Ovarian Cancer case study transcript
Jane’s Story
Meet Jane – Scene 1
Jane: I’d always known I could get ovarian cancer, because mum died of it when I was in my teens. With her being Ashkenazi Jewish they gave her the test and she had the genes. I was never really sure about getting the test but I made sure that I had regular screenings and blood tests and scans of my ovaries. Guess I thought that they would be able to pick it up early but I have stage III disease. I suppose looking back I did have some symptoms. I was more tired than usual but that is hardly surprising with two kids and working full time. My bowel was a bit different to normal but I just figured that it was my diet. This has really frightened my two sisters. Sheila the eldest is going to have the test and if she has got the gene she is going to have her ovaries removed. I feel so lucky that my two kids are boys…
Jane Returns Home Post-surgery – Scene 2
Jane: just got back after having the surgery. It’sreally good to be home. The hospital was quite a distance from where we live so it was quite hard for Andrew and the kids to come and visit. I can’t move very well because I’ve got a cut running up and down my stomach which hurts when I move, laugh or cough. The surgery wasn’t too bad, for a few days afterwards I was attached to all sorts of tubes and drips so it was difficult to get out of bed. Thankfully I didn’t need to have a bag – I was really worried about that.
Support for Treatment Decision Making – Scene 3
Jane: Just been to see a doctor about chemotherapy which I’m going to start next week. He talked about a couple of trials that are happening, one involving having the chemo directly into the stomach and there’s some new drug – targeted therapy I think he called it. I’ve decided to just have the normal treatment – it felt too hard to try and decide about which trial I should be on. I am scared about being sick because my mum was really ill with her chemo. The doctor said that the anti- sickness drugs are much better but that I will lose my hair. He also talked about pins and needles in my hands and feet, tiredness and a whole bunch of stuff that I can’t really remember. Just felt like a lot to take in all at once.
It sort of seems like it’s going to be a really long time before things get back to normal. Months and months of chemo. Not really sure how we’re all going to cope. I’m scared that the kids are going to have trouble adjusting to my not having any hair.
Jane’s Issues Following Treatment – Scene 4
Jane: Can’t believe it’s finally all over. I wasn’t expecting to feel so drained by it all. I thought that once the chemo was finished life would pretty much go straight back to normal but the tiredness is really hanging around and I am finding the pins and needles in my hands and feet really irritating. It’s actually quite painful at times but also feel like I’m walking on a layer of cotton wool and it’sreally hard picking up things or fastening buttons as my finger tips are numb. I didn’t realise that the hot flushes would be so bad. Feel like a seventy year old walking around in the body of a thirty six year old and forget sex – I think that was something I used to do for fun! Now everything is settling down I’m starting to think about not being able to have another child. I’m so grateful for my two boys but I always wanted a little girl…
The Impact of Relapse – Scene 5
Jane: Ovarian cancer is so bloody unfair. On my third different type of chemo and back playing the waiting game. My whole life is a roller coaster. Life goes on hold when I’m back on treatment but strangely I feel safer and happier when I’m on chemo – because at least something is being done to deal with the cancer. When I’m not on treatment I worry about the cancer cells multiplying with nothing to control them. I can’t sleep the night before I see the doctor. All my emotions relate to whether my CA 125 is rising or falling. I know it’s only one piece of the puzzle but I can’t help but be fixated.
Introducing Palliative Care Consultancy – Scene 6
Part 1 (Meeting Palliative Care Team)
Dr: Jane I’m glad you were able to come in today, it gives me a chance to get to know you a little and just find out how you’re feeling at the moment.
Jane: I‘m in the middle of another lot of chemotherapy with Dr Smith and he suggested it would be a good idea for me to come and see you because I’m having trouble with my bowels and he said that you specialised in those particular problems and that you might be able to help. He did say that you were a palliative care specialist that’s frightened me a bit. I’m worried that he’s not going to want to give me any more chemotherapy and that I’m going to die.
Dr: I can understand how you must be feeling about that. I think it’s important for you to understand that you know Dr Smith is looking after your chemotherapy but I’m part of a ….like himself a bigger team involved with your care. And I’m here to really help you with some of those problems, some of the ones that you’re experiencing now or may experience in the future. I look after people for a long time, people like yourself for months, sometimes years. And I think what we’ve got to focus on is getting you to feel a little bit better so that you can get on with your life. So right at the moment if I was to be able to help you with one problem would it be what you’ve been talking to me about with your bowels? Or is there something else that is more troublesome for you at the moment?
Jane: The pain in my stomach because it’s there pretty much constantly.It’s like a dull ache but then every now and then I get really sharp pains that make me cry out.
Management of Late Stage Symptoms – Scene 7
Part 2 (18 months later in the hospice)
Andrew: What are we going to do? She’s getting worse and worse and she hasn’t eaten anything properly for weeks. Is she going to starve to death? Why can’t she see Dr Jones again and have more surgery.
Nurse: Unfortunately the cancer is now at a stage Andrew where further surgery is not going to help.What we can do though is manage the bowel obstruction a bit differently. So we are about to start Jane on a new combination of medications. So that will help reduce the pain, the nausea and the amount that she vomits. In terms of eating she’ll probably just want to eat very small amounts of the things she likes so just to be able to enjoy the taste of her favourite foods in her mouth.
Andrew: But what about drinks? I mean she’s getting thirsty and dehydrated and can’t you put a drip in her?
Nurse: Unfortunately the drip just tends to make things worse. It tends to make people vomit more often. Even though she’s got that feeling of a dry mouth it’s not actual thirst. So what we suggest is frequent sips of fluid, icy poles, pieces of frozen fruit. So people just get the taste of that in their mouth.
Supporting End of Life Preferences – Scene 8
Jane: It’s got to a point where there’s nothing more we can do to control the cancer. I’m now getting my drugs through a little needle that sits under the skin and I’ve had a special tube in my stomach. It means that I can eat what I want and it then drains out through the tube so I’m not sick. Great to be able to have a bit of pizza with the kids. We had a long talk about whether I wanted to go home. But I feel quite settled here and the kids can come in and out. Although the idea of being at home surrounded by familiar things is nice, I don’t want the kids to associate their home with me dying or to have my home turned into a hospital room with beds and commodes and people coming in and out all the time. And at least Andrew can stay here over night.
EdCaN Case Based learning resource transcript – Ovarian Cancer
© Cancer Australia 2014