End-of-Life Decision Making in Geriatric Terminal Head and Neck Cancer

An 83-year-old female resident of an assisted living facility presented to the emergency department at UCONN Health with 1 week of a sore throat and 2 days of shortness of breath, mild stridor, and dysphagia. Physical examination showed a well-nourished elderly woman with no significant medical history. She had' a fixed right thyroid mass. Mental status assessment showed no cognitive impairment, and a depression screen was negative. Fiberoptic nasolaryngoscopy revealed an immobile right vocal fold. Computed tomography (CT) with contrast showed a 3.8 x 3.9 x 4.8-cm mass centered in the right thyroid lobe (figure). The mass had eroded the lateral margin of the thyroid cartilage and produced moderate to severe mass effect on the glottis and airway. It also showed a 2.6-cm left suprahilar density. Fine-needle aspiration of the thyroid mass showed squamous cell carcinoma. We discussed the prognosis of stage 4 cancer and management options with the patient. She wanted no surgical intervention and opted for "do not resuscitate/