Dad (93) was recently diagnosed with Stage 4a adenocarcinoma of the Lung. Chemo/Radiation suggested. How do we make this decision?

As my Dad said many eons ago "Go to a surgeon and it's cut, cut, cut". It is what they do. They both believe in it, and it is their job. I would decline this at this age. What does your father want? It's his decision. If he cannot make this decision then it is your decision and you know him, know from living with him life long what he would have wanted. I would certainly, were it me, decline chemo. The side effects can in themselves kill someone fragile. If you look at all the TV ads be certain to read the fine tiny print they flash away in seconds. It will say that you have perhaps four or five months more with this new (expensive) drug than with the normal protocol, while all the time the ad itself, while it describes deadly side effects, SHOWS you people dancing around on beaches or with doing dressup with grandchildren.
Those who recommend the chemo and the radiation will tell you they aren't going for cure, but for more time, and for "shrinking" this or that.
For myself, I would ask your father what he wants to do. If he is unable to make the decision I would call in hospice. For you, how you make the decision is by talking with your own family and doing the best you can. There is no one I think with an ounce of brains who would judge you WHATEVER decision you make. I wish you luck.As an ex RN at age 79 I would no longer treat any cancer save for blockages, et al, and would ask for the "good drugs". I have had a wonderful and very lucky life; I am ready enough. I am a 35 year survivor of breast cancer. Even with that knowledge I long ago stopped mammograms. Death comes to us all. The manner of death is important to me to have some say in, given what I have seen in my career.

Every patient is different. The decision is his, if he is able.
Get a second opinion, see a different doctor. There are other treatments.

Go online and view a few Youtube videos by Dr. Atul Gawande. He speaks wisely and compassionately about quality of life, end of life, and hospice.

My dad had both chemo and radiation for the same cancer. He was 50 when it started. The radiation totally wiped him out. 5 days a week for 4 1/2 weeks. It took him 6 months to recover his strength. When the tumors came back, 2 years later, he had chemo. Because of the damage from the radiation, he couldn't have the medication port on his chest; he had to have a PIC line. He totally lost all sense of taste and snell. He lost about 50 lbs and was very weak.
I can't imagine a 90+ year old person going thru the same difficulties. Sending you a big hug because you are in an untenable position.

Patty, in my opinion, these doctors do not care about the quality of life or quantity of life of a 93 y.o. man. They see your dad as a cash cow that they can milk $$ from. The treatments can run up to the hundreds of thousands of dollars or more. And a big chunk of that will go to them.

Chemo/radiation treatments on a very old sick man will make him feel so horrible that he will wish he could die.

We all have to die. Let him spend his remaining days and months in comfort.

PattyJoyce, I'm so sorry your father and you are faced with this decision.

Ask the oncologist:
a) what are we hoping to achieve?
b) what is the 1, 3 and 5 year survival rate of comparable patients? - that is, patients at this stage of the disease undergoing this recommended treatment, regardless of the patient's age. The oncologist must be able to look you in the eye, tell you it's 15% (or whatever), and still make his recommendation ethically defensible. Maybe he can, I don't know.

Then, whose decision is this? If it's your father's, then the oncologist must be prepared to be as explicit with him about the risks and potential benefits as he is with you. Informed consent depends just as much on full information as it does on the patient's (or proxy's) consent.

If your father still wants to go ahead, support him; but make sure that he has face-saving opportunities to back out at strategic intervals.

It seems cruel. I have a friend whose dad is going through this kind of treatment now. He’s in his 70’s and the regimen has totally wiped out and defeated him

I certainly hope that these doctors aren’t offering false hope to your dad. Why go through this torture at his age?

My friend’s mom decided not to do anything about her lung cancer in her late 60’s. I found it interesting that she lived longer than others who went through treatment.

She saw all of her children marry and have children. She had lost her husband many years earlier in an automobile accident. He died when my friend was 8 years old.

She was at peace with dying. She didn’t care to endure the misery of treatment for an extension on her life. Her children supported her choice not to treat her cancer.

