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Fourth Line Treatment....life expectations of time and quality.

Flint70
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Hi

After having been through kidney cancer and a "successful" operation, my mother's cancer reappeared in her lung four years ago. Two attempts with targeted drugs did dramatically reduce growth. A third line of immunotherapy knocked her sideways combined with other health issues, but growth was minimal. Due to side affects she only had that first infusion and no other treatment for 16 months - oncologist led obviously - but growth was slow. More recent growth has been quicker, so in the last appointment, there was discussion of a fourth line of treatment.

"You can have treatment, it may not work, the side effects could severely lower quality of life. We could try immunotherapy again (laughs). It could lower your quality of life but only extend for a few months" and so on.... No straight answers. No prognosis with or without treatment.

With such an airy and sometimes contradictory approach, how can someone decide to make such a decision as to continue treatment or stop  - and get left in the wilderness without any support? I understand how difficult it is to predict, but for a professional, involved in cancer and growth on a daily basis, there must be some ball park on life expectancy one could discuss ? Or someone who can help with such a decision - to go with the fourth line of treatment or not.

Both feeling lost.

  • Hello and thanks for your post,

    I can appreciate that this is a concerning time, and that it seems you felt the communication was lacking around the benefits or not, of starting a line of treatment again. This is not an easy area to explore, as it can be pretty difficult for a doctor to give a time frame to a patient, with or without a course of treatment. Cancer can go through periods where it's activity varies, and periods when it seems to plateau for a while. 

    Immunotherapy drugs can cause cause fatigue, and other side effects. These do vary, and each patient's experience of them can be very different, and difficult to predict. It is a delicate balance between having active treatment, and maintaining a reasonable quality of life. Some patients do pursue a course of treatment, on the condition that should it prove too taxing for them,(or with minimal effect on their cancer), that they then stop it at their request. For patients that decide on no active treatment, then a referral onto a community palliative care team, can be considered. This team would be well placed to care for the patient, should they then develop symptoms of advanced cancer. A further discussion with the specialist may help, or with a clinical nurse specialist (CNS) that is part of the same team.

    I hope that this reply is of some help,

    Please get back to us if you need any more information or support.  You may find it helpful to talk things through with one of the nurses on our helpline.  The number to call is Freephone 0808 800 4040 and the lines are open from 9am till 5pm Monday to Friday.

    Yours sincerely,

    Vanda

  • Offline in reply to CRUK Nurse Vanda

    Many thanks for your reply Vanda.

    I understand that the cancer growth and life expectancy is very difficult to predict - though many I have known have been given that awful deadline. Better to know or not is a difficult one and so much to plan or do. 

    But thank you once more. I will contact the palliative team to get things in place "early".

    Kindest regards

    Flint

  • Offline

    Hi Flint,

    I’m sorry the professionals have left you floundering.
    Only your Mum can decide, but she will need help in making an informed decision.
    Age, fitness and co-morbidities all have an influence on quality of life years remaining.

    In your Mum’s situation, I’d be tempted to ask the oncologist “in my position, would you opt for further treatment or simply enjoy the time I have left?”
    She’s more likely to get a straight answer that way than by asking “what do you recommend?”

    I have every empathy, I’ve been there with my Mam’s cancer care and I came very close to it with my own. 


    Best wishes to you both
    Dave

  • Offline in reply to davek

    Hi Dave

    Many thanks for your response. You've certainly been through it - on both sides - and so glad you are still available to help and advise.

    I'm afraid it is a case of reading between the lines with the oncologist but the specialist nurse we have spoken to today has been absolutely fantastic - as she always has been. Things have been made a lot clearer and my Mum is moving towards that decision. Still no idea of longevity, but will take each day at a time, as they say, and try to make the best of each.

    All the best to you and thanks again for advice

    Flint

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