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What makes the symptom free for the cancer patient in oldest old without treatment? Case Reports in a Long term care facility

Kazue Takayanagi and Yoshikuni Sato

Background: Oldest old cancer patients without treatment in our long-term-care facility, where laughter therapy is used, lived happily and longer with neither any major complaint nor individual symptoms. We would like to report on these cases.

Methods and Findings:

1 A 97 year female, with hepatocellular carcinoma, symptom free, expired by stroke. A CT showed that the tumor had grown double in size compared with its size two years ago. Tumor markers were extremely high.

2 A 79 year male with severe dementia gradually lost weight within 7 months although he had a good appetite. Abdominal ECHO and CT proved a cystic malignant tumor in the liver with cholelithiasis without symptom. High CA19-9 was noticed. He had no weight gain for four months although his appetite was the same as before.

3 An 86 year female with a long standing schizophrenia had a malignant lymphoma of the stomach confirmed by biopsy 3 yrs 3 m ago. She had severe anemia and needed several blood transfusions. Her anemia improved after the transfusions. She had a cheerful character after she suffered from herpes zoster.

4 A 95 year female, who had a right lung partial lobectomy at her 68 yr against cancer, showed left side lung mass for 4 years but was symptom-free. After 4 years, the tumor mass maintained its size but pleural effusion and thickness were seen by CT. Her high CEA suggested carcinoma of left lung.

In all cases, families preferred conservative management only as patients may not have fully understood their own physical situation. They lived happily in this facility, where laughter therapy was applied. Limitation occurs because of case reports. Epidemiologic surveys nationwide are requested.

Conclusion: There were four reported untreated cases of symptom-free cancer oldest old patients. All cases had a good appetite, cheerful, with or without dementia, and lived for an average of 2 and half years. Psychologic effects may have contributed to the symptom-free feature of the tumor. We treated several other symptom-free cancer survivors who lived happily in this facility. A further understanding of the mechanism behind this rare phenomenon may provide new strategies for management of cancer. Similarly, research on the effect of deciding on the treatment is, likewise, warranted.