1. Case Study Debra is a 67-year-old female of Italian descent. She...
Case Study
Debra is a 67-year-old female of Italian descent. She was diagnosed with stage IV non-small
cell lung cancer (NSCLC) that has metastasized to her bones a year ago. In the past year, she
was treated on a therapeutic randomized clinical trial, which consisted of standard
chemotherapy and immunotherapy. When her cancer responded poorly to the therapy, she
was randomized to receive additional "experimental" chemotherapy.
Debra and her husband, Robert, live in a house they have owned for 30 years. Debra was a
counselor and had a private practice until she was diagnosed with lung cancer. Robert
owned a construction company, which he sold two years ago. He has had diabetes for more
than 20 years and had one foot amputated three years ago. Debra was Robert's primary
caregiver before she was diagnosed with lung cancer. Both of them were very active in the
community, hosting weekly "Tea and Culture Lovers" event at their house.
Debra has a very close relationship with her oldest son Michael (40 y.o.), and he has been an
active participant in every treatment conference. Michael lives 5 miles away from his
parents, and has been coming to visit his parents daily since she was diagnosed. Michael
reduced his working hours and withdrew from a few projects as a construction manager to
allow more time to care for his parents. Michael used to bring his 11 y.o. daughter to visit as
well. Debra enjoyed having her granddaughter around. However, his daughter has been
"acting weird" lately and does not want to visit her grandparents.
For the most part, Debra tolerated the treatment; however, she struggled both physically
and emotionally with the last 3 months of treatment. Debra's end-of-therapy scans
confirmed that tumor was still present in both the bone and the lungs. Michael wanted to
proceed with an (unproven) experimental therapy in an effort to prolong her life. Debra, on
the other hand, did not desire this intervention. She asked the doctor not to administer the
drug and to allow her to die on her "own terms" at home. She does not want to be a burden
on the family.
Debra and Robert have two daughters, Jenny and Stephanie, who live in other states. They
flew in two days ago to see their mother, after Debra was admitted to a progressive care
unit as she fell at home and broke her left hip. Jenny still would not talk to her father
because she thinks Debra has lung cancer because of his long-term smoking habit.
Stephanie is a nurse. She is upset because she insisted before that her mother should be put
in a care facility rather than living at home with Robert, but nobody in the family agreed.
The hospital's palliative care team came earlier today and wanted to talk to the family, but
2. Michael refused and would not allow his sisters to talk to them either.
https://acsjournals.onlinelibrary.wiley.com/doi/10.1002/cncr.21489
https://www.sciencedirect.com/science/article/abs/pii/S0029655414002061
