor said he would not put her through chemotherapy because of her age. She did go through a new treatment called immunotherapy. It was supposed to help her body fight the progression of the cancer. It caused her to lose her appetite were she did not want to eat for days. She decided to stop that treatment and her appetite returned. Unfortunately she passed away months later from the brain cancer. Have you considered a second opinion with another oncologist? It would probably help to talk to them to get their opinion and the full side effects. I hope this helps, you are in a difficult place and maybe getting more information will help you decide.

THIS REALLY SHOULD BE AN EASY ANSWER. DAD IS ALREADY 93 YO.
WHY SUBJECT HIM TO ALL OF THE NEGATIVE SIDE EFFECTS OF CHEMO/RADIATION...WHICH IMHO AS A RETIRED NURSE AND A CAREGIVER...COULD VERY WELL SEND HIM OVER THE EDGE AND SHORTEN HIS REMAINING DAYS INSTEAD OF GIVING HIM AN EXTRA 6 MONTHS OR SO. THE CHEMO/RADIATION WILL NOT GIVE HIM A GOOD QUALITY OF LIFE. I SAY LEAVE HIM ALONE AND LET HIM ENJOY THE TIME HE HAS LEFT WITHOUT PADDING THE DOCTOR BILL AND THE HOSPITAL BILL. JUST MAKE SURE THAT HE HAS PAIN MEDICATION AVAILABLE FOR WHEN HE MIGHT NEED IT.
FYI...HAVE YOU AND HIS WIFE CONSIDERED GETTING HOSPICE IN FOR HIM WHEN THE TIME COMES?
IF HE IS A MAN OF FAITH, HAVE YOU ALL TALKED TO HIS PASTOR AS A SOURCE OF END OF LIFE PREPARATIONS? VERY IMPORTANT TO DO.

Don't make him suffer. There's no way that all of that suffering is going to keep him alive for much longer. My grandpa died at age 96, and he didn't even have cancer or any huge medical problems. I say skip the cancer treatment and let the old man live out his life the way he wants. Of course, if he wants to have it done, then so be it. I just don't see much of a point, since I've been told many times that chemo/radiation hurts like a mother f, and that's coming from a man that didn't cry when he shattered his elbow into pieces on the sidewalk. He was 32 and he said it was the WORST pain and agony he's ever been in. It's really up to you and him, but I wanted to throw in my 2 cents.

The doctors have to give you all the facts of what can be done and leave it up to the patient or Health Care POA to make the decision. Of which I as my husbands POA, have had to do 5 times for different episodes in the last two months of hospitalization with his Alzheimers at stage 6 of 7 stages. I knew what his wishes have always been, including in legal form for the doctors, but the doctors still had to present the options to me. Has it been sad for me, yes it has been very sad, but I could not allow him to be put through more, without going into detail. He is 87 years old, has had 5 major cancer operations in the last 15 years and two 21 day treatments of radiation. Now Alzheimers and 5 additional things. I want him to live out the last of his life in peace with no further discomfort/pain/probing. But I know the doctors were only doing their job and I appreciated that. I know in my heart and mind it was all because I love him so much and have for our 60 plus years of marriage. I wish you the best. Remember the doctors are giving you facts. What is best for him and if you were his age what would you want.

Imho, perhaps a second opinion physician is required.

The age of 93 is just the last straw! My mother was faced with the same decision at 78, and turned down another round of chemo etc being pushed by the oncologist. Chemo did not treat her well 10 years before when the cancer first appeared, even though it gave her 10 more years. Being pressed, the oncologist admitted that this time it would add at at most 6 months, even if it was ‘successful’. I overheard the oncologist and my mother’s physician arguing about it in the hospital corridor.

I don’t know if the oncologist was solely motivated by greed, or whether it was that she couldn’t accept not ‘rising to the challenge’ - ie that all her skills couldn’t help much at all, and she couldn’t defeat death. Whichever was the reason, it was appalling. It stressed my mother, me and my sisters, and everyone else involved. Supported by a very competent GP, we got her out of hospital. She died 4 weeks later at home, with me beside her. It was what she wanted.

Let your father pass in peace.

I say go with the drs advice: if things get bad, stop. Many times the chemo and/or radiation can shrink growths and actually make it better for the patient.

I had a relative who refused all treatments because people told him horror stories about how sick someone got - even though it was many years and many old protocols before. There are meds to help with nausea and other side effects these days. In the end my relative had to have some radiation just to shrink a tumor causing unbearable pain.

