Aging with Cancer: Unique Challenges of a Later Life Diagnosis

By Nicholas Zuk

Imagine being 75 years old, already managing the slow decline of aging. Your body is riddled with arthritis, you have to carefully watch your blood sugar levels because of your diabetes, you have high blood pressure, and your body aches all the time. Then, at a routine checkup at the doctor, some suspicious bumps lead to being diagnosed with something everyone fears: cancer. Upon learning this, most people would think about how the diagnosis will affect the rest of their lives. For elderly individuals, however, questions such as “Can my body even withstand the treatments? What happens if I can’t care for myself? Will I become a burden to my family?” A cancer diagnosis is not just a medical event that happens and passes, such as a cold or the flu. Cancer is life-altering for everyone, both physically and mentally. However, for patients at advanced ages who are already nearing the end of their lives, it can force them to face questions about their mortality, independence, and the legacy that they will leave behind. By exploring the unique challenges and emotional complexities faced by elderly cancer patients, we can gain a deeper appreciation for the struggles of older family members, friends, and neighbors we know, serving as a reminder to cherish and support our loved ones through any struggles they encounter.

            For elderly patients, a cancer diagnosis compounds the physical limitations that are common with aging, which make the body’s ability to recover diminish. As a result, treatments for cancer, such as chemotherapy, radiation, and surgery, that are difficult for people of any age to go through can be even more complex to experience for older patients. Side effects like fatigue, nausea, and immune suppression can hit harder and longer for older patients and leave them highly vulnerable. Further, when preexisting health conditions that older adults commonly deal with, such as arthritis, diabetes, or cardiovascular disease, are combined with the side effects and fatigue that come from cancer treatment, the impact can be highly debilitating. For example, if an older adult has congestive heart disease or another condition that makes surgery especially risky, then getting surgery might be complex to do because of the extended healing process that is required for the elderly. For cancer patients, these comorbidities force the difficult decision to be made to either undergo invasive cancer treatment that could put them in worse pain but possibly help them live longer or to try to live the remainder of their lives as comfortably as possible. 

Maintaining an everyday life can be extremely difficult because of the limitation’s treatments put on the elderly’s mobility, and basic daily tasks like preparing meals or walking to the mailbox can be challenging both for people of old age as well as for people diagnosed with cancer. When combined, even the most mobile and independent older adults may require mobility aids like walkers or wheelchairs. It can be challenging for people who prefer living alone but now must rely on others to remind them of their mortality and diagnosis. Additionally, elderly patients are more sensitive to medications, especially painkillers, and by taking them, they can run the risk of intense side effects that cloud their mental status (Cherry & Morton, 1989). This can be troublesome for patients who opt out of chemotherapy or radiation and choose to try to live the remainder of their life pain-free with painkillers. Sometimes, selecting either choice leads to losing control and independence, which can be difficult for many.

In addition to the physical limitation cancer can impose, a diagnosis forces elderly patients to face their mortality and answer questions about whether they will be remembered, whether they are content with the life they lived and whether the people they leave behind will be okay. Being a burden to family members or loved ones is another fear for many elderly patients. Having to rely on others for transportation, help doing household chores, or getting meals can be scary for patients who do not want to feel like a burden to others by disrupting their lives to help them. This can be even worse for elderly patients who have been caring for another aging partner, such as a spouse with dementia or Alzheimer’s, but can no longer continue due to their diagnosis and own deteriorating condition. Another issue for older patients may be having someone to confide in and speak with about their condition and their difficulties. At this age, many friends, siblings, or a spouse may have died, leading to a patient having a smaller social circle to rely on for support. This loneliness routinely leads to heightened anxiety and depression, symptoms that are already common in older adults and cancer patients (Pilleron et al., 2023). These challenges, paired with the uncertainty of the future, make patients reflect on their priorities between choosing cancer treatment and palliative care. For some, the payoff from dealing with the side effects of treatment means being able to attend a grandson or granddaughter’s wedding outweighs the pain they would be putting themselves through. For others who might have nothing left to live for, letting the cancer take its course and living out the remainder of their lives in sedation is more appealing than fighting to live. 

