Cancer and Alzheimer's Disease: When Do We Treat It and When Do We Let Go?
A friend recently came to me in tears with the news that her mother, who is in mid-stage Alzheimer's, had just been diagnosed with breast cancer. My friend was beside herself with grief, mostly because she didn't know what to do. She felt the full responsibility of making the decision to treat or not to treat her mother's cancer was on her shoulders.
I had a few suggestions for her, but only she and her family can decide what the next best step is.
- I asked her if she'd talked to her mother's doctor at length about how fast the cancer is expected to grow, what possible side effects the surgery could have, how strong her mother is physically and the likelihood of damage or death from the anesthetic.
- I suggested that the next step should be to talk with her siblings about their memories of their mom. Surely, somewhere along the way, her mother would have given some indication of her core beliefs of how far she'd want to family to go if she found herself in certain situations. During all of my years of caregiving, I relied on my memories of the decisions my parents made for their parents - my grandparents. I knew they loved their parents and would have made decisions based on what they felt their parents' would have wanted.
- I asked her if her mother could understand anything about what is going on. Mid-stage Alzheimer's isn't a fixed state. People can move back and forth in their clarity and between identified stages. If her mom has some times of significant clarity, then she can tell her mom what is going on, lay out the choices and ask her mom what she wanted to do.
My mother had some dementia (not Alzheimer's) when she was told she'd likely need surgery to prevent colon cancer from growing. Colon cancer is generally slow growing. Mom was very frail physically, and knew that she couldn't withstand the colonoscopy tests, let alone surgery. I told her I'd stand by her with whatever decision she made.
Mom chose to do nothing. Her cancer wasn't a huge issue until many years after that time, when her dementia had worsened and many other health issues made her life miserable. For her, I believe it was the right decision. We were fortunate in that she was cognitively capable of making that decision herself. During her last months, when pain was becoming unbearable, she went on hospice care and lived peacefully until death took her.
My friend and her family decided, after much discussion and several talks with the doctor, to leave her mother's cancer alone. They all felt that this type of breast cancer, considered slow growing by the doctor, would not be an issue before her mother died of other causes.
No Two Cases Alike
A colleague and his family made a different choice. This man's mother had serious lung issues, though she was mentally sharp. After the mother was diagnosed with breast cancer at the age of 85, the family - in conjunction with the mother - decided to go ahead with conservative surgery. My friend's mom came out of surgery fine and later died from her lung disease. Did the surgery hasten her death? There's no way to tell. But she did live for many months afterward.
These decisions are very, very difficult to make. Surgery is risky for anyone. As we age, it becomes more so. If we are frail, the risk rises. Yet, for some people, the choice to go ahead with surgery that may arrest cancer is the right choice.
If an elder is strong and vital, he or she should likely go ahead with surgery, since that person may yet have many healthy years left to live. Trusting the doctor is vital in these situations, so I'd suggest getting a second opinion. Then, if everyone is onboard, surgery could be the right answer.
The caregiving road is full of twists and turns. Hard decisions are made by many of us, even as we second guess ourselves along the way. Those of us with a base of faith often turn to that source for guidance. But all of us feel the pain of making choices for another person who may or may not be able to give reliable guidance as to what he or she would really want us to do.
Do your best, my friends, with your loved one's interest at heart. Then, go on knowing that you have done your best. Your best is all you can do.