Cancer Care in the Elderly: Challenges and Barriers
Ageing entails a greater need to care for aspects related to primary ageing (physical changes due to ageing) and to secondary ageing (ailments with risks increase in old age). Cancer risk increases exponentially with age. About 60% of cancers occur in people 65 years of age or older. Therefore, cancer is a disease of the old age. Cancer is a complex disease that must be analysed from several points of view, and special aspects need to be emphasised for the elderly.
Older people have cancer-related experiences in the past era when little information about cancer was available. Their personal and family experiences are of fear and concealment, and they relate terminal phases to being painful and full of suffering. People often retain these emotional memories and reject any new information regarding a newer understanding of cancer treatment. Persuading the elderly who experience physical problems to immediately consult a doctor is difficult. Older people often do not recogniee the usefulness of early detection or initiate healthy behaviour because they consider that their age is no longer worthwhile. In my personal practice, I notice that older people do not have proactive attitudes and often do not see the need to change lifestyles or to visit the doctor before certain changes or discomforts.
Older people came from a time when diagnosis details are not completely disclosed. For instance, doctors in the past did not explain to patients their actual condition and fatal prognosis. Although these approaches are changing, a tendency of not disclosing the diagnosis to the elderly may still be experienced. The families, especially in India, have a protectionist attitude. This attitude, which is to a good end, sometimes implies an obstacle in communication.
Anticancer treatments are sometimes devastating. It is seen that the elderly often do not consider treatment necessary because certain therapies may seriously affect their quality of life, and many consider at their age any therapy is not anymore worthwhile. A large percentage of the elderly affirm that the treatment for cancer is worse than the disease itself, and thus preferred not to receive any treatment in case of developing cancer. Majority of elderly fear chemotherapy. A substantial number believe that radiotherapy is dangerous while yet another group fears surgery. These attitudes can restrain older persons to have an early diagnosis because of fear of the consequences of treatments. Doctors need to realise the ibid issue and also that older people have other physical conditions that sometimes make them more fragile or complex. Hence utmost care is needed to design a treatment schedule which suits individual patient, rather than prescribe same treatment to all.
The most frequent psychological reactions to cancer are anxiety and depression. Age is inversely related to anxiety level while directly related to the degree of depression. Regarding anxiety, advanced age possibly leads to less extreme reactions to stimuli that lead to nervousness, surprise, discomfort, or tension. Elderly seem to accept cancer diagnosis much more calmly than young and the end of life consideration yields lower anxiety levels than in younger cancer patients.
Religious coping is a special coping mechanism common among the elderly with cancer. Patients with this coping mechanism attribute the cause and the course of their disease to religious aspects (usually expressed with phrases like “what God wants” or “I put myself in the hands of God”).
In conclusion, it is imperative that, through public education, the elderly should learn about the right attitude and knowledge to combat cancer. And it is necessary that the healthcare provider be sensitive to the developmental idiosyncrasy of elderly patients with cancer when dealing with one such patient.