Brief Answer: Goals of care Detailed Answer: Hello and thank you for sending the question. I think one of the most important things to establish at this time would be the appropriate goals of care. This concept basically incorporates your mothers wishes into the treatment plan. I agree that she is very debilitated and has encountered significant complications of treatment. at this time continued chemotherapy may contribute to a further decline in overall health. This is a constant struggle in the field of oncology in the case of advanced cancers and in the case of patients web encountered significant issues including pulmonary embolism and gastrointestinal bleeding. I realize this is an extremely difficult decision but I do feel that the entire family should sit down and talk about these decisions with your mother to gather what exactly she would like to be done at this time. experimental therapy and clinical trials is usually reserved for patients who are relatively fit. At this time it is a situation where her level of fitness is very very limited. I am speaking in a general sense here but it sounds like at least a consultation with a palliative care service or possibly hospice would be reasonable. I discussion does not mean that you are actually signing up for the service and it might provide you with some information to help you make further decisions. I do not see an indication for further systemic chemotherapy right now for her. This is especially the case in the setting of gastrointestinal bleeding and relative instability and an overall debilitated state. thanks again for sharing your health care concerns, Sincerely, Dr Galamaga

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Brief Answer: Followup Detailed Answer: Thanks for the followup. It usually takes 3 to 5 days to get results of imaging and biopsy. Its usually a better idea to wait until all results are in before proceeding with decision making and discussions. I think the doctor is concerned that she is deconditioned and at risk for falls and such. Internal bleeding is difficult to interpret and we cannot draw alot of conculsions about it in general - it is an individual aspect of a patients case. The counseling is a good idea for you. It is tremendously mentally and physically taxing to take care of a loved one who is very ill. The counselor will help you focus on needs of coping and will also help with strategies in taking care of your mom. I almost never provide prognosis in form of days, weeks, months or years. My focus is on quality of life for all patients. If quality of life is declining then I usually have another discussion to help establish goals of care with a patient and his or her family. May or CTCA may provide some options for you but these institutions are not always much better than a good community physician in many cases. You could always call them and discusss the case with a nurse navigator. Bottom line is to do what your mom wants. Sincerely, Dr. G

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