90 year old with recurrent colon cancer and dementia

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runt
Posts: 2
Joined: Tue Aug 18, 2015 12:31 pm

90 year old with recurrent colon cancer and dementia

Postby runt » Tue Aug 18, 2015 2:00 pm

My 90 year old mother has recurring colon cancer. First surgery was 2 years ago, with no other treatments. My siblings and I rotate staying with her in her home. She walks with a cane or walker (doesn't think she needs either), and likes to go places but tires very quickly. We fix her meals, do all her housekeeping, give her meds, help her with showers and getting dressed. She's having slight belly pains and has lost a few pounds. She's extremely hard of hearing, has dementia, and glaucoma (currently under control). No other major health issues. She thinks her previous surgery was very recent but can't remember she had cancer. She was very upset when we took her for a new colonoscopy. She couldn't understand why she was there and was very confused and crying. Most of what we tell her doesn't register. Over the last several months she's had 3 blood transfusions and 9 iron infusions, we assume due to the recurring cancer. After the previous surgery, she was extremely disoriented and confused, and recovered very slowly with several weeks in rehab after a lengthy hospital stay. There's no current blockage but surgeon says it's always a possibility.

We don't know what to do. When we first consulted the surgeon this time, he was leaning towards leaving it alone. After yesterday's colonoscopy, he's leaning toward surgery. We don't want her to hurt, and don't want her to get a blockage. But we don't know if we should put her through it all again. She'll soon be 91. She's frail but stubborn. (She also guesses every puzzle on Wheel of Fortune!) Are we worrying too much and should just agree to surgery? Would like opinions.

JDinNC
Posts: 771
Joined: Fri Jul 05, 2013 9:49 pm
Location: Murphy, N.C.

Re: 90 year old with recurrent colon cancer and dementia

Postby JDinNC » Tue Aug 18, 2015 6:24 pm

Speaking from my own experience, I was my mother's caregiver even though she was in a nursing home. She also had dementia/ Alzheimers with no serious health problems other then high blood pressure. My sisters and I decided early on that we wouldn't put her through any unnesecessary pressure because it seems to overwhelm her since her mental health was declining steadily
From what you wrote about your mother, she's reaching the same point as where my mother was. My mother passed away at 91, and if she had a recurrence of cancer, I wouldn't have put her through surgery, chemo or any other type of treatments because it just wouldn't add anything to her life.
While waiting in the lobby at my cancer center, I would see elderly folks being wheeled in on wheelchairs and gurneys to receive their treatments. I would always wonder "why" what kind of quality of life are they giving her/him?
I don't know if this makes any sense to you but we believed our mother lived as long as she did became her mind just wasn't under any stress and really didn't know what was going on. She would wake up....watch tv ..then go to bed. I understand the pain of seeing your mother's mind slowly declining. I spent 13 years watching my mother, who knew her daughter by name to that " nice young girl" to not being able to communicate at all.

I guess the questions you need to ask yourself:

If she had for her memory now, would she consider this surgery at her age?
What additional quality of life will it give her if she has the surgery..a few months maybe a year.
Are you thinking about having the surgery because she's your mother and you're not ready to lose her?
And because of her dementia, where will she be months from now...will surgery/chemo only speed up her mental decline?

I don't want to sound Harsh on this subject...but at this time it's more about her quality of life.
Good luck on your decision..I know and understand how hard it is..
61 y/o female @ DX...........
T3N0M1
6/13 DX- stage 4
Sigmoid colon cancer.
One met to lung
7/13 colon resection
8/13 lung resection
7/17 four years....NED
8/18 five years....NED
MELANOMA
63 y/o @ DX
6/15 stage 2a
7/15 surgery on arm
7/15 NED
4/16 recurrance
5/16 remove metastasis from back
5/16. Started immunotherapy
8/16 discontinue treatment
7/18...PET scan...NED

bitchslapped
Posts: 1538
Joined: Tue Sep 09, 2014 3:23 pm
Location: PNW/USA

Re: 90 year old with recurrent colon cancer and dementia

Postby bitchslapped » Wed Aug 19, 2015 12:45 pm

runt wrote:She was very upset when we took her for a new colonoscopy. She couldn't understand why she was there and was very confused and crying. Most of what we tell her doesn't register. Over the last several months she's had 3 blood transfusions and 9 iron infusions, we assume due to the recurring cancer. After the previous surgery, she was extremely disoriented and confused, and recovered very slowly with several weeks in rehab after a lengthy hospital stay.

runt wrote:(She also guesses every puzzle on Wheel of Fortune!)