Good points from Countrymouse. One thing that sticks in my mind from Atul Gawande's book is that the term "life extending" often means something very different to the doctors than what the patient and their family believe and expect. (Even Gawande's family, all doctors themselves, fell into this trap.) Unfortunately the amount of time bought is sometimes only months and it may come at a great cost.

My grandfather always said, “Doctors bury their mistakes.” I say, at age 93, enjoy the time left without the discomfort of the side effects of treatment and to be at peace with the decision. You know what people say, “The cure is worse than the disease!” And it isn’t even a guaranteed cure!

Who really knows what the motive is behind a doctor who offers this kind of treatment to an elderly man? My mom’s doctor told her when she was in her 90’s that she would never recommend any form of life prolonging treatment or surgery if she needed it. So, not all docs are money hungry.

My friend switched law careers mid stream. He was a successful criminal prosecutor. He went into malpractice law, defending doctors, saying that he would earn tons more money! He did! He has a gorgeous home, fancy cars and travels the world. Kind of says it all, doesn’t it?

We have to be careful when we choose our doctors. There are good and bad examples in all walks of life.

As a cancer survivor myself---I will not treat again when it returns.

When I was first dxed, I was 62. Did about 15 months of tx and finally, just so sick of being sick, I quit. I had done not just the 'protocol' chemo, but 6 rounds of FU tx also.

Even though it's only been 2 years, a LOT of leftover side effects have made my life about 60% of what it was and I am as 'good as I'm going to get'.

Drs will give you stats and numbers and of course, their job is to get you in remission---but a LOT of the time, they do not look at the patient's age, family dynamic, etc. They simply see a problem they can 'fix' and BTW, the surgeons will not be the ones who follow up. It will be an oncologist. I saw my surgeon TWICE and never again, b/c there was nothing else for him to do.

I'll see my oncologist for the rest of my life. And HE is respectful and honest with me. He also agrees--go see a surgeon and you will likely be a 'candidate', somehow, for surgery.

At 93--why torture your poor dad?

I think the ones who benefit from this kind of "treatment" in these circumstances are doctors, pharmaceutical companies, and hospitals. Does the patient benefit? IMO - not so much. What QOL can be expected during and after treatment? My father in law was much younger (and with a different type of cancer) when he began chemo and radiation; he didn't want the treatment, but his family insisted. He did not handle the treatment well from the beginning. It was a mistake, and he and they regretted it. Please get another opinion. I wish you peace.

https://www.healthline.com/health/stage-4-lung-cancer-prognosis

With your Dads age, not sure if I would put him through all he needs to be put thru. Radiation burns the skin. His skin has already thinned out. These doctors should be giving you the worst case scenario. When they said the word "study", I would have said no. At 93 your Dad does not need to be a Guinea pig.

My sister was in a study for a very aggressive cancer. There had not been any survivors past 3 yrs on the drug she was given. She went thru 8 months of chemo where she couldn't even work because she was sick from the chemo. She was done in June, went back to work in July, started having pains in her back in Sept and died in Oct. Her breast cancer had gone to her spinal cord and to her brain. Now, how long would she have lived without the chemo? FIL had lung Cancer at 68. Part of a lung removed and chemo. 3 yrs later it came back. Chemo again but he died at 71. My Aunt, lung cancer and even with chemo died at 79. Her brother, lung cancer died at 60 even with chemo.

I have seen what chemo can do. At 93 I personally would not consider it. Since ur Dad is cognitive, it will be his decision. If he says no, go along with that decision. And yes, Cancer is a money maker. I really am surprised that these Drs are not considering his age.

About a month ago, my 93 year old father was recommended for a burr hole surgery for a brain hematoma. Like you, I asked for advice here and most people here said I shouldn't put him through anything invasive that would cause pain. The surgeon was all about doing it of course, the pallative docs at the hospital were talking hospice. His own cardiologist said it was 50/50 chance he would die. One person, Alvadear said the burrhole operation wasn't that bad and so I went ahead with it BECAUSE I KNOW MY DAD AND I KNEW HE WOULD WANT TO TRY, It did "bring him back" somewhat, and it wasn't painful for him. But he is still dying and every day when he's having a bad day I wonder if it would have been better not to do it.

