Cancer and Dementia Together -- a Deadly Situation
By Melanie Haiken, Caring.com senior editor
Cancer patients who have dementia die much sooner from their disease than those who have cancer without dementia, researchers from Moffitt Cancer Center in Tampa, Florida, announced this week. After controlling for other factors like age, tumor type, and tumor stage, the research team, led by assistant professor Claire Robb, compared cancer patients with no dementia, mild dementia, and moderate to severe dementia.
The difference was quite dramatic: Cancer patients without dementia lived an average of four and a half years; those with moderate to severe dementia died after an average of eight months. The study was published in the early online edition of the journal Critical Reviews in Oncology/Hematology.
The results are important to talk about, Robb said: “As the population ages and as treatments improve, we’re going to see more patients with both dementia and cancer."
No one knows exactly why the patients with dementia in this particular study died so much faster, but previous studies have found that patients with dementia often receive fewer cancer screenings and doctors are less likely to recommend aggressive treatment. For example:
One study found that doctors were significantly less likely to recommend a mammogram for a woman with dementia.
In another study, people with dementia were twice as likely to have colon cancer discovered only after death.
A study of breast cancer patients found that those with dementia were 52 percent less likely to have their tumors removed surgically, 41 percent less likely to undergo radiation therapy, 39 percent less likely to undergo chemotherapy -- and nearly three times more likely to receive no treatment.
What do you think: Does having dementia diminish someone's quality of life so much that they shouldn't bother with treatment for cancer?
Cancer isn't the only disease that's more deadly for those with dementia. In October, researchers reported that patients with dementia who come down with the flu are 50 percent more likely to die than those without dementia. Their hospitalizations were also much shorter, suggesting that people with dementia get to the hospital later -- when they're sicker -- than those without dementia.
And earlier studies have found that patients with dementia who have strokes are twice as likely to die from the stroke, while those who develop post-stroke dementia after a stroke have an eight-fold increase in their risk of death within two years of the original stroke.
For caregivers, this means that our natural instincts are right; when we're caring for someone with dementia, we have to be hyper-vigilant in watching for signs of illness, since it's possible that our loved ones are unable to alert us that something's wrong. And we may have to be stronger advocates to make sure our loved ones get tested and treated for serious diseases like cancer. "A diagnosis of dementia shouldn’t discourage the use of cancer screenings and appropriate cancer treatments," says Claire Robb.
Then again, people with moderate to severe dementia may find doctors and hospitals so frightening that as caregivers, we may feel it's kindest to let nature run its course. I'd love to hear your thoughts and experiences on dealing with these difficult choices.
I feel your pain. my mom has mod to severe dementia and stage 4 colon cancer. She won't eat hardly anything. She has fallen 3 times in the last week. She can't stand on her own. She can;t tell us what hurts and how she feels. It breaks our hearts. She had teh right side of her colon removed but the cancer in in 7 lymph nodes. She couldn't tollorate the cemo. We have hospice and they are a big help. I just want to make heer comfortable and as happy as possible for the time she has left' We lost dad 2 years ago as well. I just wish she could tell us what she needs and wants. It.'s sooo hard. praying for peace and comfort.
My mother was recently diagnosed with probably lung cancer. Has two masses - one is 2.2 cm. The doctor says because of the size she doesn't know what else it could be. We are not going to put her through a biopsy because she couldn't take chemotherapy or radiation. She is 90 years old. Her dementia is terrible. The doctor says the lung problem is making the dementia worse. Has anyone heard of this. We have her at home and my husband has had to pick her up out of the floor three times today. All morning she was trying to get out the door to go home. So sad.
It is illogical and unkind to force treatment on someone that has a poor quality of life. Death should be accepted as part of life and the remaining time should offering comfort and love. Families should visit, see old friends, make arragements for death. Treatment is painful, confusing and expensive. Death in our 70sand 80s should be expected. Just because we can prevent death does not mean we should.
My step-father of 30 years, who I love very much, has moderate dementia which is swiftly moving to towards severe. He has recently been diagnosed with Grade 4 skin cancer. My mother is is prime carer and my step-sister and I are also as carers, offering them constant support. My father died of cancer when I was a teen and so my mother has decided she couldn't cope with the diagnosis and prognois and has turned the big decisions/hospital appointments over to us. We discussed long and hard as whether he should receive chemo/radiotherapy if offered. We decided, as it would be purely paliative, it would not increase his 'quality' of life, it might in fact worsen the short time he has left with us. The hopsital informed us they would not be treating him with either chemo/radiotherapy, as it would not make a major difference to his prognosis and they felt it would confuse him and also diminish his remaining time. It's tough, but we feel we couldn't explain 50+ times a day why he was having to go to hospital and the constant non-stop 'breaking the news', as each time you tell him something, it's 'new' to him. We will offer him all the love and care we can and make him as comfortable as we possibly can and try and enjoy our remaining time with him.
My Dad is 91 and my mom is 81. We have been dealing with dementia and all that entails for several years now. The drs just found a spot on her lungs and she is at the oncologist as I write this. I haven't a clue where we go from here or even what my mother will say or do. She's been having some good days, but of course the bad ones are always just around the corner. Having lost my husband to cancer I know the battle ahead. His mind was clear and he could make his own decisions. I cannot imagine what my mother (a retired registered nurse) is thinking when her mind is clear. She will shut us down immediately if she thinks we are ganging up on her and getting in her business. I have read and I understand the posts here, and I thank you for sharing your thoughts. It is definitely food for thought to me. The last thing we want is to add to her anxiety.
I was troubled with this article when I read the question "Does having dementia diminish someone's quality of life so much that they shouldn't bother with treatment for cancer?" This is an inflammatory way of discussing the issue ... assuming that the choice not to do testing, procedures and surgeries is always "not bothering". As the daughter of 2 90+ parents with various conditions and mid to late stage dementia, I think the only humane thing to do is consider the quality of the days they have left and make decisions that will make them comfortable and keep their cognitive and physical abilities at the highest level possible. This often means foregoing things like colonoscopy or any invasive diagnostic procedure that only makes them go out of their comfortable environment, possibly have anesthesia that can make for big mental setbacks and creates an enourmous amount of anxiety and possibly pain. We need to face the fact that all the medicine in the world will not make people live forever, and we need to allow the physical body to pass on at some point. If you don't want them to die of the cancer they have once dementia sets in, what do you want them to die of? There has to be some consideration of quality of life and quality of death for every person.
Hugs Oreoo, careX2, kathyw, kathyw
my father is 73 and has aliz., he can no longer reconize pain, he cannot always verbalize his needs, he nearly died from a uti that went septic, 3 months later kidney stones, it took us nearly six weeks to figure out what was going on, the removal of the kidney stones was very hard on him, he thought we were being mean on purpose, denied being sick, said we were all crazy, we didn't sleep for 3 weeks, reguired min to min care, had stent in kidney for 2 weeks, he understood none of it, I will not put him throught anything like this again. no chemo, no surgery, no radiation, he doesnt understand and he thinks we are torturing him. May God help us, but you have to draw the line somewhere. The treatment scares him, he doesn't understand why we put him through what we put him through. We will be very selective in the treatments that we allow, wieghting the trauma and benefits to him.
Hugs careX2, kathyw