Stress, anesthesia will exacerbate your mother's confusion. In some ways it seems cruel putting her through a colonoscopy prep & procedure, yet I understand your family's desire to deliver the medical care she may need. A tough decision to make on behalf of our precious elderly in a frail condition, especially w/dementia, though it sounds as though she may be in the early stages of dementia. If she can guess every puzzle on Wheel of Fortune while not under duress, is it possible she can make this decision for herself, or @ least provide some degree of input? She may not remember the past surgery or the pain from it, but she may know whether or not she wants to spend weeks in the hospital/rehab away from home, in unfamiliar surroundings, to live longer. How does she do w/the blood & iron infusions? Can your family be there as needed for her?

I don't think there is any getting around worrying too much. We want to do right by our parents. The hard part is knowing what is right. I feel for your predicament as this is a huge responsibility. Been there, done that. Let us know how this plays out for your mother & family.
Kudos to all of you for taking such good care of your mom w/love & respect that she deserves.

Best Wishes
bitchslapped
DSS,35YO,unresect mCRC DX 7/'14,lvr,LN,peri,rib
FOLFOX+Avstn 4 Rnds d/c 10/'14
Stent 9/'14
FOLFIRI+Avstn 10/'14
Gone From My Sight 2/20/15
Me:garden variety polyps + precancerous polyp, diverticulitis
Carergver x2 DH,DM dbl occupancy,'03-'10
DH dx 47YO mCRC,'04-'07, lvr, billiary tree fried x HAI
DM dx CC 85YO,CC,CHF,stroke,dementia,aphasia

alphagam
Posts: 203
Joined: Tue Jun 14, 2011 10:48 am
Facebook Username: Kathy Maine Ruess

Re: 90 year old with recurrent colon cancer and dementia

Postby alphagam » Wed Aug 19, 2015 1:29 pm

My mother in law was 85 with severe dementia. My SIL was her primary caregiver and took her to the ER with labored breathing. A simple X-ray showed a mass in her lung. The doctors gave the family two real options, do the extensive scanning and biopsies to diagnose (she was a life long smoker), or to give her the oxygen needed to be comfortable. The family decided, as she was very confused in the ER and frail to begin with, to call in hospice and keep her comfortable. Two days later, she needed pain meds. Three days after that she was at peace forever. I honestly believe that being in her home, with family (even though she no longer knew any of us) was far more comfortable for her, than putting her through medical procedures which would have just frightened her and not added a minute to her life. I wish you and your family peace at this time.
Dx Feb 2010 4 cm tumor, just inside rectum
EUS stated T3 tumor
2nd opinion, need better path
Mar 2010 transanal surgery. Surgery by board certified CRS found tumor only in lining
6 exams of surg site, 3 PET, 3 scopes laterNED.
Scope in Mar2015, clean colon
Next scope/test in 3 years

Nik Colon

Re: 90 year old with recurrent colon cancer and dementia

Postby Nik Colon » Wed Aug 19, 2015 4:23 pm

I don't have answers, but I would suggest to consider what would be the least painful, if surgery would help any pain, yes, if not I would say leave it be. Jmo considering her age and current issues. So sorry, best wishes.

behconsult
Posts: 264
Joined: Fri Jul 04, 2014 4:53 pm

Re: 90 year old with recurrent colon cancer and dementia

Postby behconsult » Thu Aug 20, 2015 7:24 am

Considering her age and dementia diagnosis. I would get more details about the cancer spread. I would consider hospice. Hospice is involved when people won't get better and when they are terminal. Surgery at her age with her diagnosis of dementia??? QOL is important. If she does the surgery, and in best case she survives, she will likely lose her ability to walk and not regain it.
Stage 4 Age 56 BrafV660E 5/14
spot on perit/ Right side tumor
Resctn 6/9/2014
Folfox strt 7/2014. 6 of 12 tx
Chemo induced DM2
Pet 4 mets to lung (1 cm, 6 mm) Xeloda/Avastin 9/16 to present.
Cryo-ablation to four spots- Collapsed lung/chest tube 2x
Possible local recurrence in a spot or two on PET. Stable CT

jens22
Posts: 1013
Joined: Wed Jun 09, 2010 9:26 am
Facebook Username: jspirio
Location: Long Island, NY

