Erasmus MC-Daniel den Hoed Cancer Center, University Medical Center Rotterdam, Rotterdam, The Netherlands.
J Clin Oncol. 2013 Sep 1;31(25):3056-60. doi: 10.1200/JCO.2013.49.3403. Epub 2013 Jul 29.
A 64-year-old woman with metastatic rectal cancer is admitted to the acute palliative care unit of our cancer center because of debilitating fatigue. She had been diagnosed with metastatic disease in 2009, when liver metastases were found 1 year after the primary treatment of her rectal cancer with preoperative radiotherapy and low anterior resection. Since then, she had been treated with resection of liver metastases in 2009 and 2010, palliative combination chemotherapy (oxaliplatin plus capecitabine) after the diagnosis of new liver and lung metastases in 2010, irinotecan in 2011, and then cetuximab until progression. She declined participation in a phase I clinical trial because she was afraid of experiencing adverse effects; she felt relatively well at the time. She had functioned without hindering symptoms until 2 weeks before admission. Her condition had deteriorated markedly since then. At admission, she is bedridden because of progressive fatigue. Furthermore, she complains of dyspnea and nausea and vomits approximately twice per day. She also suffers from pain in the upper abdomen, especially when rising from the bed. She is no longer able to care for her 84-year-old husband or her 40-year-old mentally disabled son, who lives with them. She is aware of her poor prognosis but is not able to share her sorrows with her family.
一位 64 岁的女性患有转移性直肠癌，因极度疲劳而住进我们癌症中心的急性姑息治疗病房。她在 2009 年被诊断出患有转移性疾病，当时在原发性直肠癌治疗（术前放疗和低位前切除术）后 1 年发现肝转移。此后，她在 2009 年和 2010 年接受了肝转移切除术，在 2010 年新诊断出肝和肺转移后接受了姑息性联合化疗（奥沙利铂加卡培他滨），在 2011 年接受了伊立替康治疗，随后接受了西妥昔单抗治疗，直到疾病进展。她拒绝参加 I 期临床试验，因为她担心会出现不良反应；当时她感觉相对良好。在没有妨碍症状的情况下，她的功能一直正常，直到入院前 2 周。从那时起，她的病情明显恶化。入院时，她因进行性疲劳而卧床不起。此外，她还抱怨呼吸困难和恶心，每天呕吐约 2 次。她的上腹部也疼痛，尤其是从床上起来时。她已经无法照顾她 84 岁的丈夫和 40 岁的智障儿子，他们和她住在一起。她知道自己的预后不佳，但无法与家人分享她的悲伤。
