Abstract
Abstract: For planning the therapeutic strategy, patients need to be aware of their diseases and fully cooperate with medical staff. This is especially true of patients with poor prognosis such as cases of multiple cancer.
We report here a case of synchronous multiple cancers (acute myelocytic leukemia, esophageal cancer and gingival cancer), who was failed to establish a good doctor-patient relationship.
A 69 year-old Japanese man was admitted to the emergency department of our hospital with a chief complaint of malaise and dyspnea. He was diagnosed as having myelodysplastic syndrome, and upper endoscopic examination and chest CT images revealed an esophageal cancer with metastasis to a regional lymphnode. Radiation therapy had started because he had rejected both chemotherapy and surgery. Two months after the beginning of radiation therapy, a following chest CT showed a metastatic tumor at the right costa and oral examination revealed a squamous cell carcinoma of the left maxillary gingiva. Radiation therapy for the gingival carcinoma had started, but soon had to be discontinued, since bone marrow evaluation showed transformation to acute myelocytic leukemia and imaging modalities revealed metastatic liver tumors and a pathologic fracture of the right femoral neck. Then skin papular eruptions and a hard tumor developing from the clavicle were recognized. The patient gradually weakened and died 7 months after admission. He had lived alone and had been estranged even from his key person. Although we educated him on diet and abstinence from drinking, he did not follow our instructions.
In conclusion, although establishing a good doctor-patient and doctor-patient's family relationship is mandatory for planning the therapeutic strategy, the present-day increase of the elderly population makes it more difficult, but more important than previously.