So, not to make this about ME and my dad, I think cancer is a much scarier diagnosis. I watched my mother try everything to live and the chemo was horrible. When I myself was dx'd with breast cancer at 63 and recommended lumpectomy and chemo, I said no... cut them off. I do not want chemo under ANY circumstance. Of course, when faced with the actual decision, who knows?

How has his health been otherwise? Does he have any other comorbidities? Is your step mother capable of taking care of him and bringing him to all these chemo sessions? So much factors into this decision.

The one thing that helped was when a doctor told my sister that there is no RIGHT decision and whatever decision you make you need to stop second guessing yourself and go with it. I still wonder if I prolonged his dying but I feel like we gave him the chance he would have wanted.

So sorry for your family to go through this.

My sister died of breast cancer and the oncologist in the hospital tried to convince her that she needed to pursue treatment.

When I asked what was the prognosis with treatment. He boldly said she will have roughly 8 weeks. Seriously? You would put her through chemo for 8 weeks? Yep, without hesitation.

She lived for 7 weeks with no treatment once she went home on hospice. She was in the hospital for a couple of weeks, so she had 1 additional week and they were all on her terms. No puking her guts out, loosing all of her hair, no being utterly miserable every minute.

I think that there is something very wrong with any doctor that doesn't consider the fall out of pumping a fragile body full of poison. This is western medicine at it's core, filthy rotten!

To each his own but, I would do some research on what chemo does to the human body. Radiation is a whole different bag of ugly.

Think seriously about three words: QUALITY OF LIFE. The folks here shared great examples for you to ponder. Seriously.

Hugs...

I'm not one to mince words, so here goes -- chemo and radiation on someone that age is barbaric. Chemo is literally poison, and radiation burns -- really burns -- your skin. I cannot fathom one single scenario where this would be desirable for a 93-year-old.
If your dad isn't 100% in charge and competent enough to make this decision, I believe you have an obligation to protect him from any treatment that doesn't contribute to his quality of life.

Doctors feel obliged to give you all the possible treatment ideas, but too many of them won't tell you whether it's a good idea to actually do them, nor will they answer the question, "Would you do this to your father?"

I'll give you my story -- My aunt was diagnosed with multiple myeloma and was clearly pretty far along once she was diagnosed. Her children couldn't bear the idea that their vibrant, active 90-year-old mother could possible die, convinced her to do chemo. She did about two weeks' worth, was violently ill the entire time, and died a month later anyway. She was the one who put an end to the chemo, and now her children kick themselves for robbing her of two precious weeks of relatively good health because THEY couldn't bear for her to die.

Please try to think about what's best for your dad, not what you think is best for you. That's the most important thing to take into account. Is chemo and radiation going to cure him? Probably not, so why poison and burn him?

Ask how someone with heart disease at the age of 93 is even going to survive the surgery?

I did not see the heart desease. Chemo is very hard on the heart. He will need his Cardiologist to OK the operation may not.

My mother was 91 when a cardiologist told her she had a serious heart murmur and needed a heart valve replacement and a stent. I knew the dangers of anesthesia on an elderly person and questioned all the drs about WHY she needed this done. All said she had a very good prognosis but none would offer an opinion on her mental state. She was showing signs of dementia but otherwise was in good health for her age.

Mom asked the drs how long she would live without the surgery and was told 2 years. Well, she decided to have the surgery, rehab, recovery and a steep decline into dementia. She lived another 2 years. So we might have had her for 2 years and cogent instead of 2 years not recognizing anyone. I wish now I had talked her out of it.

Bob dole is 97 and has stage 4 lung cancer. He started treatment for it in February 2021 so apparently this is standard protocol with doctors now to treat no matter how old you are. I recall reading an article about a doctor bragging about giving a 91 year old woman her first mammogram. I just don't understand our medical docs in the USA.

Ah--our country thrives on the shocking and unbelievable---MANY doctors, I would fathom, most, as consciencious, caring individuals with their patient's care. That's not news. It's not shocking.

2 of my kids are Drs. Both are overworked (NOT underpaid, I'll admit) but they are totally devoted to their 'callings'. They give patients all the options and outcomes. It would be almost malpractice to not offer all treatments. And people have a right to refuse or ask for 2nd, 3rd opinions.

