Anyone with Oncology/Lung Cancer/Palliative Care Info? Please help!

[TazJ]

Hi all,

I was wondering if there are any UK nurses here who work in Oncology or have experience with lung cancer?

My grandpa has just been diagnosed with Stage IV Lung Cancer a few days ago. Although he smoked for many years, he quit almost 10 years ago so it's quite a shock. He doesn't have many respiratory symptoms other than the occasional Shortness of Breath during activity. The only reason he even got diagnosed was because he broke his collarbone (sounds pathological) 6 weeks ago and became short of breath. A GP friend who witnessed it suggested pneumonia/lung cancer so they sent him for a biopsy but it came back inconclusive. Then they sent him for a CT scan, and the consultant confirmed lung cancer. However, he made it sound like an early stage and that treatment options would be available.

A few days ago, he finally met with the oncologist, who said it's Stage IV, there are no treatment options, and he only has 6-9 months to live.

Although I'm British, I've been in the US for quite a while now and did my nursing degree here and have some questions:

1) How do they define cancer stages in the UK? In the US, Stage IV indicates metastasis to other parts of the body. However, my grandpa has been diagnosed as stage IV even though the cancer is still limited to the lungs. I'm not sure what type of Lung cancer it is, but the oncologist said it's started 9 months ago. (I had asked my family members to ask the oncologist specifics but they were too shocked to even remember).

2) How can the biopsy come back "inconclusive" if he has "Stage IV" cancer? My mom saw the x-rays and there was clearly infiltrates and a large tumor in one area of the lungs.

3) Is it common for it to take 6 weeks for a diagnosis? I know NHS takes forever but some family members are upset that so much time has been wasted (it took 2 weeks just to get biopsy results and then only because we called to ask what's going on). In the US, patients with a history of smoking are tested more thoroughly for signs of lung cancer. My grandpa has been going to the GP regularly for check-ups and somehow the whole possibility of lung cancer was never considered.

4) What options are available in the UK for patients who are diagnosed with a terminal illness? In the US, we have palliative care options and bereavement groups. Is palliative care available through the NHS?

I would really appreciate any advice or information.

[Silverdragon102, BSN]

It is hard when family members are involved and we must remember not to drop into the realm of offering medical advice

Pallitive care is available in the UK and usually done via the Macmillian nurse with hospice care available for lots of reasons like day care or respite care to give both patient and family a rest.

[XB9S, BSN, MSN, EdD, RN, APN]

I am so sorry that you are going through this, it must be extremely difficult to be so far away from your family at this time.

The biopsy may have been inconclusive because the sample was insufficient or difficult to categorise. The further investigations would have given images that the specialists could look at and use to firm up the diagnosis and looked at any spread.

We can't give any medical advise as Silverdragon has mentioned but I have included some links to websites that should be able to provide much of the information that you need.

http://www.macmillan.org.uk/Home.aspx

http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Lung/Symptomsdiagnosis/Staging/Staging.aspx

http://cancerhelp.cancerresearchuk.org/about-cancer/cancer-questions/waiting-times-for-tests-and-treatment-after-cancer-diagnosis

As far as palliative care, in every hospital I have worked in the Palliative care teams have been outstanding and the community support equally as good.

[ZippyGBR, BSN, RN]

staging

http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Lung/Symptomsdiagnosis/Staging/Staging.aspx

the fact that there are pathological fractures i.e. the collar bone fracture , plus potentially what has been seen by the oncologist and the radiologist on the CT may be what has led the oncologist to the Stage 4 statement

or that it's T4 under the TNM staging system

http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Lung/Symptomsdiagnosis/Staging/Revisedstaging.aspx

as silverdragon and XB9S have saind palliative care in the UK is very comprehensive and is genuinely an area where money is no object care can be provided ( whether that's inpatient , inpatient hospice or hospice at home )