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Palliative care needed – metastatic pancreatic cancer, liver mass
Hello,
I need advice on a patient with metastatic pancreatic adenocarcinoma to the liver.
History:
Previously underwent Whipple procedure.
Liver mass grew from 1.9 cm → 3 cm → ~12 cm, compressing bile ducts.
Current condition:
Biliary and ascitic drains placed; drainage is slow.
Bilirubin ~12 mg/dL, pale stool.
Chemotherapy stopped due to repeated infections, fever, and portal vein bacterial infection.
No surgery, chemo, or radiotherapy possible.
Patient is very weak, with slow body movement, but no longer experiences pain from drains.
Appetite has slightly returned.
Consultation request:
Best palliative strategies for pain, nutrition, and overall support?
Interventions to relieve jaundice or improve comfort at this stage?
Recommendations for psychological and physical support to improve quality of life?
Thank you for your guidance. 🙏
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Your experience with your patient is similar to mine. At this point in the disease progression my patient was in palliative care in the hospital. I looked into home hospice care for them. The oncologist suggested home hospice was untenable. I was advised to transfer them to a residential hospice. With help from the hospital social worker and an interview with the intake coordinator at a well known hospice I was able to transfer them there. The care they received was exemplary.
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5 Reactions@louise1963 Thank you for sharing your experience 🤍
I hope you don’t mind me asking, how is your patient doing now?
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1 ReactionHe was dying but his last days spent in the hospice were a saving grace.
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6 Reactions@dar0191298, how are you doing? How is the person you are caring for doing? Have you been able to get a referral to palliative care or is it time for hospice care?
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1 Reaction@colleenyoung Thank you for asking. I’m so sorry to share that he passed away this Monday. It’s been very difficult, but I find comfort in knowing he is now at peace 🤍
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5 Reactions@dar0191298, I really appreciate that you were able to return to let us know of his passing. Sending a gentle, albeit virtual, embrace as you navigate the next part of this voyage. I know the early days are busy with making arrangements, etc.
When you're ready and if you are in need of support now or at any time, I want to let you know about a couple of things.
Hospice support for families and loved ones: Even if your patient didn't go to hospice care, many hospices offer bereavement support. Look into the availability of creative classes, support groups or counselling available in your local area.
Here on Mayo Clinic Connect, you can join the discussions any time in the :
- Loss & Grief support group https://connect.mayoclinic.org/group/loss-grief/
💜🪻
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