Palliative Radiation and Chemotherapy for Non-curable Cancer

August 19, 2018 8:22 AM

My father was recently diagnosed with bile duct cancer (Cholangiocarcinoma), and he is concerned that the recommended radiation and chemo treatments will extend life (average life expectancy at this point is about a year) at the expense of quality of life. What are people's positive and negative experiences with these types of treatment?

This type of cancer is rapidly lethal and prognoses are bad, especially for ill, elderly patients. He is not a candidate for surgical resection (due to cirrhosis and other problems) and thus there will be no cure. I absolutely understand his concerns and will support him whether or not he chooses treatment.

How much are the side effects likely to decrease quality of life? How much can the treatments do to ease pain as things progress? What will progression look like in either case?

Thank you

posted by mkuhnell to Health & Fitness (9 answers total)

My father had that too. I'm sorry.

So much of what you're asking varies case to case. I think my dad found that doctors really were happy and able to answer the questions you're asking if you asked and made it clear you wanted honesty. So please ask, get your dad to ask, they know best.

My dad chose a few months of limited treatment to extend life/quality of life.
posted by sidek at 8:48 AM on August 19, 2018 [4 favorites]

I’m so sorry.

My mom had this, but was not a candiate for chemo. She had one round of radiation with minor side effects. She went on to live a fairly happy four years beyond the year the doctors expected, passing just last week at 87.

It may be that the radiation was why the tumor stopped growing, I don’t know. I wish you and your family all the comfort I can.
posted by carterk at 8:52 AM on August 19, 2018 [2 favorites]

Best answer: This is a perfect question for a palliative care specialist. You can ask for a referral/ consultation with one if that hasn't already happened. Their job is basically to answer all the questions you asked above and help collaboratively make a plan with the patient and family. They could answer better than we can because they'll have access to his medical record and understand the implications and nuances of his particular case, including his own personal wishes. And studies have shown that getting palliative care involved early not only improves quality of life, but can extend life as well (I don't have the links at my fingertips but I think this has been studied at least in a population with breast cancer and one with non small cell lung cancer, but I wouldn't be surprised if there were more.)

Good luck, and sorry to hear this, it is a terrible disease. I hope he is able to find as much comfort and peace as possible on this journey.
posted by robotdevil at 9:01 AM on August 19, 2018 [7 favorites]

So as not to abuse the edit window, actually, here is one link to an article discussing what I described above.
posted by robotdevil at 9:03 AM on August 19, 2018 [1 favorite]

I don’t know your father’s age or other details, but cholangiocarcinoma is curable in some cases by liver transplantation. It tends to be locally aggressive but not metastasize early or often. For cholangiocarcinoma which is hilar or involves the intahepatic ducts, this is well-established. The presence of cirrhosis is not a contraindication but, indeed, is an additional indication for transplant. In this setting, you need to be careful that an intrahepatic tumor is indeed cholangiocarcinoma and not heptocellular carcinoma which, in some cases, can have cholangiolar features microscopically.
posted by sudogeek at 1:37 PM on August 19, 2018

Response by poster: He is about 70 and not in great health generally. They say that surgery is definitely not an option.
posted by mkuhnell at 1:52 PM on August 19, 2018

Best answer: Definately ask your team because every case varies. However, Studies show that physicians generally take less agressive options for themselves (personally ) and chose less invasive procedures in these types of situations as a whole. They also get DNR/DNI paperwork earlier than the general population.

Of course, he won't know exactly what side effects he will have until he tries it's really sort of a gamble. Some people tolerate things much better than others.

Of course, even if he choses radiation or chemo he can stop at any point. He's not obligated to continue those treatments especially if something unexpected happens or side effects are worse than predicted.
posted by AlexiaSky at 2:22 PM on August 19, 2018

Best answer: OK, if he’s not a transplant candidate ( and age of 70 with good heart and lungs would be acceptable, but borderline), I would also recommend palliative care. The data on chemotherapy suggest there is little benefit, imo. Experimental therapy with so-called ‘checkpoint inhibitors’ may be limited due to poor medical condition, but these do show real promise; however, the data is limited. Radiation, imo again, is useless, except for brachytherapy for malignant bile duct strictures.
posted by sudogeek at 2:30 PM on August 19, 2018

Response by poster: Thanks to you all for your support and input
posted by mkuhnell at 12:41 PM on August 20, 2018