Sense check on medical tests on my 87 yo father

[Ilovemyshed]

Just after a sense check.. father has been showing some symptoms which after a CT scan show he has lesions on the brain “likely mets from another cancer”. There is a big lump they’ve found on his chest.

They want to do a biopsy on the lump and MRI on his brain. He is very anti anything invasive or any hospital stay.

He has a number of other health conditions which limit his life to the point he doesn’t like going out, and he is happy at home between his chair and his bed.

Given that these lesions are already affecting his speech, is it the right thing to do to go for more tests, or should we leave well alone and let it take its course, with appropriate care and support from the frailty team?

The suspicion is that he has a cancer, the lesions are secondaries, and the progression with his speech has been quite quick.

I would ask what doing the tests is ultimately for. Is it to plan treatment, which he may not want, or will it help with deciding best pain management and palliative care.

Since he does not want to do invasive tests or have a hospital stay, assuming he is competent (or you have medical PoA and are following his wishes), I'd be going for palliative care and whatever support you can get in place.

I would want to know what they want to achieve by biopsying the lesion. I suspect all it would do would put a name to something. If it were my father I would support his wish for nothing invasive and opt for symptom management/ palliative care.

You are right OP, the most important question to ask when running medical tests is "will this change the patients treatment". Simply knowing something or for "completeness of diagnosis" isn't a good reason. Especially when the test is invasive or unpleasant, in the case of the biopsy.

Personally, I think it would be beneficial to understand the location of the brain lesions to inform prognosis. I wouldn't call an MRI invasive - there's no pain, there's no recovery time needed. However, depending on where the lesions are and how much they've changed since the CT, will help understand what the prognosis is and what developing symptoms might be expected. Depending on where the lesions are, they might lead to seizures, delusions, aphasia, etc. It's helpful to understand the potential now and be able to plan what next steps might be needed than to wait for an unexpected crisis.

Also, if his speech is likely to be progressively affected, then it might be helpful to introduce assistive communication as early as possible, so he has communication tools before he loses the ability to verbally communicate.

Does he have a respect form? Thats designed to help with things like this. Do you have health power of attorney for him?

@roundaboutthehillsareshining Thanks thats helpful.

@bestbeforeyes, health POA in place

Remember health PoA can only come into effect once the patient has been found to have lost capacity to make their own decisions. Unlike the Finance PoA, a patient cannot activate the health part themselves.

Well, secondary cancers can often be treated, though they can’t be cured. It might be that treatment could help slow things down considerably.

@roundaboutthehillsareshiningyes I was merely thinking that the OP should put these things in place now if not already done to help in the future