Cancer and Dementia: No Easy Answers
Aging is the main risk factor for both cancer and dementia and both diseases are among the leading causes of death for older adults globally. Gratefully, the incidence of both conditions occurring in patients is rare, but rare does not mean never.
While research indicates there is an inverse relationship between cancer and dementia, meaning those who are diagnosed with either cancer or dementia are less likely to be diagnosed with the other, there are patients who do experience both, and sometimes simultaneously.
While either of these diseases can be a difficult diagnosis to live with, when experienced together, they raise unique factors that can be a challenge not only for the patient, but also families, caregivers, and treatment teams. If you or someone you love finds yourself dealing with cancer and dementia simultaneously, here are a few tips to help guide the experience:
There is no right answer for treatment decisions. Each incident of cancer and dementia occurring in a single patient is rare and unique and must be considered on its own rather than looking at statistics or a set formula or pattern of care.
Look at the whole patient when making decisions. Where does the patient live? What is the patient’s support system? Are caregivers in place and, if so, do they understand both dementia and cancer? What are the finances of the patient? Outside of cancer and dementia, how is the overall health of the patient? How will the patient experience the treatments?
Two questions must be answered before any treatment is provided. The first question to ask is, ‘How advanced is the dementia?’ The second question to ask is, ‘What is the stage, type, severity, and prognosis of the cancer?’ The answers to those two questions must be the guiding force in determining how to proceed in any treatment decisions for someone diagnosed with both cancer and dementia.
Dementia, if advanced, may be the decision maker. Patients living with dementia generally have a harder time dealing with cancer treatments, especially if the dementia is moderate or more advanced. Given that cancer treatment can be inconsistent, time consuming, physically challenging, and involve frequent trips back and forth from the hospital for tests, those things may be too difficult to manage or even tolerate for someone with moderate or advanced dementia.
Focus may be on one disease, not both. Because each of the diseases is different, the treatments for each disease may complicate the status of the other disease. It is entirely reasonable that it is decided that only one of the diseases will be addressed rather than trying to treat both.
In a different era, it would have been common for doctors to make all the treatment decisions in a complicated situation like caring for a patient with both cancer and dementia. These days, it is more common and expected for a patient or their family to help determine how to proceed and what the treatment priorities should be, including putting a greater emphasis on the patient’s quality of life. The combination of juggling both cancer and dementia can be physically, mentally, and emotionally overwhelming for everyone involved.
Srilata Gundala, MD is a hematologist/oncologist and founder of Hope & Healing Care Centers in Lombard and Hinsdale, Illinois. She is familiar with the toll on patients, families, and caregivers when faced with complicated situations like trying to prioritize between two different diseases, “There are no right or wrong answers in these difficult situations. The best advice I can provide families is to let the patients be their guides. Ask questions, be your loved one’s best advocate, and think about their comfort and well-being.”
Written By: Sheila Quirke, MSW
Reviewed By: Srilata Gundala, MD
