Doctor's refusal to do surgery

Jaye · August 2009

I am the health care agent for my aunt, who had a severe stroke 8 years ago. The stroke left her paralyzed on one side and unable to speak. She was diagnosed with breast cancer in June, and her primary care doctor told me that she would have the tumor removed, and then we could talk about what would be the appropriate treatment afterwards. Well, I got a call from her surgeon today who, after examing her, informed me that she is not going to do surgery. She told me she was going to treat her medically. She had been on Tamoxifen, but she is taking her off that and putting her on another medication that she thinks will be better, that it should shrink the tumor. She made what I thought were some odd comments. She said she didn't want to do surgery because my aunt did not understand what was going on -- I don't completely agree with that. Then she said said, "she couldn't even get up on the table." Well, of course not -- she's paralyzed on one side. I don't even know what that had to do with anything. Then she said, "It's not like she's 47. She's nearly 80." Not sure what that has to do with anything. She insists that she will die of something else before she dies of breast cancer. Not sure I agree with that, either. I am not comfortable with this decision at all, and I am particuarly not comfortable with the fact that the doctor made the decision, not me or my aunt. I have been online looking for info. on not removing a tumor and only treating with medication, but I can't find anything that suggests that as a treatment. Is this a reasonable treatment? She told me the tumor was small, so to me it makes more sense to remove the tumor and then put her on medication. Anybody have any thoughts to share with me?

pomegranate · August 2009

Can the doc make the final decision about your aunt's care? Something doesn't sound right.

Can you get a second opinion? Can your aunt's primary doc help with this at all?

I don't understand. If the tumor is small, removal might mean she will live many more years or not--but what if it isn't removed and grows and she has much pain from the tumor and "doesn't die of something else" first--then what?

I don't blame you for asking lots of questions. If she was going to remove the tumor and now she isn't, what changed her mind?

If I were you, I'd fight to get the tumor out. Hope you can find another doc to do what this one should have done!! Isn't it amazing how little this society values its elders? Sad.

pomegranate

sheila888 · August 2009

The only reason BS refusal of surgery that i would've accepted if she was my aunt if the Doctor said " Its dangerous to put her under anesthesia ". I find it very insensitive any Doctor talking like that. She is lucky to have you as her health care agent and her niece. Unfortunately there are too much injustice going on. Number one being uninsured and then the elderly population. Sometimes its not what the person is saying but the way they are saying it makes it hurtful.

Good Luck to both of you.

Smile Sheila

cwrightrn · August 2009

So sorry to hear about your experience and I can only imagine how difficult this is on you. As a nurse I can offer a different perspective or maybe explanation of some of the Dr's comments. It is true that age is considered with medical procedures and whether it is more beneficial to treat someone medically rather than surgically because of recovery and the risk of complications. You mentioned your Aunt can't speak but can she nod her head in understanding? If that's the case, ask her what she wants....and talk to the surgeon again and if you feel led to, seek a second opinion. My 80 year old mother in law was recently diagnosed with a small tumor in her lung that was biopsied and 1/3 of her lung was removed and it was positive for cancer (she doesn't smoke) and the Dr did mention to her too that many die before they even realize they have cancer....this could have gone undetected for years in her. And my oncologist said that her treatment plan does depend on age due to quality of life and risk of complications..in other words, if they didn't get it all with surgery, they would not have done chemo. Not sure if that helps or not....

idaho · August 2009

What does your Aunt want to do? The choice is definitely hers. Tami

dlb823 · August 2009

Jaye ~ I think a big factor is what kind of bc your aunt has. Some are far more invasive than others, and do need to be removed, if at all possible. Some are not considered invasive (in other words, will never spread beyond the breast ducts), and at your aunt's age, her surgeon's comments, though perhaps lacking empathy and compassion, may not be that off base. In some instances, it is appropriate to treat bc with hormones only, and they will often cause the bc to shrink significantly.

