Navigating and Communicating about Serious Illness and End of Life

A 71-year-old man had previously received a diagnosis of stage IV non-small-cell lung cancer that was positive for epidermal growth factor receptor (EGFR) and metastatic to the spine. The cancer responded to treatment with an EGFR tyrosine kinase inhibitor, providing the patient with an excellent quality of life for 3 years. During that time, his main priority was caring for his wife, who has dementia. The patient now has leptomeningeal disease and worsening back pain. His oncologist reports the news of the disease progression and discloses the prognosis that the patient's remaining life may be as short as a few months. Despite multiple conversations with his clinician, the patient continues to state that he hopes to live several more years and that he feels his oncologist is giving up on him. In addition to starting chemotherapy and radiation therapy and referring the patient to outpatient palliative care, how can his clinicians support him in integrating information regarding his prognosis and help him with end-of-life planning?