83 y.o. woman w/ lung cancer

lady_jezebel · Jul 12, 2005

As people age and face increasing illness, broken bones, poor mobility, and less energy, they may yearn to hold onto little pleasures that provide comfort & some sense of control in their lives. This may be why your grandmother continues to smoke. At this point in her life, is it really fair to ask her to quit? What do you think could really be gained at this point by quitting? She already has enough stress and uncertainty to deal with, and she's a grown woman entitled to make her own decisions. I know how it makes you feel, but at this point the most compassionate thing to do regarding the smoking is to not mention it.

As for the rest, and oncology nurse could better answer your questions. I'm so sorry you have to face this. I can tell you love her very much.

renerian, BSN, RN · Jul 12, 2005

First let me say I am sorry your grandmother is suffering and I am sorry for you having to watch it play out. Been there myself.

Second, not smoking is moot. It won't make a difference now.

Yes what she is experiencing it normal for the illness.

Hugs,

renerian

caroladybelle, BSN, RN · Jul 13, 2005

My prayers are with you.

As a general rule, with most common forms of lung cancer, if the tumor is not completely excised (surgically) with a clear margin, there will not be a complete cure. And unfortunately, many of the people that are diagnosed with lung cancer, already have other lung damage, and would not survive removal of the cancer plus sufficiently clear margins.

Chemo and/or radiation can slow the disease down, help prevent spread of the primary lesions, or help prevent more painful/debilitating metastases. And can sometimes effect a temporary remission, ocasionally extended remission. However, the use of rad/chemo must be tempered with risk of organ toxicities and side effects, which frequently are more of a problem with the older patient.

It would be optimal if she did not smoke, but the issue is quite moot. She needs to be comfortable and living the way that she wishes. She probably has a very clear perception of what she wants to do and where she wants to be at this time in her life.

katwoman7755 · Jul 13, 2005

Sorry about your grandmother....

Agree with the others re: the smoking....

Could be some latent effects of the treatment regimen....

Could be that the treatment regimen has not worked....

Have they reassessed her status as far as the cancer? Despite the treatment, it could possibly have progressed.

Now that the treatment regimen is complete, has the MD given any new prognosis? If it isn't optimal, has hospice been considered? Also, has anyone talked with her re: advanced directives? It's never too early (for any of us really) to have a plan for what we want?

I wish you all well.....and if not well, peace.

Kathryn

soontobe_RN · Jul 13, 2005

Thank you all for your warms thoughts. I have really thought about the smoking issue and considered everything that was said. It now makes more sense to me why her oncologist was not requesting for her to quit. As far as the progress of the cancer, about half way through the tx, her doctors reassessed her condition and from what my grandmother told me, they determined that the tumor was down 40% or something like that. What ever it was she and the doctors were happy. She is suposed to have another evaluation done next month to see what is going on with the cancer. The Oncologist wanted to wait and let her feel better before they did anything else.

When my grandmother was first diagnosed with the caner, she updated her will, and got everything inorder, including advaced directives. It seemed easier for her to talk about death then it was for any of us. She even asked me what of hers I would like to have. At first I did not answer, I couldn't answer. Then she and I sat down and had a very long talk about everything. I do not want her to suffer, but as I said before, I am not ready to lose her, yet.

Anyway, thank you all again!!

soontobe_RN · Jul 13, 2005

However, the use of rad/chemo must be tempered with risk of organ toxicities and side effects, which frequently are more of a problem with the older patient.

Could this be what's causing her to have heart problems now? Her heart rate keeps going very very high, however, her BP is o.k. Does that make sense?

caroladybelle, BSN, RN · Jul 13, 2005

Could this be what's causing her to have heart problems now? Her heart rate keeps going very very high, however, her BP is o.k. Does that make sense?

Many people that have smoked for a long time develop some heart problems. As COPD makes the lungs less flexible, and nicotine causes vasoconstriction, the heart has to work hard to move the blood through the lungs (and oxygenate the blood) and then through the body, even to maintain a stable blood pressure. Many smokers develop cardiomyopathy. They also tend to thin down and develop a barrel chest. Their bodies have to work so hard and expend a great deal of energy just to breathe. This is worsened when due to lung ca, their systems are more compromised. The amount of energy just to breathe also impairs even their energy resources to digest and mobilize nutrients through the body.

As such, high calorie but easily digestible diets are indicated. There are also supplements (pulmacare) that are designed specifically for pulmonary patients.

In addition, very thin people (unhealthy thinness) tend to have higher heart rates due to demands of higher body surface area.

People with impaired oxygen exchange (due to COPD or cancer) frequently also develop panic attacks and "air hunger" anxiety toward latter stages of the disease. As the cause (difficulty oxygenating) sometimes cannot be "cured" at that point, the judicious use of antianxietics and morphine are frequently indicated. Morphine also is a vasodilator that can help by decreasing the workload of the heart.

Most chemo side effacts such as nausea occur within a few hours or days of the chemo. Same with radiation. Delayed nausea ocasionally occurs 7-14 days after chemo and is more or less a result of anemia (less RBCs = less energy/ability to digest = fatigue, nausea, generally sick feeling). There also may be taste changes (from chemo, or from tasting the general cell breakdown products in the body). Lung cancer itself can have some bad breath associated with that causes nausea.

Again, my prayers are with you.

soontobe_RN · Jul 13, 2005

Carladybelle, thank you for the information. I never realized that there was so many varying side effects from lung cancer.