Neither takes kickbacks from Big Pharma, neither are pushed by their hospitals to do unnecessary txs.

I see how hard they work and how much they are and I know they are the 'rule', not the exception.

They are always there to offer hope. Just my view on seeing them in action.

What does your father want? At 93, I be surprised if he wanted to pursue active treatment.

My question is what are we extending his life for and how long do we expect him to live a quality life. Maybe the question to his Docs should be "If this were your parent what would you do?"

If it were my mother, I'd ask what she wanted and try and go by that, knowing my mother it would be to let nature take it's course. However, I think dad would be better off looking into hospice where they can will care for him without active treatment of the cancer. They can provide pain meds and other treatments to keep him comfortable and lead and end with quality of life with dignity.

The doc is correct, if it is too much treatment can always be stopped - but before pursuing this option, first look into the side effect on a 93 yo body.

A doctor is going to give you the gold standard of care for cancer. They certainly aren’t going to say,”look your dad is old, don’t treat his cancer”. So now it’s up to you (assuming it’s your decision) to decide. I have a 75 yo friend going through chemo for lung cancer. Chemo is every 21 days as that is how long it takes for cells to regenerate. So in the extreme elderly, the cells don’t turn over as fast, so this can affect his white cell count which has to be high enough to receive the next round of chemo. Personally, I don’t see the point of putting him through this. He will die of something sooner than later...but I would hate to die from the side effects of chemo. What is his current quality of life? Instead I would enjoy him while he is here and make his last years memorable and comfortable once he requires hospice.

My Mom was 92 when she was diagnosed with vulvar cancer. Following successful surgery the oncologist recommended radiation, 5 days a week for 6 weeks. I left the decision up to her, she has a good mind and completely understood the situation. She decided against and I agreed.
She celebrated her 100th Birthday at the end of December, is doing well and is still home with me.

Why would you put anyone this age through chemo and radiation?

Most oncologists and radiologists have plenty of patients and an already overbooked schedule.

if your dad is mentally competent, this choice should be left purely to him, and you should support his decision.

This is a complicated medical issue that has lots of variables. Surely they are considering his age, mental status, overall comfort and potential outcomes in recommending treatment.

If you think their medical advice is not appropriate, seek another opinion from a qualified medical provider, not advice from strangers in a chat room.

Your father's situation is the perfect example for the need of a "second opinion." Assuming he is competent, he should be able (and allowed) to make his own decision on life sustaining measures that will likely achieve little extension of life versus the side effects of treatments and physical requirement to endure it. The doctor should present longevity expectations if treatment successful compared to none with palliative care. There is also the issue of his daily care by an already ill spouse. Have a talk with your father to get his opinion and wishes then get the second opinion.

I’m very sorry you’re having to deal with this decision for your dad. It’s easy for others to judge, but it’s no one else’s business. My dad took 3 of the 5 scheduled treatments for stage 4 malignant melanoma at age 90. He did targeted therapy (Keytruda). It works great, but causes massive inflammation. Dad also had rheumatoid arthritis, so he was crawling out of his own skin in pain. He became weak and felt so much pain he could barely lift his arms or get out of bed. Dad said he couldn’t take any more of it- he’d rather die. So I asked his oncologist to tell him he’d whipped the cancer and didn’t need more treatments. He understood our situation and did that. We discontinued treatments & talked to hospice. He began a super low dose of morphine each day which allowed him to be pain free and alert. He lived for another year and was comfortable and able to enjoy himself with family. Dosages varied as the cancer progressed, but when adjusted correctly, it doesn’t “zombie” one out; instead, it simply provides immediate pain relief! God bless you and your family. We will all die at some point, question is: how did we live?

It's mostly his decision. It sounds like he has a backup plan if things are not tolerable. But you should discuss having aides and people coming in to help, as needed, with cleaning, laundry, shopping, cooking them meals, etc. if they don't already have this. He may feel tired and weak with his treatments. Is your stepmom able to do all of these things for both of them?

As a survivor of a stage four cancer and having received both radiation and chemo I think it might be better that any treatment should be for palliative care at his age. Contact Hospice, they can guide you better than this oncologist. God bless you on this difficult journey.