Dear Carol: My mom has been undergoing cancer treatment for months and her latest tests show stability which satisfies the oncologist. Unfortunately, this doctor only sees Mom’s cancer and has zero insight into her as a whole person.
Mom had early-stage dementia before treatment, but her thought process has gotten so much worse that we'd like to take her off her cancer medication for a while to see if her mind clears up. The family feels that even if this is a temporary option, she may improve enough to help us make decisions for her future. We’re also looking into hospice care but she’s too confused to understand her options. Your column has been helpful to me over the years, so I’m looking to you for help. — LW.
Dear LW: I’m sorry to hear that your mom is going through this. This is hard for you, too, I know, so I’m impressed with the way that you are handling a situation that will require medical trade-offs.
Unfortunately, your mom’s oncologist isn’t unusual for having tunnel vision when it comes to her health. To be fair, specialists have studied a long time to learn to help people in their field. However, while there’s progress in this area, there's still room for many specialists who don’t regularly work with older adults to learn to communicate better with geriatricians or other doctors who understand the concept of different treatment criteria for adults in your mom’s age group.
You’re right that many drugs have negative effects on cognition and that includes some cancer drugs, so stopping the drug could be an option. Input from a geriatrician would be ideal, but an internal medicine specialist who routinely works with older adults can be a good alternative. While seeing a memory specialist may also be helpful, your mom’s primary doctor should anchor her care provider team.
It’s common for older adults to need to make, or have made for them, hard but necessary choices about treatments and medications. Often, there are trade-offs such as the one that you are considering. You mentioned hospice and this, too, would depend on working with a doctor who can look at your mom as a whole person. Perhaps, with the doctor’s help, you can have her taken off the drug and that may help your mom’s mind clear up enough for you to learn more about her wishes. If her thinking doesn't improve, you’ll need to do your best with what you’ve known about her beliefs in the past.
Your mom’s doctor would decide if your mom qualifies for hospice care at this time. Even if she doesn't, it’s still a good idea to contact your local hospice organization(s) to learn more about how they can help your mom when the time comes that she’s ready for their care.
The bottom line, which I believe you already understand, is to work with a doctor who considers all aspects of your mom’s health and her daily life. Together, you can determine what’s right for her.
Carol Bradley Bursack is a veteran caregiver and an established columnist. She is also a blogger, and the author of “Minding Our Elders: Caregivers Share Their Personal Stories.” Bradley Bursack hosts a website supporting caregivers and elders at www.mindingourelders.com. She can be reached through the contact form on her website.