At this point, I am spending as much time as possible with her and just trying to make her comfortable and happy. Tomorrow, I am going over to wash her hair, and going to give her a hair cut, paint her nails, and stuff like that. Because of losing her hair, she has felt very selfconcious lately. She wants me to do her hair b/c she doesn't want to go to a salon. Whenever she became ill in the past, I would fix her up and make her feel better. She wants me to cut her hair and try and get it even. She laughs about it and says she is going to shave whats left off. When her hair started falling out, she bought a few hats, but she doesn't like to wear them that much, unless she is going out. Mainly b/c her scalp is dry and flaky. Well, anyway, thank you again!! :) Everyone who has posted has made me feel a lot better. Just knowing answers to my questions is a relief in itself.

caroladybelle, BSN, RN · Jul 19, 2005

Please feel free to PM me if you need to.

thursdaygrl · Jul 19, 2005

Hi soontobe_RN,

I am an older student who returned to school two years ago to get a degree in nursing. I already have two degrees, including a masters. Why "nursing" you ask? Because I lost my Mother to multiple myeloma in 1997, after 18 months of caring for her (I quit my job to take care of my Mother--she was worth it). While I was in my first year of nursing school (Spring 2004), my Dad found out that he also had cancer--lung cancer (large cell carcinoma). He had smoked for 70 of his 77 years. When I graduated this past May, I had planned to move back to my home town to care for my Dad as long as he needed me. My Dad died in April--one month and a half before I graduated. I learned just yesterday that I passed my boards and I plan to specialize in Oncologic nursing. In fact, I already have a job in the field.

Why am I telling you this? Because obviously I have quite a bit of personal experience with cancer (I'm in my 30's--hard to be an orphan to cancer before you are 40). My Dad quit smoking when he learned of his cancer, but I think it was quite hard on him, although it was HIS decision--the doctors nor his family asked him to quit. If your Grandmother does not feel she is ready to quit smoking, just hide your disappointment/frustration/disapproval and let her enjoy her life AS IT IS NOW. Who knows what tomorrow will bring? While surgery would probably be the BEST thing, it sounds as if the docs are making the right decisions not to put her through a surgery, which requires a strong fortitude--even for a healthier person. Looking back, I'm not sure my Dad should have had surgery (he had a lower left lobectomy, with no lymph involvement, no metastases or additional tumors).

While I am very interested in oncologic nursing and have wanted to specialize in this field since I started in nursing school, I can also be realistic and say that chemo and radiation are NOT fun treatments--in fact, they are almost monstrous in their actions (kill most of the 'good' stuff while also killing the bad). After some rounds with radiation and chemo, patients are going to experience side effects (depending on the type of chemo/radiation).

Let your Grandmother enjoy her life. The treatment for cancer is bad enough and quitting smoking now will just make her possible recovery that much worse. My thoughts and prayers are with you!

twillows7 · Jul 19, 2005

hey My grandmothe went through the same thing about 3 years ago... it's sad to say...but The doctors gave her 6 months to live and she lived for the next 3 weeks after all the same things as your grandmother... I loved my grandmother to death.. she was my best friend... I lost her last year and still miss her to death.. I miss her wisdom and her ability to spoil me... but my advice is to just enjoy every minute you have with her.. because she was doing fine one week and the next 3 weeks she was gone.. she also was a smoker.. she was trying to get my aunt and mom to sneak her cigarettes while she was in the hospital.. but I pray that you at least spend as much time as you can with her... because they are not going to be here forever... I think my grandma loved me more than her own children...hahahahha... life is tooo short...enjoy it while you can... take care

The 83 y.o. woman is my grandmother. She was diagnosed w/ lung cancer about 6 months ago after she fell and hurt one of her ribs. Needless to say, after all of the PET Scans and CT Scans, the oncologist determined that she had Grade 3 lung cancer in her lower Rt. lobe and a small tumor in one of her brochioles. Other than that, the cancer had not metastasized. Because of her age, and the fact that she has Reumatoid arthritis and osteoporosis, they decided not to put her through surgery. For several months she was recieving chemotherapy once a week and radiation every day for 15 minutes at a time. About a month ago she finished the treatments. During the tx my grandmother was not experiancing any of the side-effects associated with the chemo and radiation. Honestly, we were all hoping that maybe she wouldn't have any side effects at all. Then suddenly, about 3 weeks ago she started feeling very ill. Everything from nausea and vomitting, to anxiety and extremely high heart rate, she has. Her weight has decreased from about 97lbs to 74lbs in that little bit of time. My grandmother says that it is because of her heart problems she was having. Well, the oncologist has her on many different meds for all sorts of symptoms. They even started her on that one med that has the same ingrediant as marijuana. Sorry, I can't remember the name.
Basically, I wanted to know if it is normal for her to be going through all of this. Also, how long will it last? What can I do to make her feel better? and my big question is, what are her chances of surviving lung cancer? Please be honest. If I couldn't handle the truth I would not ask.
Yes, my grandmother is a smoker. And I say is, b/c she still has not stopped smoking. Everytime I talk to her about it she tells me that she isn't ready but that she has cut down a lot. As much as I pray that my grandmother will quit, I do understand why she hasn't. After smoking ever since she was 14y.o. and suddnely being asked to stop, would be hard for anyone, let alone someone going through what she is going through. The part that makes me pset is that I am the only one asking her to even think about quitting. Her bestfriend, who is also her roommate, tells her she doesn't have to do anything that she doesn't want to, and the oncologist asked once and then, suposedly, nev mentioned it again. Is it hopeless? Should I not mention it either?
I know my grandmother is not going to live forever and I don't want her to suffer, but I am just not ready to say goodbye, yet.