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Before her surgery, my mother said she wouldn't treat it if she had cancer. But in front of the doctor, she said yes. The tumor was very large (11 inches) and wrapped around several organs. She weathered the surgery like a champ. Still waiting on the pathology report, which has been sent to Stanford. The type of tumor she has is very rare.


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My Mother is 88. She has Vascular Dementia and was diagnosed with suspect Ovarian Cancer June 22 but no biopsy so it is considered Peritoneal Cancer, which is treated same as Ovarian. She is having Carboplatin IV Chemo treatments once every three weeks… She is on the 2nd treatment, After the first treatment the fluid buildup appears almost gone. The dementia seems ok at times. More agitation and wide awake from steroids given just prior to each treatment. Hope your Mother is doing well.
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See that she gets her rest and good foods, antioxidants, keep her encouraged. Pray for the best and check periodically on her tests don't wait for them. Hope all goes well.
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My mom ,my best friend in the world, died of lung cancer she had lewy body dementia and alzhiemers disease. She would not have been able to tolerate the chemotherapy and had told me years before to never put her through that. I am so sorry for what you are going through. So hard to see your loved one suffer with dementia and the every day decisions. When I took my mom to the hospital to have her biopsy she totally freaked out from the fear alone. One of the hardest decisions of my life to stop trying to keep fixing what I could not. Mom is in heaven now and she is at peace. She helped others in the end by donating her brain to Mount Sinai Research. They also helped me by my last question. Cure the cancer or let her live out what she had left. They answered ...Let her live out what she has left. Angels watching over both of you.
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There is no way I would put my 85 year old mother through Chemotherapy. I'm sorry for the situation you are facing, but always keep in mind what your Mother would want and what you would want done to you if you were that age.
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If this were my mother - or even me - I would definitely hesitate regarding chemotherapy. Take a really deep breath and think. You need to carefully research the side effects of whatever chemo is being prescribed. Is it an oral med or IV? What is your mother's life expectancy WITHOUT any treatment? What is the efficacy of the treatment being suggested. Believe me, there are statistics available if you look. Please, please, please get a 2nd and even a 3rd opinion regarding what the likely outcomes are with and without these drugs.
IMPORTANT questions to ask are: How long has this drug been in use? It is still experimental? Would this be compassionate use? How long will it allow my mother to live? Again, get more than one opinion; do your research. I am a retired oncology nurse. The practice I worked for dealt mainly with ovarian cancer patients. Best to you and your mother.
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I would definitely turn down the chemo based on her age and the dementia. Btw, A few yrs ago, I watched a documentary with a former oncology nurse and she gave alot of insight into the dark side of chemo. It ranged from side effects, cure rates, to it causing other types of cancer, and finally the profitability aspect. They said chemo is one of the only treatments where the Dr. actually profits from the use of the chemo drugs themselves. So, some Drs. are more inclined to recommend it for patients where it makes no sense. At 85 years with dementia, I recommend going by what your mother previously communicated. Good luck to you, wishing you all the best.
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LindaP1944 Apr 2021
I responded before reading your post. You definitely nailed it. Profitability and the number of patients that can be 'accrued' for RESEARCH are routinely placed ahead of truth and compassion. That sounds awful, but it's the way I saw it when I worked as a chemo nurse. Research is necessary, but so is QUALITY OF LIFE. I was appalled at the number of patients 'accrued' for research by A) Alluding to( false) hope and B) Implying they would be helping humanity by agreeing to "go on study". Capital BS. Some oncologists pedal false hope; others were straight-up honest.
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Chemo is not always the best choice. It's a lot to put a younger person through let a long an 85 year old. That also has dementia. Just enjoy the time you have don't make her suffer.
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If she is still able to make her own decisions then it is her decision to make. Have a serious talk with her. You can’t make a decision until the pathology report comes back . If it is cancer then it is best to ask the doctor what her chances are if she has chemo. Off hand I would say at 85 , if her chances are not good let her live out whatever time she has left without having to go through chemo.
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Imho, perhaps you should see what Stanford has to say.
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I pushed Mom to take chemo and she did it “for me.” The doctor had recommended against chemo for a patient in her 80s.

She was so sick after the 6th round she was saying she wished she would die. I regretted begging her to go through the treatment.

