Expert: Claes-Gustaf Nordquist, M.D. - 11/14/2010

Question
My father (aged 71) was operated on for a GBM in early July 2010.  He suffered a stroke during surgery and had one month of rehab before six weeks of radiotherapy. Radiotherapy finished in September and he has not been out of bed since treatment finished. Dad is now incontinent, can not feed or bathe himself and is unable to stand or walk. He "rests" all day with his eyes closed.  We are not sure if he is resting or asleep. He has been like this for the last three weeks with a rapid decline in the last 7 days. Should he be on morphine now (as he does complain of pain) as he is currently only on codeine. Also, do you think that his current state is indicative of the final stages and if yes, how long do you think he may have.  Kind regards Louise

Answer
My evaluation suffers from the fact that on top of his surgery he also suffered a stroke during surgery. That does complicate my evaluation very much. Normally since ALL GBM tumours have a very bad prognosis regardless of treatment I would tell you that survival time after all treatment has been done is around one year and when the patient sleeps all the time the end is near. But in this case I can hardly do that. Furthermore, since he complains of pain he is hardly yet asleep all the time. Still, his prognosis is bad and his remaining life span can most probably at most be measured in months. With this bad prognosis there is no reason for him to suffer so I think there is no reason to avoid the use of morphine! More than that I can not say. I'm sorry I have nothing better to tell you!


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