Cancer diagnosis in aging patients presents unique problems. Senior Care, Caregivers.
HomeCare London, Woodstock, Ingersoll and surrounding areas.
By DR. CRAIG EARLE University of Toronto
Mon., Nov. 26, 2018
Last week I saw a patient recently diagnosed with cancer who is also managing the challenges of early-stage dementia. Her cancer is curable with chemotherapy and radiation, so I moved to start her on a regimen which involved having an IV pump at home to deliver the drugs.
I had made sure that, given her condition, she had family or other personal support available, so someone would be able to report any side effects if they occurred. Despite these precautions, the woman got confused at one point and pulled the IV line out of her arm, leading to chemotherapy drugs spilling everywhere.
Some aging cancer patients face other health issues and might face issues of having no close family support or transportation problems. A geritric assessment is a way to help outline and deal with those issues.
On the same day I saw another elderly patient, also with a very treatable cancer, who is the main caregiver for his wife. She is also in her eighties, recovering from hip surgery and in the early stages of dementia. In addition, he has his own issues with kidney dysfunction that will affect his ability to tolerate cancer treatment. He struggles to balance his own treatment needs with supporting his wife’s chronic health conditions.
More and more I’m seeing older cancer patients having to manage the disease alongside other age-related conditions: cognitive decline, organ dysfunction and mobility issues. This poses serious obstacles for the patient, but also brings new considerations and difficult treatment decisions for oncologists like me, other care providers, and family members.
Life expectancy continues to increase in Canada and with people living longer comes the increased risk of developing diseases of aging, including cancer. While all cancer patients experience challenges with treatment and posttreatment life, older patients often find themselves in a situation of dealing with multiple medical problems at the same time.
There are promising signs in our health system as many cancer centres are starting to ask elderly patients about age-related issues or refer them to geriatricians for an assessment before starting treatment.
This extra probing can uncover crucial information. For example, we often assume that older patients will have support from family and friends to support them in their cancer experience. Often, though, relatives live too far away to see someone through a course of cancer treatment, and elderly friends have their own health challenges.
Geriatric assessments are not yet standard practice in Canadian cancer care because they require additional resources from our stretched system and may be difficult to incorporate into the cancer treatment process in a timely manner.
So older people with cancer, or their loved ones, must advocate for themselves and to establish supports as early as possible following a diagnosis. Specifically:
Ensure family and friends are aware — I have seen in my own practice that older people sometimes try to protect their family and friends by not telling them about their cancer diagnosis. In reality, this is the time when you need family and friend support more than ever. Be open and honest and look for whatever supports are available within your network. And if you do not have any feasible supports, be up front and tell your care provider as they will direct you to resources within the cancer centre or through cancer agencies.
Monitor and discuss your state of health — Keep track of any health issues you are facing and mention them to your oncologist. Have a discussion on potential effects they could have on your cancer treatment. This can naturally be challenging with cognitive decline or dementia so be sure to have a discussion with your family or caregiver to ensure they can fill in the blanks for your care providers if you are unable to do so yourself.
Discuss logistics of treatment — A recent report found that health care providers in Canada frequently do not discuss the practical aspects of cancer treatment including how a patient will get to and from appointments. This is especially important with the elderly as many no longer have their driver’s license and their children may live out of town. Be proactive and ask about what options are available. Services such as Wheels of Hope, provided by the Canadian Cancer Society, can assist with transportation to and from appointments.
Right now, there is a national engagement to modernize the Canadian Strategy for Cancer Control. Canadians with cancer and their loved ones can visit cancerstrategy.ca to share their disease experience and insights to help shape this national cancer plan.
Dr. Craig Earle is a professor of Medicine at the University of Toronto and a medical oncologist at Sunnybrook Hospital. He is also the VP, Cancer Control at the Canadian Partnership Against Cancer
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