C.G. is a 69-year-old male with a history of right head and neck cancer that you have been following for one year. The carcinoma was initially localized to the head and neck-specifically at the left lingual tonsil region and went on to complete a total of 6 weeks of radiation and chemotherapy. Recently, the last PET scan indicated some metabolic activity in the left lymph node area along with other regions of abnormal metabolic activity in the body-particularly the liver and the lungs indicating metastasis. C.G. indicates that he is tired of the effects of chemotherapy and radiation and does not want to pursue any more treatment for cancer.
Background:
Right head and neck cancer with metastasis to liver and lungs; patient is refusing further treatment.
PMH:
Hypertension
Hyperlipidemia
Stomatitis
Anemia
Neutropenia
Current medications:
Carvedilol 12.5 mg po 1 daily
Furosemide 40 mg po daily
Surgeries:
2012: right radical neck dissection
Allergies:
None
Vaccination History:
Influenza vaccine last received 1 year ago
Received pneumovax at age 65
Received Tdap 5 years ago
Has not had the herpes zoster vaccine
Social history and Risk Factors:
Former smoker-stopped smoking at the time his cancer was diagnosed-2 years ago
Negative for alcohol intake or drug use
Patient does not have an advanced directive or living will. He is refusing further treatment for his cancer and his wife and children are in disagreement with him. The patient wants to know what his options are for the remainder of his life.
Family history:
Negative
Discussion Part One:
- Provide differential diagnoses (ID) with rationale.
- Further ROS questions needed to develop ID.
- Identify the legal/ethical issues involved with the patient and describe your approach to aIDressing end-of-life care for this patient.
