Challenging decision-making at the end of life in an SCLC patient with severe paraneoplasia and immune CPI-toxicity: A case report

IF 0.9 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

PROGRESS IN PALLIATIVE CARE Pub Date : 2022-03-27 DOI:10.1080/09699260.2022.2052504

D. Hamberger, M. Villalobos

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引用次数: 1

Abstract

Background In advanced tumour disease, the situation of patients may worsen due to paraneoplastic syndromes and the side effects of new therapies. In small cell lung cancer, immunotherapy has shown an improvement in outcomes for the first time in decades. Still, the prognosis remains dismal, challenging supportive care for new treatment side effects and the shared decision-making process at the end of life. Case presentation we present a patient with advanced small cell lung cancer. His situation is complicated by ectopic ACTH production with severe hypokalaemia and immune-related myocarditis after treatment with atezolizumab, leading to changing ECG findings and bradycardia. Conclusions At the end of life, priorities can shift, so medical treatments must be critically questioned regarding their benefit for the patient. New oncological treatment options may hazard the timely integration of palliative care and thus, lead to more extended hospital stays and more aggressive care. The challenging shared decision-making is time-consuming crucial in achieving goal-concordant care.

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一名患有严重副肿瘤和免疫CPI毒性的SCLC患者在生命末期的决策具有挑战性：一例报告

背景在晚期肿瘤疾病中，由于副肿瘤综合征和新疗法的副作用，患者的情况可能会恶化。在小细胞肺癌癌症中，免疫疗法几十年来首次显示出结果的改善。尽管如此，预后仍然令人沮丧，对新的治疗副作用的支持性护理和生命结束时的共同决策过程提出了挑战。病例介绍我们介绍一名晚期小细胞肺癌癌症患者。在接受atezolizumab治疗后，异位ACTH产生伴严重低钾血症和免疫相关心肌炎，导致心电图改变和心动过缓，使他的情况变得复杂。结论在生命的尽头，优先事项可能会发生变化，因此必须严格质疑医疗对患者的益处。新的肿瘤学治疗方案可能会危及姑息治疗的及时整合，从而导致更长的住院时间和更积极的治疗。具有挑战性的共同决策是耗时的，对于实现目标一致护理至关重要。

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来源期刊

PROGRESS IN PALLIATIVE CARE PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

2.60

自引率

11.80%

发文量

期刊介绍： Progress in Palliative Care is a peer reviewed, multidisciplinary journal with an international perspective. It provides a central point of reference for all members of the palliative care community: medical consultants, nurses, hospital support teams, home care teams, hospice directors and administrators, pain centre staff, social workers, chaplains, counsellors, information staff, paramedical staff and self-help groups. The emphasis of the journal is on the rapid exchange of information amongst those working in palliative care. Progress in Palliative Care embraces all aspects of the management of the problems of end-stage disease.