I'm guessing the surgeon is thinking of switching your aunt to an aromotese inhibitor, which sounds like the right thing to do, especially in view of her prior stroke. Tamoxifen is not an appropriate drug for someone who has had a stroke. My only concern is that this sort of decision should come from an oncologist -- not her surgeon. So I would encourage you to get a face-to-face appointment with an oncologist to review that recommendation.

Your aunt's overall health (not just the prior stroke) may also figure into the surgeon's recommendation. But, that said, I strongly believe in second and sometimes even third opinions, because all doctors do not see a patient the same way, and they often recommend quite different treatment options. So a second opinion will either reconfirm what you've already heard, or give you another option and possibly lead you to even a third opinion to help decide.

Good luck, and your aunt is very lucky to have you helping with her care! Deanna

mumito · August 2009

I also think your Aunt not the doctor should decide on what way to handle her treatment.

barbe1958 · August 2009

Jaye, though the comments seem harsh, I think they were made with your aunt's comfort under consideration. Surgery and recovery for something that may not be aggressive could cause your aunt unnecessary pain and even more immobility. As far as her not getting up on the table, wasn't someone in there with her? I would think she would have a family member to consult with her and the doctor. My grandmother had stomach cancer in her late 80's and they wouldn't operate. She lived another 10 years and by that time was ready to go.

Quality of life is important. The comment about her not be 47 could refer to recovery rate. They may also be worrried about her present health and not want her under anaesthetic. I'm only 51 but have turned down the reconstruction surgery as I don't think my body can handle being under for 10-14 hours with the pre-existing medical conditions I have.

I think a second opinion is definitely in order. If only to get an empathetic answer, not a clinical one. Good luck to you both.

noni1 · September 2009

Jaye, I think that the doctor was not very upfront with you, it does seem that your aunt has other health issues that would make going under anesthesia for surgery very risky, I do not know why she did not just be truthful with you. My mother who is 80 was diagnosed with lung cancer in April of this year. Because of her age and health and the effect that surgery will have on her it was not recommended. She is however having some chemo and will start radiation this month and then she will be done by the end of the year. She has had 8 chemo treatments and had a CT last week and the chemo has slightly shrunk one tumor, but has not done much for the two others, given her age I think it is a bonus everyday to have her here. I would get a second opinion and seriously think about her quality of life. I am in the medical profession for 25 years and it is hard to see loved ones sick, it is even harder to make life altering decisions.

God Bless You

sherrymathew93 · February 2010

As a nurse I can offer a different perspective or maybe explanation of some of the Dr's comments. It is true that age is considered 640-816 with medical procedures and whether it is more beneficial to treat someone medically rather than surgically because of recovery and the risk of complications. You mentioned your Aunt can't speak but can she nod her head in understanding? If that's the case, ask her what she wants....and talk 640-822 to the surgeon again and if you feel led to, seek a second opinion. My 80 year old mother in law was recently diagnosed with a small tumor in her lung that was biopsied and 1/3 of her lung was removed and it was positive for cancer (she doesn't smoke) and the Dr did mention to her too that many die before they even realize they have cancer....this could have gone undetected for years in her. And my oncologist said that her treatment plan does depend on age due to quality of life and risk of complications..in other words, if they didn't 640-863 get it all with surgery, they would not have done chemo.

bygracealone · March 2010

My mother in law will be 100 this October. When she was 80 she had a watermelon size benign tumor removed from her abdomin. A few yrs later she fell and broke her hip. Then she had a cancerous lesion removed from her colon. She bounced back each time. At age 98 she had a double mastectomy.

We never know how a person is going to respond based on age. I will send a prayer that the best decision is made for your aunt.

Hugs, Sandra

spar2 · March 2010

I say take her to another dr and get another opinion, something is not quite right here. It makes me angry when our elderly are not treated right. Let us know how she is.

Doctor's refusal to do surgery

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