Caring Currents

Cancer and Dementia

Last updated: Dec 28, 2009

Day 349. Day of eating crap and feeling wreckless.
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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.