Her doctor took her off chemo because she couldn’t tolerate it. I think he was concerned the chemo itself would take her. The side effects created permanent damage.

If you are following her wishes, that is the most important thing. Sometimes people change their minds when they have all the facts and the scenario is no longer hypothetical. Although she has been diagnosed with some dementia, her brain may work more effectively when faced with a crisis.

These are difficult times and it is so wonderful you are there for her. Lots of people disappear when facing such challenges.
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As a clinical ethicist and having been through these decisions with both parents, I understand how difficult this time is. If your mother has dementia and depending on its severity, she may not have the decisional capacity to make decisions. Meaning that she can't comprehend or fully understand the consequences. Additionally, patients feel they must go along with the physician, who is in a position of power. As many have mentioned, chemotherapy often has toxic side effects that make patients' lives miserable in addition to traveling back and forth to the clinic. These are your options as I see it - 1) no chemo per her previous wishes to foster a better quality of life instead of increasing # of months/years, 2) low dose chemo to limit the side effects but may give her less time to live, 3) try chemo knowing you/she can stop at any time, or if life is more important than quality, take full dose of chemo in hopes of more time but feeling lousy. Ask your Mom if quality-of-life is more important than quantity of time and what that means to her. Tape the conversation and then revisit her physician and be firm with your choice. We had to be very firm about my mother's decision to have no chemo. Hope this helps and know that many of us understand and are thinking of you.
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What is her current quality of life? Does she have an advanced directive, durable power of attorney for healthcare, living will? Is she really able to make decisions for herself? Does the physician even realize she has dementia? Many mild to moderate patients can prevaricate enough so that they fool medical professionals who don't see them regularly and are not looking for it. Chemotherapy will make her miserable and may or may not make a difference in her life span, especially if her lymph nodes are involved and/or metastasis to additional organs. How long will the chemo last? What are the expected outcomes? Prolong her life, cure the disease, palliative? Lots of questions, and probably more, before a final decision is made. She might change her mind if asked again today. It will depend, somewhat, on how the question is asked.

My mother, at 75 told me they had spotted a lump in her breast on a mammogram and put her through stereotactic biopsy before she told me about it. I asked her why, at her age, she was still having mammograms? She said, "because the doctor ordered it" for her. The 'lump" she had was not cancer but fibrocystic disease, totally benign. If it had been cancer, the chances that it would have grown fast enough to be her cause of death were pretty low. Before she got the results, she had decided after a long talk with me, that she would not go through treatment as she had had friends that did who were miserable and regretted their decision to have chemo. She also decided to no longer have mammograms at her age. On her next visit to her primary care doc, she told him her decisions (no mammograms, no chemo for anything if something showed up, except palliative) and he wrote it in her chart. Luckily, this all happened prior to her mild mental decline when my dad died. She died at 82, 3 1/2 years after my dad died. She was miserable and depressed without him after 62+ years of marriage and I considered it a blessing for her.
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How advanced is the dementia.? What are your mother's wishes? Does she have a living DNR? Has she given you her Medical Power of Attorney? Other than the tumor is her health really good? Sounds like a lot of questions, but she is 85. When Mom was alive, she said and put into writing all her wishes for her health care. It was a blessing as her Dementia was pretty bad. She always said she did not want any Drastic measures done to keep her alive. We did what was necessary to keep her going, comfortable, and happy, but nothing more.

It was tough to do, but I did find that only going on her wishes did make it easier in the end. I know, in both mind and heart we (me) what she wanted. By the way she lived to 98. God's blessings and care for both of you. This is not an easy time for either of you. Hugs and comfort!
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Im thankful she had the surgery and came through it well. It will prolong her time here on earth and enjoy her family. Enjoy each moment she is with you. As her dementia progresses you and siblings will have to make the decision what to do. Just remember her body will start to shut down the appetite , incontinence for 1 and 2 , so have home care come in a couple of times a week or hospice. They will help tremendously. My husband wouldn't eat anything but fried egg sandwiches so I was fixing these every meal. Don't stress yourself for you need to take care of yourself in order to take care of your mother. Sending prayers for you and family . God bless, He is in control.
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I would ask about other options to Chemo! Everyone I have known that has gone through Chemo did not do well.

