Quality of life vs. quantity

October 2, 2007 6:25 PM

My 82 y.o. mother has stage 4 cancer. It's not known if it originated from lung or breast, both of which she was previously treated for. She's currently alert, but very weak, and on continuous oxygen. The decision to be made involves an apparent growth that's pressing her esophagus closed.

She has everything someone in her situation needs: she and my father are in an assisted living facility connected to a nursing home, with hospice care. She's not overly uncomfortable, and all preparations such as DNR orders have been dealt with.

The treatment options available are a feeding tube or a stent, but my parents are inclined to let nature take its course, and my siblings and I are inclined to agree. The feeding tube is out of the question in any event, but I guess I just want to confirm my gut feeling that a stent would likely offer only a chance of prolonged suffering. With quality of life being more important than quantity, might such a procedure be worthwhile? Thanks.

posted by sgass to health & fitness (6 comments total)

Based on quick PubMed-Fu...

A South Korean study of 83 patients concludes that "patency rates of esophageal/GEJ obstruction were 93.5, 78.1 and 67.0% at 30, 90 and 180 days, respectively." In other words, about 1/3 of the stents become occluded again within 6 months.

I can't really comment on your decision, but I just thought I'd throw that tidbit of information out there.
posted by jytsai at 6:45 PM on October 2, 2007

sgass, i'm so sorry to hear this. i was in a similar situation with my grandfather, and we also chose to terminate care because although things -could- be done to prolong his life, he would have had to be sedated just to tolerate them. unlike you, we didn't know his exact wishes, which made it extraordinarily difficult, even though we all knew him so well we were pretty sure we knew what he'd want to do. you are fortunate that your parents have already taken care of this.

no one here can tell you what is best for you and your family, but i suspect that if this procedure will neither save her life nor give her more quality time, it will ultimately give you more comfort to follow your mother's wishes. your family is in agreement, and your mother has given you her blessing. and that's all that matters.

go easy on yourself, and be well.
posted by thinkingwoman at 6:52 PM on October 2, 2007

I'm so sorry - My mother, a bit younger than yours, was diagnosed with terminal cancer last fall so I can truly empathize with the decisions you are having to make. As TW above said, I can't tell you what is best for you or your family but I can tell you that what helped me a great deal when faced with very difficult decisions was knowing what my mother's wishes were. She was not sufficiently coherent to give guidance about specific procedures but we knew that she did not want extreme measures simply to prolong life. For me, this didn't make the decisions easier but I found it very comforting and I tried to make decisions in the spirit of her wishes.

I wish you and your family well and when the time comes, a peaceful passing for your mother.
posted by bluesky43 at 7:42 PM on October 2, 2007

It's always a hard decision and you and your family have my sympathies.

My grandmother passed away last year from stomache cancer and she decided against a feeding tube*. I think that your mother's wishes are paramount.

As you say, it's the quality of life, not the quantity that's important since it sounds like she has had the time to tie her loose ends.

Dying of not being able to eat - not that there was nothing to eat - is a really cruddy way a Cantonese person can go.
posted by porpoise at 9:16 PM on October 2, 2007

This cannot be easy - I'm sorry.

A friend of mine lost her dad to cancer, and he too had something trying to close off his esophagus. They put a stiff plastic tube in so he could breathe(?I think?) -- I'm not sure if this is what they're considering for your mom. My friend has talked to me a few times about how hard it was to see her dad with it in -- he seemed in pain because of it, and he couldn't talk. She really wanted to be able to talk to him and hated seeing him uncomfortable because of it and was really glad when they took it out. Best wishes for this hard time.
posted by salvia at 10:37 PM on October 2, 2007

hi there. whether taken orally or provided through a tube, nutrition will not give your mother any survival advantage, not with metastatic cancer. in your mother's case neither a gastrostomy tube nor an oesophageal stent will significantly lengthen her life. therefore the only consideration is quality. does your mother still derive pleasure from eating? i imagine your mother has experienced abnormalities of taste and has an already frustrated interest in food. has she mentioned? does your mother have an appetite or maintain an interest in eating? if so it may be kind to advise her that an oesophageal stent could be a worthwhile thing. hope this helps you. these are never easy decisions. cheers.
posted by de at 10:25 AM on October 3, 2007