Question: My sister is a 70 year old single woman diagnosed with small cell lung cancer which had metastasized to her liver and bone and brain in 6/15. She immediately had standard chemo, carboplatinum and etoposide, and cyber knife for several lesions in her brain. Several months later when additional brain lesions appeared, she was referred to radiation oncologist and received whole brain radiation which she completed in 1/16. She also subsequently received radiation to her lungs and clavicle when she started experiencing pain there.

In the beginning of May, CT scan showed progression in her lungs, adrenal glands and liver. Her oncologist mapped out all the options and my sister decided she wanted to keep fighting so they began WBT 11 chemotherapy, which she continues. In the beginning of XXXXXXX a brain MRI showed progression in her brain – old lesions that had grown and new lesions that had appeared, about 10. Her radiation oncologist and the cyber knife oncologist that had previously treated her all agreed they were not recommending any further radiation treatment. They delivered the news very kindly but said that her life expectancy was probably in the range of 3 to 4 months.

We told her the brain scan showed brain swelling and that was why she was prescribed 4 mg Decadron every six hours. Because there were no further decisions to be made, family agreed there was no benefit in telling her the rest of the bad news about the brain scan. It is important to note that at the time of diagnosis she put all of her affairs in order and there is nothing left to be done .

I love her dearly and am her primary care taker. I take her to every doctors appointment and every treatment and she always tells the doctors my phone number and tells them to talk to me, not her.
My question is whether we should go for further opinions as to whether any further radiation would be of any benefit to her. She is still feeling very good, enjoying a wonderful summer seeing lots of family and friends and feeling very hopeful. Of course we are afraid that if we tell her the news she will emotionally crash and all of that will end. Her oncologist is continuing to chemotherapy hoping it will address the disease outside of the brain. We have been told that by and large the chemotherapy does not cross the brain barrier and is not expected to help much there.
My question is whether we are doing the right thing – is there anything more to be done?

She has been prescribed 4 mg of Decadron every six hours for swelling in the brain. Aside from the internal brain benefits, it seems to have put a little pep in her step , more energy and she continues to sleep very well. I got the impression when it was prescribed however that it was going to be short-term and I am concerned they are going to terminate it. I am aware of the long-term problems with steroids but her life expectancy is quite limited and it seems to have more benefit than risk . It does seem to have given her a little stomach irritation, no actual nausea but a sense of indigestion. I am hesitant to tell the doctor about this for fear they will terminate it. Is there something they could prescribe for the stomach sensation and is there any reason at this late stage for them to terminate it?