Walter Thompson

Patient Snapshot: Walter Thompson, DOB 02/11/1944, 82-year-old male with Stage IV gastric adenocarcinoma (peritoneal carcinomatosis and hepatic metastases), now transitioning from disease-directed treatment to comfort-focused care.

Narrative Summary: Diagnosed 11/2025 after presenting with early satiety and iron-deficiency anemia; completed two lines of palliative chemotherapy (FOLFOX, then ramucirumab/paclitaxel) with radiographic and clinical progression. Course marked by progressive cachexia, an estimated 18 lb (11%) weight loss over the past three months, and worsening performance status. Palliative chemotherapy was discontinued 05/2026 due to poor tolerance and declining function.

Recent Context: ED visit 05/28/2026 for intractable nausea and dehydration; managed with IV fluids and antiemetics and discharged home the same day with a hospice referral. No inpatient admission was pursued, consistent with the patient's stated goals.

Social & Environmental: Lives with his spouse (primary caregiver) in a single-story home; adult daughter lives nearby and is engaged in care. Full-code status was revised to DNR/DNI on 05/12/2026 after a goals-of-care discussion.

Potential Decline: Trajectory is consistent with end-stage malignancy: PPS has fallen from 60% to 40% over roughly eight weeks, oral intake is reduced to a few bites per meal, and the patient is now largely homebound.

Key Events: Two acute care encounters in the last 60 days (05/03 and 05/28) for pain and dehydration; palliative chemotherapy discontinued 05/2026; hospice referral initiated on discharge.

Trend Clarification: A stable body-weight reading in mid-April is misleading — it reflects new ascites rather than true nutritional stability; dry weight has continued to fall. Albumin is 2.6 g/dL and CA 19-9 is rising across the last two draws.

Potential Primary: Malignancy — gastric adenocarcinoma, Stage IV — is the best-supported primary hospice diagnosis given metastatic disease, discontinued disease-directed therapy, and functional decline.

LCD Criteria Reference: Consistent with LCD guidance for hospice in malignancy: metastatic disease with a declining PPS (40%), progressive involuntary weight loss, hypoalbuminemia (2.6 g/dL), and cessation of anti-cancer therapy. Supports a prognosis of six months or less if the disease follows its expected course.

Relevant imaging: CT abdomen/pelvis 05/10/2026: peritoneal carcinomatosis, multiple hepatic metastases, and moderate ascites — progression versus the 02/2026 study.

Secondary conditions: Cancer-related cachexia, chronic kidney disease stage 3, hypertension, and type 2 diabetes mellitus (now with reduced oral agents given poor intake).

ADLs: Requires assistance with bathing, dressing, and toileting; ambulates only short distances with a walker and rests frequently. PPS 40%, ECOG 3. Declining ability to perform activities of daily living is a key hospice-eligibility signal and is trending downward week over week.