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How is your MIL feeling about this?

If it were me, I would ask again about hospice. I would also ask for a detailed, considered assessment of the pros and cons of the proposed treatment, perhaps asking for quality of life to be prioritised as a factor. Support your husband in remembering that just because treatments are possible it doesn't mean they're necessarily the best option *for your MIL.* The questions to ask are "what happens if..." followed by

we accept this treatment option
we consider other treatment options
we do nothing

I'm very sorry that she has received such a discouraging assessment. How are you and your husband coping?
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Thank you Churchmouse. We (husband, brother, mother, myself) all agree that we are going for comfort care not extending her life by any mans possible. She has a health care directive in place which states that. Letrozole will be taken to stop or perhaps even shrink the tumor. From my readings, not from the nurse practitioner, I understand this stopping or shrinking the tumor growth may prevent the tumor from ulcerating/breaking through the skin. From what I've read having the tumor ulcerate through the skin would negatively impact her quality of life. A masectatomy would serve no purpose since it has spread unless it were done because the tumor ulcerated. We are not having a body scan as the results would not change anything. Thank you for the answer on hospice. I was surprised given everywhere they know the cancer is, her age, her health directive choices, and the cancer being stage IV that they did not feel she qualified for hospice. The tumor is the size of my husband's fist. I also didn't understand being told the side effects to the Rx is photoflashes and issues with bone density. She is 87 and I would think the side effects would be more intense and well, just more. I will be thankful if all she gets is hot flashes. My MIL was happy to hear she has to take a pill for the cancer thinking it is going to stop or slow it down. She is a blinders type of person - more so with age.
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But isn't the skin already ulcerated..?

If your MIL understands the possible side effects and is much happier to be taking medication than facing surgery - which you can quite see she would be - then it's worth trying the Letrozole and seeing what happens. In that case, I'd shift gear and remember that if she struggles with it, or if it's not helping, she can always stop taking it (under medical supervision, of course, not unilaterally).

I'm extremely surprised at what the nurse told you about hospice too. Actually, surprised is a bit of a euphemism - it sounds like hooey. Why not just start again when you see the oncologist?

There is quite a lot of information online - Google "Letrozole in the elderly," otherwise you'll get too much irrelevant stuff. The bone density really isn't a worry so much because it takes years to happen; but I wouldn't dismiss the other side effects just because they're not lethal. The question is how they make her feel, and if the cure is worse than the disease... But, maybe she'll get lucky. Goodness knows she's due some good luck!

Where there's life there's hope isn't a bad attitude if it's keeping your MIL in good spirits. Just don't let it make her doctors think she's all gung-ho for heroics after all. Hope you're all looking after one another, too - this is a rough experience for everyone.
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Yes, the skin is ulcerated in spots - under the breast and there red sores on the tumor itself. But, there is the risk the tumor being as large as it can break through the skin. She would then have a very large open would. I believe it may be referred to as a fungating (sp?) tumor. That would be very hard on her emotionally and physically. I think my main issue was the nurse saying she was not critical within 6 months. With all we know and what we don't know I just am having difficulty thinking she has that much time. It is not that I'm don't want to be optimistic my personality or coping response is to be the organizer ask questions type. I am glad that you seem to agree I am not out of line to ask my brother-in-law to clarify hospice and her care with the oncologist. My husband and I will be out of the country and we will ask him to check with the oncologist on things. Got her all set up with little wrap gifts to open for each day we are gone!
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I would call a local hospice organization and ask THEIR medical staff to evaluate her. it seems unbelievable to me that someone thinks shes not eligible wit a stage four aggressive tumor
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I looked up Letrozole and found it it was also called Femara, which is given to women who have breast cancer and have gone through menopause. It's an anti-estrogen drug. Apparently the estrogen is feeding the tumor.

I was on that pill for a couple of years and had to switch to something else, for me it was not user friendly. It made you feel like you were going through menopause all over again big time. Plus other major side effects.

So I am keeping my fingers crossed that if your Mom has those side effects that they are mild for her.

If Mom just cannot handle Letrozole, ask the doctor about Tamoxifen, which is another common pill. Yes, there are side effects but not as difficult.
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