Try it/stop it if need be.

Really? At 93 yrs old, why is that even a consideration? The heck, with them. Your dad, doesn't seem to have a long time to live. Why, torture him, with any type of treatment, other than to make him comfortable. There, is a time, when we should let life, take care of itself. The treatment the Oncologist wants to put him on, is not going to make him better! Nothing, can. Please, don't put him through treatment because, it's recommended. It's just a shame, to be guilted into, unnecessary and undue, suffering. God bless. Also, chemo killed my mom, after 1 treatment. It could kill your father too. Chemo, is hard on one's body.

Really? At 93 yrs old, why is that even a consideration? The heck, with them. Your dad, doesn't seem to have a long time to live. Why, torture him, with any type of treatment, other than to make him comfortable. There, is a time, when we should let life, take care of itself. The treatment the Oncologist wants to put him on, is not going to make him better! Nothing, can. Please, don't put him through treatment because, it's recommended. It's just a shame, to be guilted into, unnecessary and undue, suffering. God bless.

Really? At 93 yrs old, why is that even a consideration? The heck, with them. Your dad, doesn't seem to have a long time to live. Why, torture him, with any type of treatment, other than to make him comfortable. There, is a time, when we should let life, take care of itself. The treatment the Oncologist wants to put him on, is not going to make him better! Nothing, can. Please, don't put him through treatment because, it's recommended. It's just a shame, to be guilted into, unnecessary and undue, suffering. God bless.

I would also highly recommend seeking another opinion, someone totally unrelated to this current doctor. I would bring any test results and imaging and a LONG list of questions that need answers. Your dad deserves ALL the information and answers he can get. It sounds like he is of sound mind, so really this is his decision, but he needs to make that an INFORMED decision.

We haven't seen the test results (presumably the doc has shown them to you both.) Even if we were the doctors, tests can only show so much. A lookup of this type of cancer shows that stage IV is the worst, and in general there is no cure:

"In stage IV lung cancer, chemotherapy is typically the main treatment. In stage IV patients, radiation is used only for palliation of symptoms. The chemotherapy treatment plan for lung cancer often consists of a combination of drugs."

https://www.lungcancer.org

The big concern with this stage is whether or not it has metastasized, which is common. If they don't know, they can't really predict how well treatment will work. If they do know, they most likely would also know how badly this will affect someone your dad's age. His age and other medical issues are also a concern.

I would likely come up with many more questions if I'd been faced with this, but for starters:

1) Radiation, chemo or both?
2) How long will these treatments go on?
3) What can one expect during treatment (side effects)?
4) If he stops treatment, how long before side effects go away, if they do?
5) What is longevity with AND without treatment?
6) What can one expect without treatment?
7) What other options are there for maintaining relative health w/out tx?

Your dad has other issues, not to mention his age. I would want him to know everything they could possibly tell us before saying okay dad, it's your choice.

Not that it's the same, but my oldest kitty had some kind of lung tumors. She'd been going slowly down the kidney disease path (crossed the boundary at age 15), developed hyperthyroid which was treated with medication only, but she kept losing weight, so about age 17 I said enough and had the RadioIodine treatment done (vet scared me off this with the CKD and heart murmur.) She never really gained much back (lost about 5#), but was holding her own. At age 18 we found lung spots, down low in the lungs, in a Xray. I did take her to a specialty vet place, to see if there was something we could help her with. Wasted time and money - they repeated ALL the tests we had done, which they were given, and said they would need biopsy to decide what drugs could be used. That meant surgery. If I felt she would do okay with surgery, I would have had MY vet do a lobectomy and skip that waste of time and money! Of course, had we done that, the type could have been determine from the tumors in the removed section. Given her age (roughly 90 in people years!), weight loss and CKD, I opted to just wing it. No more vet visits or vaccinations (car ride was always hard on her - puked every time!), eat drink and be merry kitty, and sleep as cats do. She didn't suffer. We had a short bout of what I figure was kitty dementia (maybe it spread to her brain, who knows?) Eventually she forgot what the litter box was for, but stayed in the big kitchen, so it was just tread lightly and watch for wet spots! She was eating better than any of the other cats, until near the end. She didn't quite make it to age 22 (about 21y 8m or so - with us since spring 1999! Age est 102+) Very few coughs and passed peacefully on her own. :-(

My point is she survived at least 2 years with some type of lung tumors, which presumably spread. It wasn't the CKD that took her, that was certain.

