How reasonable is it to delay investigating cancer diagnosis?

May 2, 2024 4:01 AM

Waiting two weeks for a dying patient to improve before getting a closer look at their probable cancer seems risky. What has happened in your experiences with cancer diagnosis?

My mom, whose health has been in decline for years and who spent several long stints in the hospital last year for different reasons, went back into the hospital last week and a few days later received a probable diagnosis of lung and liver cancer. Probable because she was deemed not strong enough yet for a PET scan or a biopsy procedure. Nor would she be able to handle chemo or radiation well in her condition, the oncologist said. So far they have been going by whatever markers the CT scans have picked up, in addition to the symptoms she presented with.

The plan has been to "get her strength up," they say, by letting her rest at home for two weeks before coming back to try the PET scan, so apparently they willl discharge her at some point today and then... wait, I guess. This strikes me as kind of running down the clock at a time when I'd think moving quickly would be important. Are they saying they have the time because she's got a fighting chance, or are they saying they have the time because it can't get much worse? How should I read the tea leaves here?

posted by emelenjr to Health & Fitness (8 answers total)

Having a diagnosis isn't particularly helpful except in leading to treatment. If she's not strong enough to handle the treatment that would be prescribed, having a definitive diagnosis isn't valuable on its own. If her health improves enough to make treatment possible, there will be time for a biopsy/scan, but while her current condition is acute, that's the priority, not the next thing down the road (no matter how daunting that next thing may seem).
posted by rikschell at 4:46 AM on May 2 [29 favorites]

Agree with rikschell; also, I am sorry you're getting this hard news. Enjoy the time with her, visiting and relaxing.
posted by wenestvedt at 4:50 AM on May 2 [5 favorites]

I would take their comments on the biopsy at face value, personally — ie I would trust that they are slowing the roll here because they think rushing will not benefit her overall. My dad, who had both COPD and lung cancer, pushed for a biopsy on the strength of concern from his siblings, who imagined the cancer was likely to be more treatable if dealt with early. At the time we were all really confused about why nobody was in a hurry. But the biopsy kicked off a more rapid decline than I think he would have faced otherwise, because it turns out that the cancer wasn’t his biggest problem — his COPD was — and he never really regained the lung function he lost from that surgery. Presumably, the doctor who declined to do the biopsy himself saw that coming when we did not. It can be hard to get physicians to be explicit about what your comorbidities mean for your course of treatment, but your description of your mom’s last few years makes me think this might be relevant. I’m sorry.
posted by eirias at 4:50 AM on May 2 [12 favorites]

For what it's worth: no doubt important details are different, but it does remind me of my mom's case: age, plus other health issues, meant an oncologist recommended against biopsies to diagnose her probable cancer(s). She would have needed multiple hospital visits and invasive procedures, only to reach a diagnosis which would not be terribly useful since none of the available treatments would be mild enough for her.

Since her oncologist is recommending waiting, not taking further investigation off the table entirely, I assume your mom's case is different. But, still, it might be worth asking whether it's worth continuing this way, or whether your mom would be better off at this point with a focus on quality of life?

My mom went into hospice care. A year later, after some rocky months, she's actually feeling much better, and happy with the decision not to spend more time in hospitals.

I get the impression doctors are sometimes reluctant to be really frank about this, if they're short on time or don't sense that you're ready. In our case, we had a separate appointment with the rest of us (mom was too sick at the time), where the oncologist walked us patiently through her issues and explained the situation, and it was sad but also a relief to have that discussion.
posted by bfields at 6:33 AM on May 2 [9 favorites]

I'm sorry you're going through this. The tea leaves, unfortunately, say there's very little they can do because she's not well enough for even diagnosis, much less treatment. They believe that doing anything will kill her faster than the cancer (or whatever condition looks enough like cancer to assume it's cancer). It does not sound like chemo and radiation might be an option in two weeks, either; at best you will get a confirmed diagnosis and be told again there's little to nothing they can do.

There is I guess some possibility that going home to rest might well give her enough of a rally for the PET scan. But in your shoes I would operate from the assumption that in two weeks you will be transitioning to hospice care and she will be in measurably worse condition than she is today.

There are immunotherapies that in some cases are way less brutal, but I suspect they would fall under palliative care: treatment, but only good enough to buy a bit of quality-ish time. It'll also leave her even more vulnerable to bacteria and viruses.

I agree that doctors are reluctant to be frank about this. I think you should present them with the various scenarios and ask what happens next IF: 1) go home for 2 weeks and she's still too unwell for the PET 2) 2 weeks, PET is successful and dx is some kind of probably metastatic cancer 3) go home, stay home.
posted by Lyn Never at 6:47 AM on May 2 [3 favorites]

Yes, it sounds like they think the likely dx would ordinarily be addressed by treatment she either is too ill to even be offered or that would obliterate her remaining quality of life if she did try it. They're hedging their bets by giving her some time, but you should be prepared. I'm sorry.
posted by praemunire at 7:26 AM on May 2 [2 favorites]

Agree with what's been said above. In addition, not all cancers are fast moving, so delaying in order to diagnose or begin treatment likely will not likely have much effect on the outcome.
I speak as a patient currently in the middle of chemo for stage III rectal cancer. When I first got diagnosed I was all about "lets get this done yesterday!" only to realize that certain steps require healing, and that the planned treatment was designed over a long period of time for various reasons that make sense but still suck.
I hope things work out for your mom. It's okay to ask hard questions of her oncologist, sometimes they need to be prompted to dig deeper about the answers you seek, especially if it's only choices among bad outcomes.
posted by OHenryPacey at 7:27 AM on May 2 [4 favorites]

You started this question by describing your mother as dying. I'm really sitting with that, and your description of the myriad health problems she has been living with.

I can't speak to the treatment options for your mother in particular - cancer is an enormously broad category and treatment protocols vary widely based not just on the provider but also on the patient's underlying health, and other factors (unfortunately, including their insurance coverage, zip code, etc).

But I can speak to being a family member of someone with severe, life-limiting illness - as both a family member and as a nurse case manager. I can also say that having both lung and liver cancer, on top of multiple other severe medical issues, in an elderly person, may not be meaningfully treatable.

I'm wondering if your mother, and you, are weighing treatment options in terms of how long she is likely to live, and what sort of life she wants to live during her time here? There are online tools to aid in having these conversations. But I would recommend requesting a referral to a palliative specialist. This specialist is focused primarily on your mother's comfort - physical, emotional, spiritual. Most physicians, especially oncologists, are frankly totally unprepared to have big picture conversations with people with this level of sickness. Palliative specialists are experts in these conversations, and can help your family think about what options are available. They may also be able to make some quick recommendations to improve your mother's comfort.

Wishing you the best.
posted by latkes at 9:39 AM on May 2 [4 favorites]