How to ensure stage 4 cancer supportive care in the elderly?

Question

Hello doctor,

My mother is 65 years old. She is diagnosed with stomach cancer, stage 4. We consulted the situation with five top oncologists, and based on their suggestions, we decided not to put her under chemotherapy. We are keeping her under supportive care at home. She is not taking any medicine for cancer as of today.

The current concern is that she is 99 pounds in weight and is able to take only liquid food since her diagnosis. She does take semi-solid (mashed) food sometimes, but it may be twice or thrice in a week. As you can see in her PET scan attached, the tumor may be causing physical obstruction for the food to pass from the stomach to the small intestine, and also from time to time she feels some liquid with a stale smell rising up her stomach. She wants to eat, but is unable to do so because of this weird nausea-like feeling.

Can you please suggest some medications to overcome the above problem? Or is there any other way she could be given enough nutrition to manage the situation? Looking for your help at the earliest possible.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through her reports. (attachment removed to protect patient identity).

As per the above reports, it looks like metastatic stage 4 gastric cancer. And as I can gather from the history above, the decision of supportive care only without any chemotherapy was taken.

For gastric cancer, surgery remains the best palliative treatment, especially if there are features of obstruction as seen in her case. However, surgery is usually not preferred because of its invasive nature. Her symptoms can be explained by moderate luminal obstruction of the stomach. In that case, another option is to go ahead with percutaneous jejunostomy for feeding, which bypasses the stomach and helps maintain nutrition.

If such a facility is not available, then an endoscopic feeding jejunostomy tube can be tried. Sadly, only medications such as anti-nausea drugs will not help much, as the problem is due to mechanical obstruction.

I hope this helps.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

So, Buscopan won’t help much in case of mechanical obstruction, and it can make it worse by reducing motility further. In case she has abdominal cramps, it can be used as needed.

Octreotide might help by reducing reflux. But again, it won’t provide complete relief. The majority of her nausea is due to a distended stomach and reflux. I would also advise light meals only.

I would be happy to help you if you have any other questions.

Thank you.