I've been going through the same question with my brother (65) with a very rapidly advancing grade IV glioblastoma. He got worse after surgery. Radiation and chemo have been delayed by an infection, and then Covid, and he's too far out from surgery for it to be of help--6 weeks is optimum and he would be looking at 10 weeks when he started. He's out of isolation now. I and my niece have opted for hospice. He has little cognitive skills and often turns down meds in skilled nursing where he is now. If he's not taking basic meds, how is he going to take chemo in the form of a pill. I contacted both oncologists yesterday; I was still offered the chemo pill but have decided against it. I just want him to be comfortable and able to be awake enough to have visitors.

I would suggest consulting with a palliative care doctor who could give you a better idea. They specialize in comfort in treatment. Seek as second opinion too.

I'm also reading "Farewell: Vital End-of-Life Questions with Candid Answers" by Edward T. Creagan who was the first palliative care physician at Mayo Clinic. This is a must read for anyone dealing with this question. More than once he explains that often patients accept treatment that was offered with more optimism than was warranted and the patient suffered much to the family's regret. It really helped me firm up my decision. There may be a lung cancer support charity that helps patients and families with these decisions. I found one for brain tumors; they even went over my brother's medical records and gave me more forthright information than the oncologist was willing to do. What is your goal? Comfort or longevity. Studies show that people who go to hospice early, rather than a death's door, have a longer and more comfortable life because they aren't subjecting their body to extreme treatment. Longeveity of 2 months while feeling like hell isn't worth it. Good luck.

I know I blow everyone’s mind when I speak of my 95 yr old mother and all her co-morbidities. She’s been on hospice for 2 yrs (since the age of 93 yrs old) for end stage chf. A year ago she was diagnosed with inflammatory breast cancer which is metasisizing now and fungating profusely. She’s had invasive squamous cell carcinoma for many years and has had numerous surgeries (over 30 Mohs surgeries) to remove tumors from all over her body (mostly head and neck areas) just in the last 8 yrs as this cancer has ramped up. And her pace maker was put in 12 yrs ago and is probably not really operating any more. She declined getting a new pm. She has decided not to treat with chemo or any other form of harsh treatment from early on on her skin cancer or breast cancer. She is still managing in her own home and her quality of life is not that bad considering. Hospice helps out a lot and of course I have to do my part. I think she has it in mind that she will continue like this until the clock runs out. So far, she denies any pain, and when that happens I suspect she will become more bed-ridden because she will need strong pain meds. When that happens, I cannot care for her and she knows she may have to go to our beautiful Hospice Facility. This is her call.

I've been through chemo for my nhl and I don’t think my mother could handle it. But I never influenced her in any way. I never told her about my cancer as we lost my sister to brain cancer and I didn’t have the heart to tell her about my illness.

I feel my mother made the right decision. She is still of sound mind.

Please get a second opinion. If there is a hospital that specializes in cancer, please see them. Even with treatment, multiple myeloma has a high rate of reoccurrence.

At 93, you can always ask about palliative care. It does not lengthen his life, but it seeks to keep him as comfortable and "able" as possible. If he is given 6 months or less to live if his cancer isn't treated, then ask for a hospice consult. You may have to talk to his primary care doctor about getting these orders if his oncologist is not willing to cooperate.

Personally, I would consider three things:
First and foremost is, after being presented with the facts, what would I/the patient like to do. I’m a realist and take a pragmatic approach to everything I do.
Second, the facts - prognosis (life expectancy) with or without treatment.
Third, Quality of Life during and after treatment. Mind you, the will to live is on a broad spectrum from ‘at all cost’ to ‘pick up my toys and go home’. I’ve lost 4 people very close to me in recent years; 1 had no choice the others made it clear to me long before what there wishes were. They all drew a line in the sand where treatment would be stopped and they stayed true to their word when the time came.

I spent years in Oncology field and now am a patient advocate. Only to add to this feed is be sure to have those discussions before the age of 93 with loved ones. Have them with the whole family at any time prior to these events so everyone is clear on next steps.

AlvaDeer totally nailed it. Chemo would probably give your dad 3 or 4 more months, but he'd be a lot sicker the whole time. And if your Dad can make his own decisions, what does HE want?

My husband had lung cancer and declined chemo as he saw no point in living longer when he'd be sick all the time anyway. Without chemo he was able to function with some normalcy for most of his remaining months.

