Case Study: Stage 4 Non-Small Cell Lung Carcinoma and Ethical Decision for Palliation Care

Authors: Fadi Ali Jamaleddin Ahmad1, MPH., BS, Latoya Alexia Bethell1, MS., BS, William Hunt1, MDiv., BA, and Athena Andreadis1, MD. 

Affiliation: American University of the Caribbean Medical School1

Abstract

A 64-year-old male and long-term smoker with a history of COPD, chronic respiratory failure on continuous home oxygen at 4L nasal cannula for the past 6 months presents to the Emergency Department with new-onset chest pain for the past 12 hours. Vital signs: T 98.6 F, BP: 98/62, HR: 110, RR: 23, and O-S: 90% on 6L non-rebreather and EKG showing diffuse ST elevation. He has been seeking experimental treatments for his recent diagnosis of Stage 4 Non-Small Cell Carcinoma. Patient was on experimental therapy per oncology, unclear if it had been started at the time of the evaluation. Complete blood count (CBC) with minor elevation in hemoglobin/hematocrit and platelets due to reduced lung field availability increasing circulating red blood cells (RBCs) in an attempt to increase oxygen availability to the periphery system and inflammation, respectively. In addition, troponin levels were elevated to 1.2, and basic metabolic panel (BMP) shows a minor elevation in renal function. CT chest shows diffuse lung cancer bilaterally with a minimal amount of viable lung tissue preserved. Also, CT shows diffuse enlargement in the pericardial sac and cardiac silhouette. After evaluation by an Emergency Physician and recommendation for a Cardiac Tamponade, the Cardiothoracic Surgical Department instead requested hospital admission to discuss the patient’s goals and ultimately a Pericardial Window was performed. The patient is accompanied by his family with the hopes to cure his cancer given the opinion of other specialists. This case will discuss palliation (primary care physician, oncologist, hospitalist, etc.), resources, and overall outcome for the patient. In addition, the differences in opinion for treatment, non-intentional suffering faced by the patient and his family members, and how much is enough to provide care for Stage 4 cancer will be discussed. This case will bring important public health significance in understanding how to provide care to patients who need palliative care in an effort to increase quality of life in their remaining days. 

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