Managing Colon Tumors in Elderly Patients with Parkinson's Disease

Colorectal tumor + Parkinson's disease + elderly age

Dear Dr.
Ke,
My mother is 83 years old and has a history of Parkinson's disease for about 20 years.
She has lost her ability to move independently and requires assistance with feeding (not via a nasogastric tube).
Recently, she has been unable to eat for several days due to bowel obstruction and has not had a bowel movement.
After being hospitalized for treatment to relieve the obstruction and undergoing a colonoscopy, a tumor was found in the transverse colon near the liver, completely obstructing the bowel, making it impossible to assess the condition of the ascending colon.
Currently, she is still unable to eat (with medical advice to refrain from eating) and is only receiving nutritional intravenous therapy to maintain her strength, with no bowel movements.
Given my mother's condition, would surgical removal of the tumor be the best option? She is opposed to ostomy and surgery.
If we rely solely on nutritional intravenous therapy, is this feasible under the current health insurance system?
I apologize for taking your time, and I appreciate your help.
Sincerely,
A concerned family member who just wants to alleviate my mother's suffering.

Mr. Yan, 50~59 year old female. Ask Date: 2020/05/01

Dr. Ke Fangxu reply Surgery

The issue of colorectal tumors is quite complicated because if surgery is not performed, it can lead to bowel obstruction, resulting in an inability to eat.
Of course, if the patient is elderly and has underlying health issues, the physician should understand the decision not to pursue surgical treatment.
However, to resolve the obstruction, surgery is indeed the only option.
Since the tumor is located in the transverse colon, it should not require a colostomy.
If surgical treatment is not considered, palliative care must be contemplated.
As for how long this situation may last, it is difficult to predict.
Personally, I believe that health insurance is not the main issue; rather, it is the family's distress in watching their elderly loved one suffer over time that is truly agonizing.
Ultimately, whether to choose surgical treatment or palliative care should be a decision made collaboratively among the patient, family members, and the healthcare team to reach a consensus.

Reply Date: 2020/05/01

More Info

Managing colon tumors in elderly patients, particularly those with Parkinson's disease, presents a unique set of challenges that require careful consideration of both the medical and ethical aspects of treatment. In your mother's case, at 83 years old and with a long-standing history of Parkinson's disease, the situation is further complicated by her inability to eat independently and her recent bowel obstruction due to a tumor in the colon.

Surgical Considerations
When evaluating whether surgical intervention to remove the tumor is the best course of action, several factors must be taken into account:
1. Overall Health Status: The patient's age and comorbidities, such as Parkinson's disease, significantly affect surgical risk. Elderly patients often have decreased physiological reserves, which can complicate recovery from surgery. In this case, your mother’s advanced Parkinson's disease and lack of mobility may increase the risk of postoperative complications.

2. Tumor Characteristics: The location of the tumor (near the liver in the transverse colon) and the degree of obstruction are critical. If the tumor is causing a complete obstruction, it may lead to severe complications such as bowel perforation or ischemia, which could be life-threatening. Surgical removal may be necessary to alleviate these risks.

3. Patient Preferences: Your mother’s expressed reluctance to undergo surgery or have a colostomy should be respected. It is essential to have open discussions with her about her wishes and quality of life considerations. If she prefers to avoid invasive procedures, this should be factored into the decision-making process.

4. Palliative Care Options: If surgery is deemed too risky or if your mother refuses it, palliative care should be considered. This approach focuses on providing relief from symptoms and improving the quality of life without aggressive curative measures. Nutritional support through intravenous fluids may be necessary, but it is crucial to discuss the implications of long-term reliance on such measures.

Nutritional Support and Quality of Life
In cases where surgery is not pursued, managing nutrition becomes paramount. Intravenous nutrition (TPN) can sustain life, but it does not replace the benefits of oral intake, such as the enjoyment of food and the social aspects of eating. Long-term TPN can lead to complications, including infections and liver dysfunction, and may not be sustainable indefinitely.

Ethical Considerations
The ethical dilemma of choosing between surgical intervention and palliative care is significant. It is essential to involve the healthcare team, including surgeons, oncologists, and palliative care specialists, in discussions to ensure that all aspects of your mother’s health and preferences are considered. A multidisciplinary approach can help in formulating a care plan that aligns with her values and goals.

Conclusion
In summary, the decision to operate on an elderly patient with Parkinson's disease and a colon tumor must be made with careful consideration of her overall health, the risks of surgery, her personal wishes, and the potential for palliative care. Engaging in open discussions with her healthcare team and ensuring that her preferences are respected will be crucial in navigating this challenging situation. Ultimately, the goal should be to minimize suffering and enhance her quality of life, whether through surgical intervention or supportive care.

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