I was sad not to have had my husband around longer, but he was the one who would have had to endure the effects of chemo. Of course the oncologist urges trying it,; that's his business. Unless your father wants the chemo, it's a "No!"

The problem with “if it’s too much for him we can stop” is it ignores damage the chemo might do. My dad got nerve damage from his first dose of chemo (a lung cancer chemo in 2003) which prevented him from swallowing properly. His inability to swallow meant no liquids and made his last days extra miserable.
I am sorry you and your dad are facing this.

what does your dad want? unless he is incapable of making his own decisions, ask how long he will have "without" the treatment. In todays world they have stuff to give people for the sickness related to the chemo........but you can still ask what other side effects he would have IF he took the treatment. However if your father can make his own decision, let him make it. Unfortunately there still are some doctors that push for treatments knowing full well that even if they do the treatment it won't help.........so make sure you ask that question also. If he takes the treatment what are the percentages that he will beat the cancer. if the chances are slim, then why bother, but again that is a decision he has to make. wishing you luck and the family as well.

Obviously a personal opinion here but there is one persons opinion that matters the most.
Simple question for you (maybe not so simple though)
WHAT DOES YOUR DAD WANT TO DO?
What quality of life will he have given the effects of treatment....
(By the time side effects reach the point of getting too bad it might be too late for any quality of life)
I would contact Hospice. Have him evaluated. Discuss with Hospice what they will do for him. They will offer not just supplies and equipment but education as well as medical, emotional and spiritual support.
In general doctors do not want to "give up" as they see that as a failure but there is also a side of me that looks as many treatments as a "cash cow" to some degree. I think doctors in general are not taught in Med School how much of an advantage and how beneficial Hospice can be.

As a survivor of a stage four cancer and having received both radiation and chemo I think it might be better that any treatment should be for palliative care at his age. Contact Hospice, they can guide you better than this oncologist. God bless you on this difficult journey.

It's mostly his decision. It sounds like he has a backup plan if things are not tolerable. But you should discuss having aides and people coming in to help, as needed, with cleaning, laundry, shopping, cooking them meals, etc. if they don't already have this. He may feel tired and weak with his treatments. Is your stepmom able to do all of these things for both of them?

I’m very sorry you’re having to deal with this decision for your dad. It’s easy for others to judge, but it’s no one else’s business. My dad took 3 of the 5 scheduled treatments for stage 4 malignant melanoma at age 90. He did targeted therapy (Keytruda). It works great, but causes massive inflammation. Dad also had rheumatoid arthritis, so he was crawling out of his own skin in pain. He became weak and felt so much pain he could barely lift his arms or get out of bed. Dad said he couldn’t take any more of it- he’d rather die. So I asked his oncologist to tell him he’d whipped the cancer and didn’t need more treatments. He understood our situation and did that. We discontinued treatments & talked to hospice. He began a super low dose of morphine each day which allowed him to be pain free and alert. He lived for another year and was comfortable and able to enjoy himself with family. Dosages varied as the cancer progressed, but when adjusted correctly, it doesn’t “zombie” one out; instead, it simply provides immediate pain relief! God bless you and your family. We will all die at some point, question is: how did we live?

Your father's situation is the perfect example for the need of a "second opinion." Assuming he is competent, he should be able (and allowed) to make his own decision on life sustaining measures that will likely achieve little extension of life versus the side effects of treatments and physical requirement to endure it. The doctor should present longevity expectations if treatment successful compared to none with palliative care. There is also the issue of his daily care by an already ill spouse. Have a talk with your father to get his opinion and wishes then get the second opinion.

Most oncologists and radiologists have plenty of patients and an already overbooked schedule.

if your dad is mentally competent, this choice should be left purely to him, and you should support his decision.

This is a complicated medical issue that has lots of variables. Surely they are considering his age, mental status, overall comfort and potential outcomes in recommending treatment.

If you think their medical advice is not appropriate, seek another opinion from a qualified medical provider, not advice from strangers in a chat room.

Why would you put anyone this age through chemo and radiation?

My Mom was 92 when she was diagnosed with vulvar cancer. Following successful surgery the oncologist recommended radiation, 5 days a week for 6 weeks. I left the decision up to her, she has a good mind and completely understood the situation. She decided against and I agreed.
She celebrated her 100th Birthday at the end of December, is doing well and is still home with me.