placiddrifter19 said:Thanks so much for the advice.
I was hoping maybe Avastin might be an option. The radiation oncologist says they can't target the lungs because the metastases are too widespread. My only remaining move might be to ask if Gamma Knife surgery is possible in the short term just to clear a path for chemo. As for seeking treatment abroad, honestly, I haven't had a chance to look into it yet. I was secretly hoping we wouldn't have to go that route, and frankly, I wouldn't even know where to start.
I don't know—did we have any options here in the States to take on chemo at our own expense and responsibility, and would any local oncologist actually sign off on that? To be honest, I didn't even know what "off-label" drugs were, let alone which ones might apply....
Thanks,
Best,
To undergo any kind of oncology treatment, a person needs to be in decent physical shape. Unfortunately, based on everything you’ve described, things aren't exactly leaning in that direction. I’m no doctor, but I think you absolutely need to seek out a second opinion. It’s purely to rule out the potential fallout an oncologist at a major hospital might face if they dare to prescribe an expensive therapy to a patient with advanced disease and a very uncertain prognosis... I hope you understand where I'm coming from. In our healthcare system, there's a lot of pragmatism involved; people tend to pinch pennies when it looks like a situation is sliding downhill.
It isn't just about taking personal responsibility; it’s about medical ethics and whether it’s clinically justifiable to give someone a treatment that, in a doctor's view, might cause more harm than good regarding their quality of life—which is always the number one priority. Don't get me wrong, I'm referring specifically to therapies like Sutent or Nexavar, which generally aren't used once brain metastases occur or if the patient suffers the kind of complications your dad is facing. Sometimes the benefit does outweigh the risks, and those cases are reviewed individually, where the patient signs off acknowledging the dangers. Still, the ultimate moral and ethical weight rests on the physician managing the case.
Regarding off-label use—that refers to using medications that are FDA-approved for one condition but have studies proving they work for other diagnoses. In those instances, a doctor can prescribe them if there is a legitimate, justified reason.
You won't get anywhere without a second opinion. Dr. Miller is solid; you can start with him, and he’ll give you his straight opinion on whether anything makes sense. Once you have that, take that perspective back to your primary oncologist and neurosurgeon to see if they agree and if that surgery can be moved up.
I am sending you so much strength and courage, but I also want to warn you: you might not get the answer you're desperately hoping for. Unfortunately, navigating life in these situations often means making those hard calls and accepting reality. You surely realize by now what this disease entails, and I'm sure you've already done your homework. Given his diagnosis and the available treatments, your dad has held up incredibly well for a long time—kudos to him for his grit, to the doctors for managing the treatment well, and to you all for being such a great support system. I hope he gets more quality time with you, whatever that looks like, even if it means pivoting to palliative care. If the curative specialists take that stance, please don't mistake it for giving up on him. It isn't.