Do you tell a 90 year old parent that they have cancer?

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Do you tell a 90 year old parent that they have cancer?

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My mom had a biopsy in the hospital where she was being treated for something else. She was released and then went into a rehab facility to get better to go home. Her results just came back and a family member ( medical proxy for my mom ) was told the results that she has cancer. My mom does not know yet, She has so many other health issues to deal with currently, heart disease, diabetes and kidney disease. Because of her age and history, she is not a candidate for surgery or chemotherapy. Should my mom be told she has cancer at this point in her life? The family thinks she would be devastated if she found out about the cancer. Not sure what to do. Any advise would be helpful.

Cancer End of Life

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If the family consensus is to not tell her, then don't. Cancers in the elderly move very slowly and chances are one of the other things will take her long before cancer has a chance to.

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ptsteg is right. My mom at the age of 80 was diagnosed with uterine cancer at the age of 82, had the hysterectomy followed by chemo and radiation. Following the surgery she started this long slow decline of Alzheimer's, probably at least in part due to anesthesia which is very hard on the elderly brain. Mom is still with us and entering the late stages of Alzheimer's. The siblings had no say whether the treatment would occur, mom was competent for the most part at the time and she had remarried a year previous. But knowing now what we didn't then, that the anesthesia would have the effect it did and that cancer in elderly is very slow we would have discouraged the treatment.

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There is no reason for her to know at her age, the family is right that it would only devastate her. Allow her to live out her days with some peace of mind there is no reason to upset her this late in the game. She is already in her 90's and has lived a good life, just as they (the medical team) doesn't want to put her through any treatment because of her age should speak volumes. Blessings and Best of Luck.

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Whether or not to tell your mother about the cancer is a decision that must be based on her level of mental alertness. And, what would you want done if you were in her position?

If she is mentally alert and competent, she has the right to be told. Then she can plan ahead. For example, if she has things to say to people, written messages she may want to leave behind, bequests for who gets what, etc.

However, if she has dementia then it would be cruel to tell her because she won't remember and will suffer anew each time the cancer is mentioned. In this case, tell everybody else so that they can visit her and say their good-byes.

Blessings to everyone involved in this situation and may all parties be blessed in the outcome.

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Nothing to be gained, plenty to be lost.

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The default position is that you do tell her unless there is an extremely good reason not to. Other people's belief that 'she would be devastated' does not constitute a good reason.

Good reasons would include:
irrelevance, if the cancer is so slow growing that it will have no effect whatsoever on her. But in that case, why the biopsy? Presumably they were looking for it because it is already causing symptoms;
dementia to the point where she lacks mental capacity;
other forms of mental disability, so that she would be unable to process the information;
her own previously expressed desire to have bad news kept from her.

Insufficient reasons would include:
her age;
the lack of treatment options;
fear of upsetting her.

And, by the way, how is she going to give her informed consent to palliative care treatments if she doesn't know that they're palliative?

She has a right to know the truth of her own situation. She has a right to understand what is happening to her body. She has a right to prepare herself for death, if (God forbid) that is the reality she must face sooner than expected.

Having said that, you know your own mother. As long as you're approaching her as the person you know her to be - as an individual with her own views, beliefs, character, identity and NOT as some poor little old thing who couldn't possibly cope - you are best placed to decide whether she will want to hear the truth or not.

Stop press: I've just consulted my 89 year old mother (severe CHF, stage IV kidney disease, early to moderate multiple dementia but high baseline IQ and lifelong interest in ethics) on this very point, to have it from the horse's mouth, so to speak. This particular horse says firmly - albeit hypothetically, let's not forget - that she would want to know. I quote: "how can you deal with it if you don't know it's there?" Your horse may have a different view, of course. But in any case I am grateful to you for raising this point: now I know what my mother wants should this ever come up for us.

I wish your mother success in her rehab, and hope there will be positive news about how her cancer can be managed.

