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Ramifications of declining surgery

Posted: Tue Mar 06, 2018 7:05 pm
by Rosemary_1706
My 95 year old mum with uterine cancer and I will meet with a consultant and member of the multi disciplinary team that has reviewed mum's case. The local consultant has twice told us that surgery is s an option but mum will be prone to complications - infections, pneumonia.,......

So if an operation is offered tomorrow and mum declines opting for palliative care and hospice, will that refusal to against her with respect to care and treatment options going forward?

Re: Ramifications of declining surgery

Posted: Tue Mar 06, 2018 7:38 pm
by Crispy
Rosemary, are you able/willing to say what treatment you fear your mother might be pushed into/refused if she declines the operation?

I can only give you anecdotal evidence from my own family. Person one refused further chemotherapy when a tumour regrew. They were offered ongoing scans and monitoring and were given all the treatment they needed for a separate condition. Person two also refused chemotherapy. Again, they were offered ongoing monitoring and continued to be given the blood transfusions their condition required. Where their care was delivered varied at diffrent times: at home, in hospital and in one case in a hospice.

At no time did we have to push for any of this. The decisions to refuse the specific treatment options were respected but I don't believe they otherwise affected the care delivered. I hope this helps, if only to give you an idea of what can happen.

I am sorry you both find yourselves in this position.

Re: Ramifications of declining surgery

Posted: Tue Mar 06, 2018 7:45 pm
by bowlingbun
In that position, I think I'd like to know the maximum length of time I would be likely to live with the cancer. So if they said "it will kill you in 3 months if you don't do anything, you have to weight that against the chance of living significantly longer IF you survived the op. A simple risk/reward decision to me.
On the other hand, if they said I could survive comfortably for three years, as opposed to months, without the op, then that would be much more difficult. In those circumstances, I might not have the operation.
Will it be a straightforward hysterectomy, or more extensive? Will it be done vaginally, or an incision through the stomach?
If mum has lots of other problems as well, then that will make surviving an op more difficult, and if she had an element of dementia the anaesthetic might bring on unwelcome complications, perhaps delirium.
A really, really tough decision to make.

Re: Ramifications of declining surgery

Posted: Tue Mar 06, 2018 10:34 pm
by jenny lucas
So much depends on her state of health, if you see what I mean, especially mental. This is only my opinion, but personally I would say that if her mind is failing, it would be 'unfair' to seek to prolong her life with surgery/treatment etc. Of course she must be kept pain free and non-distressed, that's without question. But to seek to prolong her life by intrusive and invasive treatment, surely would be cruel and even 'perverse' - at 95, surely she has the right to want 'nature to take its course'?

But yes, very very hard to make choices. (Which is why, of course, when we DON'T have choices in this respect, it can be easier....)

Re: Ramifications of declining surgery

Posted: Thu Mar 08, 2018 10:02 am
by Rosemary_1706
Thank you for your heartfelt and Frank responses.

We spoke to a surgeon and oncologist at a top London cancer centre yesterday. They spoke more directly to us and ruled out surgery as the first treatment mode. So mum doesn't need to decline surgery. Previously it seemed that the local doctor was giving us every opportunity to opt out of surgery before we had heard from the specialist team what they proposed. That left me uncomfortable that we were being urged to decide prematurely. A bit like who's going to concede first.

Thanks again for your replies. This is the place to. discuss without skirting around the crux of the matter.

Re: Ramifications of declining surgery

Posted: Thu Mar 08, 2018 10:37 am
by Rosemary_1706
Another aspect to this situation lies in the issue of the medical reasons for making mum an unsuitable candidate for surgery/treatment and potential medical negligence that has contributed to mum's present state.

All stressful but I believe mum's hospital care was below minimum acceptable care standards. Solicitor is investigating.........

Re: Ramifications of declining surgery

Posted: Thu Mar 08, 2018 10:37 am
by jenny lucas
That sounds much clearer, doesn't it. It could be that the local doctors simply didn't know as much as the top oncologists, and had 'assumed' that surgery could not be on the cards for such an elderly patient, but didn't quite want to say so? Now you have the top guys on the case, you will be able to trust their judgement with more confidence.

From my own family experience of cancer, I do know that one of the things that the oncologists think is this - that sometimes it is a case of dying WITH cancer, rather than dying OF cancer.

In other words, it can be that they can see that the rate of cancer is less than the rate of old age, and that the latter will 'win' first, and it won't be the cancer that will cause the end of life. In which case, there is no point subjecting a patient to uncomfortable and difficult treatment.

I hope your mother will be physically, and psychologically comfortable with the oncologists' decision, and that whatever happens she will be painfree and not in emotional distress or confusion.

Have the oncologists ruled out ALL anti-cancer treatment, and opted for 'best supportive care' and 'palliative care' only, to ensure your mother's final months/years are comfortable? Have they recommended you contact your local hospice for advice and support for 'the future' (whenever that happens). I found my local hospice charity absolutely wonderful when my husband reached end stage for his cancer.

Re: Ramifications of declining surgery

Posted: Thu Mar 08, 2018 10:39 am
by jenny lucas
Sorry, just seen your post on medical negligence - how upsetting, to say the least. Hope it can get resolved....

Re: Ramifications of declining surgery

Posted: Thu Mar 08, 2018 10:56 am
by Rosemary_1706
The top guys indeed!!!!!!! Great choice of word for the specialists!

We went on a day when the head and neck, gynae and breast clinics were held.

Clear to see the seriousness of the condition and the treatment.