Breathlessness with pulmonary metastases: a multimodal approach

Area of Science:

• Oncology
• Palliative Care
• Medical Case Study

Background:

• A 58-year-old breast cancer survivor developed a second cancer diagnosis of malignant melanoma.
• The patient experienced multiple recurrences, including lung and liver metastases, significantly impacting her quality of life.

Purpose of the Study:

• To illustrate the clinical course of a patient with recurrent malignant melanoma.
• To highlight the challenges and strategies in managing complex symptoms such as breathlessness, pain, and anxiety in advanced cancer.
• To emphasize the role of multidisciplinary symptom management and palliative care in end-of-life care.

Main Methods:

• The case study details the patient's diagnostic process, including imaging (CT, MRI, PET scans) and surgical interventions.
• Treatment modalities discussed include stereotactic radiosurgery, ipilimumab, and subsequent palliative interventions.
• Symptom management involved pharmacologic (duloxetine, lorazepam, opioids) and non-pharmacologic approaches (fan therapy, relaxation exercises, positioning).

Main Results:

• The patient initially responded to stereotactic radiosurgery but experienced disease recurrence and progression.
• Symptom management interventions provided partial relief, but breathlessness and pain remained significant challenges.
• The patient ultimately received hospice care, with opioid titration and patient-controlled analgesia (PCA) for symptom control at end of life.

Conclusions:

• Malignant melanoma can present as a second primary cancer, requiring vigilant monitoring and management.
• Effective symptom management, including pharmacologic and non-pharmacologic strategies, is crucial for patients with advanced cancer.
• Palliative and end-of-life care are essential for ensuring comfort and dignity in patients with progressive disease.