Friday, November 25, 2016
An older adult who is diagnosed with cancer may need help making treatment decisions. Our Geriatrics Service Chief discusses how to lend support.
- Decisions should be made based on each individual’s unique situation.
- It’s important to consider the goals of treatment as well as treatment options.
- Memory, cognitive, or other impairments should be discussed up front.
- Insurance or financial concerns are also an issue.
Assisting with decision-making is at the heart of caring for anyone with cancer. For older adults, making those choices can be more challenging or complicated than for younger people.
Whether you’re a spouse, a partner, a friend, or an adult child helping a parent or relative, you may be unsure of how you can best assist your loved one in understanding and reaching decisions about his or her care.
We talked to Beatriz Korc-Grodzicki, chief of Memorial Sloan Kettering’s Geriatrics Service, about the most effective ways to assist an older person confronted with a cancer diagnosis.
Discuss Wants and Needs before the First Appointment
According to Dr. Korc-Grodzicki, there are “no one-size-fits-all treatment decisions for the older adult with cancer — it’s all about the individual.”
In advance of a first meeting with an oncologist, it’s important to have a conversation with an older adult about his or her ability to be independent, other medical conditions, and level of social support.
You should also determine how much assistance your loved one wants or requires during that first appointment. Some people may simply want you there as a second set of ears and will be comfortable guiding the conversation on their own, while others may want or need your active participation.
Dr. Korc-Grodzicki recommends writing down everything you learn from the patient and preparing a list of questions for the doctor so you’re sure all of your concerns are addressed.
Taking notes during the first meeting with an oncologist, too, will allow you and the patient to review what was said.Back to top
Ask the Doctor about Treatment Goals
“Before making any treatment decisions, be certain you and the patient understand exactly what type of cancer he or she has and if it has spread,” says Dr. Korc-Grodzicki. Once you have that information, the next step is to ask about the goal of treatment. Is it curing the cancer, extending the patient’s life without curing the disease, or reducing cancer symptoms to give the patient a better quality of life, regardless of how long that might be?
Depending on a person’s age and general health, he or she may care more about feeling well than curing the cancer permanently. But some older adults may want doctors to do all they can to aim for a cure. Dr. Korc-Grodzicki notes that advanced age alone is not a necessarily a reason to forgo treatment that may lead to a cure or significantly extend life.Back to top
Ask about Treatment Options Too
Dr. Korc-Grodzicki recommends that you ask the oncologist these important questions:
- What treatment options are available?
- What is the goal of each treatment?
- What are the risks and benefits of each treatment?
- What are the potential side effects of each treatment?
- Will a hospital stay be necessary for treatment or can treatment be delivered on an outpatient basis?
- How often will treatment be given and how long will it last?
- Will the treatment plan affect the person’s ability to live independently?
- What treatment would the doctor recommend and why?
Older adults with cancer should not be discouraged from also considering clinical trials, says Dr. Korc-Grodzicki. A research study may offer an older adult a treatment that is not yet widely available but that may be beneficial. Your oncologist can help you and the patient understand more about your options.Back to top
Share Your Knowledge
Your conversation with the patient before his or her first appointment will help you answer the doctor’s questions about the person’s ability to perform tasks of daily living, such as bathing, dressing, and managing medications, and whether he or she will need help getting to and from treatment and other medical appointments.
If the patient will be undergoing treatment but has limited or no help at home, there are usually resources within a hospital — such as social workers and case managers — who can help with these issues.
In addition, an oncologist may ask about behavioral and mood concerns, including anxiety and depression. You should also feel free to bring these topics up.Back to top
Address the Patient’s Impairments
Older people may experience memory loss, a decrease in cognitive function, and some loss of hearing or vision, says Dr. Korc-Grodzicki. This is where a caregiver can play a critical role.
If a patient has difficulties with memory or understanding, it’s vital that the doctor be aware of this. You and the patient may need more time with the doctor than a younger person might.
If the issue is hearing, the doctor will know to speak clearly and to face the patient when talking.
If vision is a problem, Dr. Korc-Grodzicki suggests a simple solution: Ask that any instructions the patient will need to read be printed in a large, clear font.Back to top
Don’t Forget Health Insurance and Healthcare Proxy
Cancer is an expensive illness. Even if a patient has health insurance — in the case of the older adult, this is usually Medicare and possibly a supplementary health insurance policy — it surprises many people to learn how much they may have to pay out-of-pocket for cancer care.
An older patient may need help keeping track of the costs, including figuring out what’s covered and what isn’t and paying any deductibles or co-pays. There may also be other financial concerns on top of medical bills such as taking care of day-to-day expenses like groceries, rent or mortgage, and utility payments.
You or someone else will need to help set up a system for tracking costs and looking out for insurance statements.
Again, Dr. Korc-Grodzicki says, you should let the doctor know about any financial issues you anticipate may arise. MSK’s financial assistance program may be able to ease some of the burden.
If an older patient wants you to be able to speak with his or her physician, members of the care team, or Medicare and/or an insurance company, you’ll need to get the patient’s healthcare proxy. Also known as a durable power of attorney for healthcare, medical power of attorney, or healthcare agent, it lets patients appoint someone whom they trust — such as a family member or friend — to speak on their behalf.Back to top
Know the Value of Your Role
Though there are many questions that come with a diagnosis of cancer, there are many ways to help an older adult approach and complete treatment.
“Facing a diagnosis of cancer at any age is difficult, and the amount of information that comes with it can be overwhelming. It’s almost like learning a new language,” says Dr. Korc-Grodzicki.
“Caregivers can play vital and meaningful roles in helping older adults navigate the cancer experience,” she adds, “from anticipating challenges in advance to providing physical, emotional, and practical support.”Back to top