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My 75 yr old father died on October 7 2014 of Liver Cancer. 4 yrs before that he suffered 2 strokes and then developed Parkinson's Disease. The strokes left him without the use of his right side. I cared for him in my home for most of that time. Sometimes he was in a nh for different reasons but it was only short term. I had to assist him with everything. he received a diagnosis of cancer 2 yrs before his death. Then he was hospitalized with something else and the hospital told me he did not have cancer. Almost 2 yrs later the same hospital informed me that he did indeed have cancer. By this time my dad had grown frail and the ammonia levels from the cancer were affecting his behavior and his general health. Hospice was called and dad stayed there for 11 days until he died. The hospice nurse asked me if he knew he had cancer and I said No. My dad had been through so much at the end of his life that I was not going to tell him one more bad thing about his health. It would not have changed the outcome and he had had enough. I don't regret my decision and would do it again.

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We struggled with this last year. My aunt was 92 at the time and in pretty good health (plays golf everyday). She was diagnosed with a rare skin cancer - Merkel cell carcinoma. It's usually a grim prognosis. Her doctors didn't tell her much about this cancer - she had Mohs surgery. I researched the cancer as soon as knew the diagnosis & the protocol is surgical removal (tumor usually on the face), biopsy of nearest lymph gland, and radiation. I know someone whose 85 year old grandmother had the same thing & she lived 5 years after immediately having surgery, lymph gland biopsy, and radiation. Chemo is generally never suggested for the elderly - but new studies indicate healthy people in their 90s tolerate radiation. My aunt's doctors were apparently unaware of these new radiation-in-the-elderly studies, as they advised against it. Months later, the tumor was growing back & my aunt demanded radiation. She got through the radiation just fine (it is a little tough) - but it was too late. She should've had the radiation immediately after the diagnosis. She's still alive a year later, but the late radiation didn't kill the tumor. I asked my primary care doctor about whether we should've been upfront about her diagnosis and options and he informed me that no matter the age, people have a right to know about their health status and their options. My aunt didn't know all of her options at the earliest stage possible, something we now regret. She was never able to make an informed decision, as we all advised against radiation at her age. BTW, my doctor's mother died of cancer; my own father was diagnosed with colon cancer at age 89. He was told surgery or die a terrible death with an obstructed colon. He chose surgery and lived for another 15 months. He was quite frail, but he was able to make his own decision and enjoyed one more Thanksgiving, Christmas, several times going to church, etc. I've told my friends to let me make the decision in my old age if I'm not suffering from dementia - but tell me the treatment options and probable prognosis so I'll be informed.

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This is to a flippant answer but your mother will probably last longer without any treatment.
The important thing is to co-operate with hospice to control her pain and other symptoms. Let Mom take the lead.
If she does not want certain medications don't force her. Many people are very fearful of morphine but it does an excellent job of controlling pain and the distress associated with difficulty breathing.
The DNR is not a major problem just make sure everyone knows she has it. it really comes into play is she has a stroke or heart attack and someone calls 911 which as you know you should not do for a hospice patient. The EMTs can be very aggressive in wanting to treat but if you show the DNR they have to abide by that. Make several copies and post them prominently where everyone can see them but out of Mom's sight. The main thing is to prevent anyone starting CPR or intubating her
Don't be afraid to question hospice every step of the way they are there for you too.
Not having any information on Mom I can't begin to guess how long Mom has left and for the family this really is the hardest time. it sounds as though she is a very put together lady and very ready to let nature take it's course. Make sure you take care of yourself and get plenty of rest and good food. Don't be afraid to go out and have someone sit with her. Of course she may die while you are gone but many people do actually wait till their nearest and dearest are absent to slap away. It would be the way she wanted it not something you missed. Blessings to Mom and your family.

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How do you approach what? It doesn't sound as if there is much left for you to do, if your mother is fully aware of her own condition and able to understand the implications of refusing treatment.

If you're at a loss as to what to say to her about it, I'd suggest asking her if there is anything she wants to talk about, or would like someone to explain.

If you yourself are unhappy with decisions she has made, or want to know more about how her condition is likely to develop, ask her hospice team for help and advice. If they can't answer your questions, they are likely to know who can. I'm sorry you're going through this - don't forget to take care of yourself, too.

Do you tell a 90 year old parent that they have cancer?

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