Beyond the effects a cancer diagnosis has on the body and mind, there are also financial and logistical burdens of cancer in old age. Even with Medicare, Medicaid, or private insurance plans, the costs of chemotherapy, radiation, surgery, and medications are prohibitive; for most elderly patients who are retired or living on a fixed income, affording these procedures and prescriptions is overwhelming. Retirees often rely on their life savings, pensions, or social security, which is not always enough to cover living expenses and treatment costs. This can result in patients cutting back on necessities like groceries or utilities to afford care, which can lead to more stress. Further, most adults with children hope to leave them some inheritance once they pass. If deciding to get treatment no longer makes an inheritance possible, then an elderly parent’s decision to receive treatment might be influenced.

Transportation is another hurdle for elderly cancer patients because, by this age, many have stopped driving due to their physical limitations, vision problems, or cognitive decline. This makes getting to and from medical appointments much more complex and often requires patients to rely on someone else to take them. Public transportation is also not feasible because it is not a suitable environment for immunocompromised patients or dealing with severe treatment side effects unless another person goes with them. Again, however, because elderly patients may not want to burden others or want to remain independent, this may result in them choosing not to attend their appointments, which can lead to worse health outcomes. If a patient lives in a rural or underserved community, gaining access to treatments and medical help can be even more complicated by the distance from urban communities.

Although sometimes difficult, it is common for elderly patients to have their adult children, other family members, or spouses serve as caregivers to help them continue living their day-to-day lives. However, this can be difficult for older people to come to terms with, especially if they spent much of their life as a caretaker raising their children, managing a household, or supporting their spouse. The reversal of this critical role can be difficult to accept because it also attacks their sense of autonomy. Additionally, older people can be stubborn in receiving help from their caregivers if they feel their care is taking a toll on a loved one. Other caregiving options, such as professional caregiving services or hospice, are often used that, while effective, can amplify loneliness for patients. A fear for many older adults is being left alone or forgotten; unfortunately, being placed in care homes or under professional care often leads to a patient’s family members not visiting as much because they may believe their family member is in good care and does not need to be visited as often (Boamah, Weldrick, Lee, & Taylor, 2021). 

            A cancer diagnosis at an advanced age can be a reflection-inducing experience that can lead patients to look back on their lives and answer tough questions about their legacy, unfinished hopes and dreams, and their impact on the lives of loved ones. At the same time, however, it can be isolating because of limited support networks, worries about whether their families will be okay once they are gone, and having to weigh painful decisions regarding receiving or continuing treatment. By understanding these patients’ struggles, we can learn to be more patient, kind, and understanding of our elders. Though it may not always be convenient to spend the extra time speaking to our parents, grandparents, or any older adult going through a challenging diagnosis, it can make a world of difference that can brighten their day and make them feel a little less alone in their battle. Time catches up with us all, and one day, we will also seek help from our younger family members and friends. By showing compassion and support now, we not only ease the journey for elderly cancer patients but also set an example of care and empathy for future generations. 

References

Boamah, S. A., Weldrick, R., Lee, T.-S. J., & Taylor, N. (2021). Social isolation among older adults in long-term care: A scoping review. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC8236667/#:~:text=Buckley%20and%20McCarthy%20(2009)%20reported,risk%20for%20becoming%20socially%20isolated.&text=Older%20LGBTQ2S+%20adults%20were%20stressed,214). 

Cherry, K., & Morton, M. (1989). Drug sensitivity in older adults: The role of physiologic and pharmacokinetic factors. Retrieved from https://pubmed.ncbi.nlm.nih.gov/2651322/#:~:text=Age%2Drelated%20changes%20in%20physiology,and%20potentially%20harmful%20drug%20effects. 

Pilleron, S., Sun, V., Ayala, A. P., Haase, K. R., Arthur, E. K., Kenis, C., … Puts, M. (2023). Loneliness in older adults living with cancer: A scoping review of the quantitative and qualitative evidence on behalf of the International Society of Geriatric Oncology Nursing and Allied Health Interest Group. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC10641442/