A reader sent me this picture of metastatic small cell lung cancer manifested as skin mets:
There's something you don't see every day. I saw this patient in consultation for the attending oncology service. The patient was getting palliative chemotherapy for the last month or so. I'm not an oncologist and don't claim, by any means to know all the nuances for treatment. But someones gotta help me understand why give any chemo at all to a guy with systemic mets in liver, bone, kidney, mesentery, skin. Severe cachexia, severe protein malnutrition, with an albumin of less than 2 and a compensated ischemic cardiomyopathy with an ejection fraction of 15%.
Someone needs to help me understand what the purpose of any chemo at all as opposed to straight up hospice cares. While I find it hard to believe, the patient says nobody offered him the option of no treatment at all. The patient discharged in 24 hours to hospice after a palliative care consult. It seems silly but we just spent over $10,000 in Medicare dollars, easily, for him to come to the hospital, get worked up for back pain, to get an MRI, medications, nursing care, I don't understand at all what was gained in all that.
Why should palliative chemo should be chosen over hospice. They are both comfort measure programs. Both have the same outcome and one is a heck of a lot cheaper than the other. Maybe some others can shed some light on these choices.