There are new things that are being discovered right now that sound wonderful. I truly believe we are on the verge for a cure to most cancers.
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bundleofjoy Apr 2021
dear familyneeded,

i agree, about asking for other options!

dear ThisIsntFun,

i think you should avoid chemotherapy.
i have a friend (mother with cancer), doctor urged chemo, friend was against it, doctor kept insisting, mother went ahead with chemo. it was terrible. only made things worse. she died. doctor later said sorry, she shouldn't have done chemo.
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No matter what you decide, I would advise you to request a copy of all that is discussed in each doctor's appointment. Let the doctor know that you are expecting this. I am often amazed at the lack of detail in doctor reports that represent a visit. Knowing she couldn't count on her memory my mom used to ask for the notes before leaving the doctor's office. I thought that was very smart of her. With those notes in the official print out from the doctor is an excellent point of reference for those discussions that you will likely have with your mom. No disagreements as to what was said. As to her moderate dementia, was there any conversation regarding the cause of it in the light of her cancer diagnosis? Could there be a causality not considered before? Some conditions can look like dementia when in fact it is something else. Your mother may have felt confident about not accepting treatment in concept, but when confronted with the reality, she might have felt differently. Surgery is treatment, and she accepted that. Did she weather the anesthesia well without any deterioration of memory? Try to gather as much information as you can, and support her decision. There are no perfect answers but there are answers that are best for the time.
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Honestly, I would question the motives of a doctor who would consider chemo for an 85 year old patient with dementia. My husbands mother died from a brain tumor. She had done the chemo thing, when the first round didn't work, she said she would NEVER do chemo again. It was so terrible.
My husband was diagnosed with colon cancer over 11 years ago. The surgery was a great success, but the oncologist wanted him to do follow up chemo. I researched the side effects he would deal with and he said NO. The chemo would have made him an invalid for who knows how long. The surgeon was thankful when my husband made that decision because he didn't think it was in my husband's best interest. My husband is 68 years old, still works full time, is planning to expand our garden this year, and is SO thankful he did NOT do the chemo. Ask the doctor if he will be there to clean up the vomit.
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Advise: How does your Mom feel about Chemo? Does she trust her doctor?

Check out Chris Wark for more information. Chrisbeatscancer!
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The more that I think about this question, the more I am inclined to say to let her live out her remaining days in peace.

Chemo is so rough on the elderly. She’s 85.

Most of her years are gone. Let her know that you love her and when it’s her time she won’t be suffering from chemotherapy.

I will keep you and your mom in my thoughts and prayers.
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The long & short answer.....don't do it. If you are POA, you can make that decision.
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Simple words ... I often think mans medicine gets in the way off God’s plan.....
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tf110862 Apr 2021
Amen!
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I have cancer. I go to chemo. I don’t do radiation as yet. The days after treatment are hard. I don’t feel well and it takes time for me to feel better. Has the oncologist done tests to see if the cancer has metastasized? Have they told you that they got everything out? My mother is 95 yrs old. She has breast cancer. She chose not to treat for it as she has so many other health issues too. It is hard to stand by and watch and wait. Our first instinct is to treat and cure. But sometimes curing is not in the realm of possibilities. Does your mom have any other health issues that would factor into whether or not to treat besides mild dementia? I’m curious to find out if the cancer has spread. If that’s the case, it is difficult to chase that around the human body. Then they have to do a more aggressive approach and that is so very difficult mentally and physically. Quality of life sure plays a role in these decisions.
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It is well-known in medical circles that chemo in the elderly simply makes them wish they were dead due to the HORRIFIC side effects. Opt for quality like your mother expressed. Doctors recommend chemo, but perhaps not for the reasons you think. On average, chemo treatments cost $7,000 each--the doctor receives about half of that if not more. So what is the true incentive here? Health care is big business and doctors are part of it. Things have dramatically changed in the past 10 years. Everyone is looking for their pockets to be stuffed though people want to believe their doctor is truly looking out for their best interests. Behind the scenes is a very different story. As a nurse, I have witnessed many a discussion between doctors regarding how much they can make by ordering certain drugs, sending patients to physician-owned facilities, etc. Perhaps we should ask why is it that we are using the same junk chemo we used in the 1970s...are we to believe that in over 50 years we can't come up with anything better? No. It's about money. In one study of >1,000 doctors, MORE THAN 70% said they would never want or consent to chemo. Why? Because they know it simply makes you so miserable you will welcome death. Let your mother have her quality time and tell chemo to pound sand!
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LindaP1944 Apr 2021
Amen and Amen! Couldn't agree with you more.
RN, OCN.....retired.
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I think someone touched on this already but if I were you I would consult her PCP and any other doctors she knows and trusts. Specialists often see their lane rather than the big picture. What I mean by this is the Oncologist see cancer and the treatment of cancer rather than the 85 year old with moderate dementia. They don’t clean up after the treatments her primary does that most of the time (some places have a cancer primary if you will as well as several specialists and do treat the whole person all the way through clean up) once the cancer has been treated as best it can be which might be surgery, chemo, radiation...they follow the patient once every 6 mos or year to check for cancer. The more advanced your age especially with cognitive issues already, the higher the possibility there will be further cognitive decline, this applies to any surgery that requires sedation not just cancer, a mind and body can only handle so much. My point being it isn’t really about how good of an oncologist the doctor is he or she is an oncologist and they are trained to treat cancer, get rid of it if they can so I would consult her primary who is trained to treat and farm out the whole patient and or any other specialists who know her. Ask the question suggested here with mom in the room of course, “what might the benefits be and what will living through the treatments be like, what could the permanent side affects be? What would you suggest your 85 year old mother do in tI situation”?

