small cell lung cancer question

My mother in law was diagnosed with small cell lung cancer in early January. It had already spread to her liver, pancreas, and bone. She completed her fourth round of chemo in April, and some of the tumors did shrink. But her dr. says no more chemo, she is too frail to withstand any more. She has had to have blood transfusions twice, she shakes uncontrollably all the time...dr. thinks it is anxiety that is causing her to shake. I disagree. She is always tired and takes naps several times a day. She has zero energy, and can't walk without a walker now. (She is 71) Before the cancer, she was so energetic. It's hard to watch her deteriorate. She does have pain from the bone metastases, but it is controlled with a pain patch for now. It is in her skull bone and her left femur as of the last CT scan...My question is, since she cannot have any more chemo, and further treatment will only be palliative, how fast will things go downhill? She already seems to be getting worse since the chemo is clearing from her system. What can we expect now that more chemo is no longer an option? Thanks.

[HeinrikMD]

Hi,

If chemotherapy is no longer an option, then the course would be generally downhill. The symptoms would depend on which organ system would start failing. As such, the best way to prepare for managing these complications would be in consultation with her doctors as they can tell which areas seem to have responded poorly to the previous treatment.

The lungs would probably have some symptoms such as cough and difficulty breathing. If the liver and the pancreas would start failing, there may be changes in her skin color (turning yellow) and the white of her eyes, there may be general itchiness, there may also be changes in wakefulness. The brain is also another organ frequently a site of symptomatic progression – this may consist of headaches, vomiting, seizures.

The pain which is one of the most dreaded complications is generally managed well in the majority of cases. What’s more, there is a new drug to address the problem of constipation from strong pain medications.

Discuss about expectant management with her doctors. Try to focus on what can be done rather than what you cannot do.

[Siamo Uno]

Thank you so much for taking the time to give me some information. I greatly appreciate it.

Tina