SHM Converge Scientific Abstract ePoster Gallery-The Cost of Uncertainty: Fragmented Decision-Making in Advanced Cancer Care

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This case highlights the challenges of fragmented decision-making in advanced cancer care when prognosis is uncertain. A 67-year-old woman with no significant past medical history presented with newly diagnosed metastatic lung adenocarcinoma. Early imaging also showed a pelvic mass abutting the adnexa, raising concern for a second primary ovarian malignancy. Multiple services were involved, including gynecology-oncology, surgical oncology, medical oncology, interventional radiology, and colorectal surgery.<br /><br />Several procedures were considered or attempted to clarify the diagnosis and guide treatment. A planned hysterectomy with bilateral salpingo-oophorectomy was cancelled because the pelvic mass might also be metastatic disease. A pelvic lymph node biopsy was inconclusive. A later biopsy of a perisplenic lesion confirmed metastatic high-grade lung adenocarcinoma. Follow-up CT of the abdomen and pelvis showed rapid progression of the pelvic mass with invasion into the sigmoid colon, associated with gas, stool infiltration, and central necrosis.<br /><br />As the patient’s condition worsened, including declining mental status and a septic picture, the teams held differing views about prognosis and goals of care. Colorectal surgery estimated survival at weeks to months, while medical oncology felt she might live around 12 months if chemotherapy were started. A diverting ostomy was planned but ultimately cancelled. The patient was started on alectinib, but she transitioned to comfort-focused care within days and died shortly thereafter.<br /><br />The case underscores how lack of consensus among treating teams can delay clear communication, limit timely palliative care involvement, and complicate advance care planning. It emphasizes the importance of early multidisciplinary alignment and goals-of-care discussions, especially for patients with intermediate prognostic uncertainty.

Asset Subtitle

Sahana Holla

Meta Tag

Author List Luay Mousa, Sagar Prabhu, Sahana Holla, Tricia Keller

Category Clinical Vignettes

Concept Advanced Cancer

Concept Prognostic Uncertainty

Concept Palliative Care

Concept Advance care planning

Concept Metastatic Disease

Distinguished Non-Finalist

Presenter Organization The Ohio State University Wexner Medical Center, Department of Internal Medicine

Presenting Author Sahana Holla

Track Adult

Keywords

metastatic lung adenocarcinoma

advanced cancer care

fragmented decision-making

uncertain prognosis

multidisciplinary care

pelvic mass

ovarian malignancy differential

biopsy

sigmoid colon invasion

palliative care

Advanced Cancer

Prognostic Uncertainty

Palliative Care

Advance care planning

Metastatic Disease