Good for you asking the questions and doing the research by the way, not simply jumping in to treatments. This is not to say when you have all the info you need chemo won’t be the path you both choose of course but better to go into it with eyes wide open rather than tunnel vision. Thinking of you through this battle.
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I'm the caregiver for a cousin with dementia, who was diagnosed with a massive and very aggressive sarcoma about two years ago. Though her dementia was moderate at the time, she definitely didn't have the capacity to understand all the implications of the diagnosis or treatment, which involved surgery and radiation (but no chemo), so the ultimate decision fell to me. As her caregiver, it was a difficult position to be in, because if I'd asked her before she developed dementia whether she would wanted to be treated for cancer when she already had Alzheimer's, I'm pretty sure she would have said no. (I think most people would probably say no.) But when faced with the decision in a specific situation, I discovered it wasn't so clear-cut. I had a long conversation with the doctor about what her quality of life would be like with and without treatment, since her quality of life is what I most cared about (and what I'm confident she would have most cared about, too). Based on that conversation, I concluded that she had to get treatment because without it, her end of life would have been prolonged and horrible, and she would have suffered immensely, without understanding why she was suffering. Honestly, if that hadn't been the case -- if she could have had a peaceful end of life with her type of cancer -- the family and I might have made a different decision on her behalf, because I don't think she would have wanted us to prolong her life with cancer so that she could have a long slow decline from Alzheimer's. But given her prognosis, I think we made the right decision: The surgery and radiation wasn't fun for her, but in her case, it was clearly the lesser of the evils -- two very difficult weeks (she had a specialized intense radiation over a short period of time) vs. what would likely have been months and months of misery. She's now almost two years past the surgery and she's had a pretty good quality of life, even with the Alzheimer's. I want to stress that all of this is specific to her type of cancer, and I do recognize that the picture could be very different for someone with a different type of cancer. I also would never presume to speak for another family's choices. But I do think that if you keep her quality of life in foremost in your mind, it will help to guide you. Best wishes with this, and please keep us posted -- it is a very difficult position to be in both for everyone concerned.
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LauraJMT Apr 2021
I should add that chemo was not involved in my cousin's case, and chemo is also a quality-of-life issue; if she had needed that, it certainly would have been a big part of the family's decision. Again, best wishes and please do let us know how your mother is doing.
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It is PITIFUL her doctor did not discuss the adverse side effects of chemo, especially for the elderly. To me that is *very* irresponsible. That should be explained to you in very plain language and the decision should be informed. In my opinion she needs another doctor. One who will not discuss risks scares me...because that is your mom. Chemo is a very VERY serious decision and you need ALL the facts before you. You need to know what drug they proposed to give her, and all the side effects and risks. She may even need a port because chemo often destroys veins and her delicate tissues can become damaged. Frequent lab draws. Along with a port--increased risk of infects. She's elderly.


