Relative with stage 4 PC that has spread to liver, adrenal glands and lymph nodes. He had his second of 6 rounds of Folfirinox yesterday. We were just curious what happens after all chemo rounds are done. I know he will have a CT scan that will either show the chemo has worked or not but then what happens? Is he just sent back to his family doctor? Would he have chemo again at a later date? He had his first meeting with the palliative care team the other day that has everyone upset basically as "the end" has never been talked about really. THANKS!
I'm so sorry to hear that your relative is battling stage IV cancer. I don't know for certain, but my understanding from speaking with my mom's oncologist was that as a chemo regime moves along for stage IV, the staff periodically (I think every cycle) checks CA-19-9 levels in the bloodwork to see how the chemo is working (the general hope is that the number trend would go down), and then after several months, there would be a CT scan to confirm where the cancer remains and whether it shrank. The oncologist had told us that if the chemo worked, she would just continue on that regime for another X cycles. Lather, rinse, repeat (with possible interruptions, missed dosages, etc., if she got infections, low counts, etc.) If the cancer didn't respond, a second-line treatment might be tried (i.e. completely different chemo drugs) to see if the tumors would respond to those. Her oncologist told us that when we reached a point where he was convinced there would be no more response to chemo, he would have a frank discussion with her about it and then refer her to hospice for symptom management until the end. Maybe your relative's oncologist has the same plan. They should be willing to discuss the plan of attack with the patient. It is really unacceptable that they do not lay this out for the patient if the info is requested.