Talking to Your Doctor about Liver Mets

What should you and your doctor talk about if your colon or rectal cancer has spread to your liver?

Deciding on the best way to manage liver metastases from colorectal cancer isn’t easy. It’s best done with the involvement of  multidisciplinary team of doctors and thoughtful discussion with the patient.

In developing the ASCO 2009 Clinical Evidence Review on Radiofrequency Ablation of Hepatic Metastases From Colorectal Cancer, the Expert Panel developed points for patients and physicians to consider during an office visit to learn about treatment options.

In an Appendix to their Evidence Review, the Panel wrote the following for physicians meeting with patients:

Discussion Points Between the Patient and Physician: Hepatic Resection and/or Other Treatment Options (eg, Radiofrequency Ablation) for Hepatic Metastases From Colorectal Cancer

  • State that the goal of the appointment is to make sure the patient understands all the treatment options and has all the information needed to make a choice. Ask the patient, “What are your goals for this visit?”
  • Ask the patient how much prognostic information he/she wishes to hear during the discussion and whether he/she prefers to hear risk and benefits estimates conveyed as numbers (eg, 30%) or as words (eg, very small). It is important to understand the patient’s perceptions of risks and benefits and to discuss other patient/family issues that might influence decision making.
  • Tell the patient that treatment for hepatic metastases from colorectal cancer is often performed in stages and may be ongoing.
  • Discuss the role chemotherapy may play in determining if and when hepatic resection is recommended and/or if radiofrequency ablation (RFA) or other treatment is considered.
  • Tell patients with resectable tumors that hepatic resection is recommended and the prognosis is good (5-year survival for 40% of patients and 10-year survival for 20% of patients). There are differences in survival for patients with single versus many tumors and small versus large tumors.
  • If RFA is considered for unresectable tumors, discuss which method (open, laparoscopic, or percutaneous) is indicated and whether the RFA procedure will be performed alone or at the same time as hepatic resection. Discuss imaging, surgery, anesthesia, hospital stay, and recovery issues. Consider patient preferences.
  • Any comorbidities and/or patient preferences should be discussed in detail and placed in perspective as to their effect on potential benefit of therapy versus potential risk.
  • Discuss possible complications.
  • Tell the patient about the importance of high-quality, up-to-date preprocedural imaging as well as the importance of follow-up computed tomography or magnetic resonance imaging scans according to the recommended schedule after the procedure to determine whether the tumor was completely ablated and to plan for additional treatments as necessary. Explain how the appointments will be scheduled.
  • Additional potential prognostic and predictive markers should be discussed (eg, carcinoembryonic antigen).
  • Talk to the patient about colorectal cancer surveillance and the importance of all follow-up appointments, tests, and scans. Encourage the patient to use the American Society of Clinical Oncology Colorectal Cancer Surveillance Flow Sheets to keep track of follow-up appointments.

SOURCE: Wong et al., Journal of Clinical Oncology, Volume 28, Number 3, January 20, 2010.

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