A woman recently told me that she had a friend with Alzheimer’s disease who was being treated for cancer. She asked me if that was the right thing to do.
It was a good question for which I didn’t have a quick answer other than, “It depends.”
I’ve been thinking about this for a few days and have attempted to come up with some general guidance.
First, does the patient have the capacity to make medical decisions? Individuals with early Alzheimer’s (or other forms of cognitive impairment) might be capable of understanding the pros and cons of cancer treatment and be able to make their wishes known. If so, their wishes take precedence. Even if they don’t understand the details, they may understand the general notions of focusing on the quality of life versus the possibility of extending one’s life.
If the individual with Alzheimer’s is unable to make medical decisions, it’s usually up to a family member or trusted friend to make these decisions. (This is another example of why it’s important to name a health care proxy – who do you want making this type of decision for you?).
A critical question is whether the proposed cancer treatment is designed to extend the patient’s life, or is it designed to make the patient more comfortable? Some treatments are palliative, that is, they’re undertaken to ease pain and other symptoms. Don’t say no to all treatments when you really mean to say no to all life-extending treatments.
Many scenarios are difficult even for the experts. For example, most people would agree that a 90-year-old woman with advanced Alzheimer’s disease should not be given chemotherapy for breast cancer. But should she have surgery to remove the tumor to prevent it from growing and potentially breaking through the skin? I don’t think there is an obvious “right” answer to this.
There needs to be an open and honest discussion of the pros and cons of treatment. Oncologists need to frame the discussion in language that’s accessible and clear, and loved ones should focus on what the patient would want. Input from clergy, the patient’s family physician, and hospice representatives might be helpful as well.
Reprinted with permission of the Ithaca Journal.
Original publication date: November 22, 2014