What cancer treatment option would be best for my father with severe dementia?
Our dad was diagnosed with a cancercous tumor in the ureter and it's an aggressive / slow growing stage 4 type. Dad is 85 years old with severe dementia. He is in a nursing home. The doctor gave us three options for treatment. One is to do nothing and let it take it's course. Two is to surgically go in and remove the ureter and replace it with a tube as a replacement. Option three is to go in and remove the kidney. Now, with option three there's a possibility that they can do a laprascopic procedure which would mean minimal cutting. Dad is not the best patient. Last year when he was hospitalized he kept trying to get out of bed on the opposite side of where his intravenous rack was pulling it over. He pulls the catheter out and gets belligerent when the nurses try to help him. His dementia is so bad that he got out of bed to go to the bathroom and urinated in the air conditioner next to his bed. We know he is not going to be a good patient this time either. The four of us need to make a decision as to the best course of action from the three choices given. None of us wants the first option of doing nothing. My personal preference was the least invasive with the laprascopic method. If we decided on the more invasive removal of the kidney he would be picking at the bandages and the incision not to mention all of the equipment again. If they were to try and tie his hands down there would be an all out war. My question to the doctor was what kind of timeline we are talking about as far as decisions to be made. He said since it is slow growing we have time. I do appreciate his honesty with us in saying that if it were his dad he wouldn't know what he would do either. I guess I am looking for the crystal ball that we all know doesn't exist. Have any of you encountered this type of cancer and these treatment options? I know everyone is different and each case is unique. None of us kids know what the best option is. Thanks in advance for any guidance.
Expert Answer
This certainly is a very difficult decision with no obvious "right answer". I have not seen this specific situation but there are a couple of general considerations when thinking about cancer treatment in a patient with severe dementia.
The place to start is to look at his life at the moment and ask if he would wish to continue living like this if he had a choice. No matter which path you choose, how he is now is probably the best he will be. If you believe that how he lives now is not how he would wish to live, it does not mean "do nothing" but it does beg the question of how much suffering (pain, being stuck in the hospital, etc.) he would wish to undergo if the best outcome is less than what he would want.
A second point is what you already mentioned about considering not just the treatments but also how your father will react to the treatments as well as possible side effects. From your description, doing anything that puts him in the hospital will be hard on him.
One question to ask the doctors is what "doing nothing" means. Certainly he would receive medicine to treat his symptoms, nursing care, etc. These together are not the abandonment that "nothing" sounds like. It would be reasonable to ask about hospice as part of the "doing nothing".
My thoughts would be that if your father does not understand who he is or where he is, then perhaps the question to ask is the following. Assuming appropriate pain medicines and treatment of other symptoms, which path would likely (no crystal ball here) lead to the least suffering for your dad, even if it meant that his life would not be prolonged as long as possible.