Chemo is actually a POISON attacking rapidly growing cells, or stops them from growing. Because stomach cells, bone marrow, and hair are rapidly growing, that causes the terrible side effects. Although chemo drugs have improved to target specific cells, they all still have side effects. If you want to know the truth, "chemo" *should* be called poison therapy, was discovered by *accident* during WW2. Mustard gas was used as a weapon of war--it works by destroying rapidly growing cells, so it kills by depleting bone marrow caused aplastic anemia. Rapidly growing cells are also tumors (cancer) cells, so a watered down version begun the era of cancer drugs known as chemotherapy. Mustard nitrogen disrupts the DNA--that is why it prevents rapidly growing cells from growing.

The chemo can make her very sick. Even violently ill. It can even shorten her life due to the side effects and the pure misery it can put her through.

She won't eat. Some side effects include vomiting, infections, anemia, hair loss, sore mouth...complete loss of appetite. Vomiting and diarrhea, which will deplete her electrolytes will necessitate more hospitalizations.

My father had chemo at age 65 and died anyway...but he was put through pure misery and suffering due to the treatment. For one thing, he said he could smell the chemicals in water and it would make him wretch and vomit. He was so violently ill he could not longer tolerate chemo.

https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/chemotherapy/chemotherapy-side-effects.html

HERE is a very good online article to explain about chemotherapy..

https://consumer.healthday.com/encyclopedia/cancer-8/mis-cancer-news-102/chemotherapy-and-side-effects-648006.html

Risks of chemotherapy if the peripheral vein "blows" and leaks out to tissues:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4227315/

PS: If she stops eating due to chemotherapy she will probably need a feeding tube. That is hard work in itself to maintain and more risk of infection. But probably if you give her tube feeding she will probably vomit it up and get lung aspiration pneumonia.
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When you talk to the oncologist who will be in charge of the chemo drug selection, find out the side effects especially on someone at her age. As we all know cell turnover as we age gets slower and slower. Chemo is a poison not just to cancer cells but non cancer cells. Often affected are the cells in our mouth and those lining the intestine. Dry mouth is an issue as is bowel dysfunction. Every side effect should be listed. And I suggest recording this visit so you don’t have to write it down and can play it back. If I were 85, I have lived most of my life...what else is truly waiting for me? Do I want to live it in chemo misery? Hell no! I will let it take over and go on hospice and enjoy the time I have left. Most likely at 85 the outcome will not be a good one.
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This might be me sitting on the fence again but...
If mom is aware enough that she FULLY understands what the diagnosis is, what the treatment involves along with all the side effects AND what the chances of them curing the Ovarian Cancer is then she can make an informed decision.
BUT
I would not want to put my loved one through chemo.
I would opt for Hospice at this point.
There is a VERY good chance that they did not get all the cancer and she would have to undergo more surgery
She may have done well with the anesthesia this time but next time it may not clear her system as well.
As she declines each chemo session will become more difficult.
And there is a "chemo fog" add that to dementia.
I am so sorry...
((hugs)) for you and mom.
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LindaP1944 Apr 2021
In my many years working with specifically ovarian cancer patients, most of them died despite surgery, chemo, radiation......and they were totally miserable during all the treatment. The vast majority of the time, once ovarian cancer is found because patient is symptomatic, it's too late. Very sorrowful job....and then the husbands begging their wives to EAT something. Heartbreaking isn't an adequate description of these situations. We women are virtually HOUNDED to get that mammogram, but why not a yearly CA-125?
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My personal opinion: life has just given your mom and you a get-out-of-jail card. Dementia is a HORRIBLE disease, worse than the cancer she is having. I would not go thru with the treatment and let her die with dignity. Dying from dementia is a sad, sad way to go.

My husband has advanced dementia and I know if he was still lucid, he’d choose death from cancer than dementia.
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My family has all gone, and my mom and aunt had dementia. After doing everything I could do for each family member...I believe that regardless of my mom/aunts dementia, if either said yes then I'd do it. My aunt had stage 4 labial cancer and she would not speak when asked (in fact, didn't speak again after her diagnosis. :( ...she did not have radiation-which is what they suggested, but they said that it would be hard on her since they were doing one spot radiation so I didn't do it and she passed 4 months after her diagnosis. The weight would be too heavy for me if I said no...and she said yes. One of my best friends has multiple melanoma and she takes a chemo pill...it's been very gentle on her and appears to be working. Ask about this. Love and prayers to you all.
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