Re: 90 year old with recurrent colon cancer and dementia

Postby jens22 » Thu Aug 20, 2015 10:09 am

I'm sure you and your families goal is to give her the best " Quality of Life " Possible. Seeing how she did with the colonoscopy it will be much worse with a surgery and the prep before. It will also be bad for a longer time. If an Ostomy is needed....Well...Dementia and Ostomies are usually a bad mix . They just don't understand why it is there...so they remove it.

Obstructions can be dealt with if they even happen.
Colonoscopy 3/10 for ? hemmorrhoid.
Diag Colon Cancer 3 days later
Colon Ressection 3/30/10
Stage 3B 5/14 Nodes positive.
Power Port and 7 months of Chemo
Port removed 11/11
8 negative Cat Scans..... 10 years cancer free and Discharged from Sloane Kett!!
Diag age 47 , now 57 Mom of 3 boys.

runt
Posts: 2
Joined: Tue Aug 18, 2015 12:31 pm

Re: 90 year old with recurrent colon cancer and dementia

Postby runt » Fri Aug 21, 2015 11:45 am

Right now we're leaving it alone, and will get help to manage her pain as it increases. Will deal with any emergency issue if it develops. We feel guilty, but want her to have the best quality of life possible. She refused a routine colonoscopy several months ago, but we don't think she understood. We agreed to it this time because a CT scan showed a mass at the original surgical site. The prep, done in the hospital, took over 18 hours due to her confusion, being so upset and agitated, and poor hearing. We kept reassuring her it was just a test. She sometimes doesn't remember which one of us is with her. She remembers her previous hospital stay and rehab, but never remembers she had cancer. She guesses the Wheel of Fortune puzzles, but can't follow what they say on TV. She can't follow a conversation, but if she initiates conversation, she can sometimes follow a word or two. Her hearing aids don't help with that. She still does word search puzzles, and likes to tell childhood stories (same ones every day) but uses some words out of context. She reads the newspaper constantly because she can't remember she just read it. She keeps removing her hearing aids all the time, so dealing with a colostomy bag would be a big problem.

Thanks for the replies and good wishes.

Val*pal
Posts: 860
Joined: Sun Feb 10, 2013 1:24 pm
Facebook Username: Valerie Barkus Kantner
Location: Metro Detroit, Michigan

Re: 90 year old with recurrent colon cancer and dementia

Postby Val*pal » Sat Aug 22, 2015 1:51 pm

This is just my personal opinion, but I would NEVER have put my mom through cancer treatment at age 90. I think we in the U.S. are programmed to a degree to "fight for life", but there comes a time when the treatments are too difficult, especially for the elderly. I know my mom would not have wanted to be put through anything like that. My sister and I had to make end of life stage decisions for my mom just before she passed at 89, and we opted to just keep her comfy. She did not have cancer, but we knew she only wanted quality of life, and we made sure she had as little discomfort as possible at the end. Don't feel guilty. There are (obviously) limits to lifespans and your mom has had a good long one. She needs to be made comfortable.

Though my husband was "only" 65 when he passed away from colon cancer, I personally felt that the oncologists were too aggressive about keeping the chemo going until about two months before he died. The chemo, as he weakened, wiped out any quality of life he had. He basically just slept and felt miserable until they did finally end the chemo. After it was stopped, he enjoyed a few "good" weeks before he died. I believe that like in anything, experts tend to get blind to what the ultimate, true goal is, and that is to first make sure that patients are comfortable.
DH dx'ed May '11, age 62
Jul '11: resection Stage IV
10/11: 6 mo Folfox
8/12:thyr canc, surg/tx
2/13: peri mets
2/13: Firi/Avas
6/13: Ok
8/13: break
10/13: Lung, peri, mets
10/13: Firi/Erb
1/14: Erb Fail; spread
5/14: Tx stopped
6/20/14: At rest


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