Abstract | April 9, 2023
A Case of Significant Life Prolonging Care of Advanced Colorectal Cancer — Comprehensive, Integrated Palliative Care of a Young Adult Woman
Learning Objectives
- 1. Describe the medical challenges of advanced stage colorectal cancer in younger patients
- 2. Enumerate the goals and benefits of palliative care for patients with advanced or severe diseases
- 3. Consult or refer patients to the palliative care team for holistic, integrated advanced disease treatment
Introduction
Colorectal cancer is increasing in incidence and death rates in younger adults, but physicians may find it challenging to treat younger patients with advanced disease. This case report highlights the importance of palliative care integration into the treatment of young cancer patients.
Case Presentation
T.D., a 30-year-old caucasian woman, presented to an outside hospital in January 2021 for abdominal pain and nausea. After a prolonged workup, she was diagnosed in June 2021 with stage IV rectal adenocarcinoma with pelvic metastases complicated by recurrent transient partial small bowel obstruction (SBO), pain crises, and frequent hospital admissions in the setting of peritoneal carcinomatosis. Her social history included being a single mother of a 4-year-old child, unemployed, and with limited funding at the time of her cancer diagnosis. In September 2021, the palliative care team began a multifaceted approach to her care. With her and her family, palliative care discussed symptom management, advanced care planning, and goals of care while also coordinating palliative chemotherapy. A venting gastrostomy was placed which successfully improved quality-of-life and decreased admissions for SBOs. The patient was initially prescribed opioids for pain management, but they were ultimately inadequate. Chronic opioid use was a concern for exacerbating gastrointestinal dysmotility and contributing to her pain. Instead, an intrathecal pump was placed, successfully reducing her pain. Palliative care worked closely with the patient and her family during this time to provide extensive support, including assistance from social work and spiritual companionship from chaplains. As a result, the patient scored favorably given her condition on the Palliative Performance Scale and had a period of no admissions for several months. By May 2022, the patient and her family agreed to initiate comfort care and was transferred to inpatient hospice where she passed away in June 2022. Diagnosis
T.D. was diagnosed with stage IV rectal adenocarcinoma with pelvic metastases.
Outcome
With the combined efforts of the multidisciplinary palliative care team, the patient lived for 12 months after initially being diagnosed. Palliative care offered substantial benefits to her quality-of-life and survival while amplifying her goals and wishes throughout the course of their care.
