Treatment Options for Advanced Liver Cancer in Elderly Patients

Is liver cancer metastasizing and spreading throughout the body?

Dear Doctor,
My mother is 89 years old.
Last year, she was diagnosed with liver cancer, and after undergoing transarterial embolization and radiofrequency ablation, it was discovered that there were metastases, which were also treated with radiofrequency ablation.
This year, it has been found that there is widespread metastasis.
I would like to know if targeted therapy or chemotherapy would be effective.
The doctor mentioned that the cost of targeted therapy is over NT$200,000 per month, which is beyond my financial means.
Is it guaranteed to be effective? I am also considering chemotherapy, which is covered by health insurance, but I have heard that chemotherapy has significant side effects.
Given that my mother is nearly 90 years old and in poor health, would it be suitable for her? Thank you for your guidance.
Sincerely,
A Concerned Family Member

YOYO, 60~69 year old female. Ask Date: 2019/02/24

Dr. Lai Yicheng reply Oncology

Dear Sir,
Regarding your inquiry, according to the National Health Insurance regulations, there are conditions that qualify for coverage.
However, whether your mother’s physical condition can tolerate the side effects of targeted therapy or chemotherapy needs to be assessed through an actual consultation.
The effectiveness of the treatment can vary from person to person, so we are unable to provide a definitive answer at this time.
We appreciate your understanding.
If her quality of life is affected, it will depend on the willingness of the family or the patient themselves to continue treatment.
Our hospital has a Department of Hepatobiliary and Gastroenterology, and you are welcome to visit for a consultation.
Changhua Hospital cares about you.
Sincerely,
Dr.
Lai Yi-Cheng
Department of Radiation Oncology

Reply Date: 2019/02/24

More Info

When considering treatment options for advanced liver cancer in elderly patients, particularly in the case of your 89-year-old mother, several factors must be taken into account, including the patient's overall health, the extent of the disease, and the potential benefits and risks associated with various treatment modalities.

Treatment Options
1. Targeted Therapy: Targeted therapies, such as sorafenib or lenvatinib, are designed to specifically attack cancer cells while sparing normal cells. However, as you mentioned, the cost can be prohibitive, and the effectiveness can vary from patient to patient. While these therapies can be effective for some patients, they are not guaranteed to work for everyone, especially in advanced stages of cancer.
2. Chemotherapy: Traditional chemotherapy can be an option, but it often comes with significant side effects, particularly in elderly patients who may already have compromised health. The effectiveness of chemotherapy in advanced liver cancer is generally limited, and the potential for side effects must be weighed against the benefits. In older adults, the risk of severe side effects increases due to factors such as decreased organ function and the presence of comorbidities.

3. Palliative Care: Given your mother's age and the advanced stage of her cancer, palliative care should be a primary consideration. Palliative care focuses on providing relief from symptoms and improving quality of life rather than attempting to cure the disease. This approach can include pain management, nutritional support, and emotional and psychological support for both the patient and family members.

4. Clinical Trials: Depending on your mother's specific situation, you might also consider looking into clinical trials. These trials can offer access to new therapies that are not yet widely available and may provide additional options for treatment.

Considerations for Elderly Patients
- Overall Health: The general health status of elderly patients is crucial in determining the appropriateness of aggressive treatments like chemotherapy or targeted therapy. If your mother has other health issues, such as heart disease or diabetes, these could complicate treatment and increase the risk of adverse effects.

- Quality of Life: It is essential to prioritize quality of life over aggressive treatment in elderly patients. Discuss with her healthcare team about the potential benefits and burdens of each treatment option. Sometimes, the side effects of treatment can outweigh the potential benefits, especially if the expected increase in survival time is minimal.

- Support Systems: Ensure that you have a robust support system in place, including family, friends, and healthcare providers. This support can help manage the emotional and physical challenges that come with advanced cancer.

Conclusion
In conclusion, while targeted therapy and chemotherapy are potential options for treating advanced liver cancer, their effectiveness and appropriateness must be carefully evaluated in the context of your mother's overall health and quality of life. Given her age and the advanced nature of her disease, palliative care may be the most suitable approach to ensure she remains comfortable and supported during this challenging time. It is crucial to have open discussions with her healthcare team to explore all available options and make informed decisions that align with her values and preferences.

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