This will be kind of a doozy to apologies.

A bit of background:

My grandmother is 80 years old today. Though she is only 80 it seems she is aging much faster than her other elderly peers. My grandfather died nearly six years ago of a heart attack and my grandmother has lived with me ever since. Ever since his death she has been severely depressed and seems she is only living to die at this point. She is still mourning his death but is also becoming increasingly scared of her own demise. For the past six years I have watched a major cognitive decline in her.

Terrible Year:

This past year she has been unable to catch a single break. In June she received a cortisone shot right before finding out she needed her second hip replacement. She had to wait three months in severe pain for the cortisone to leave her system. She got the replacement in Sept. and is still struggling. She was told she need spinal stenosis surgery but that was delayed when they found a large growth on her breast that she refused to tell anyone about (she has had breast cancer before). They took out three lymph nodes while removing her breast and found aggressive cancer cells in one of them. Now they would like to do chemotherapy to make sure microscopic cells haven't spread through her lymphatic system.

Possible Dementia:

It seems as though no family members will listen to me when I say I believe she has dementia. Her cognitive decline is not "normal aging". I've seen it for a couple years but it has become increasingly severe over the last year. She is incapable of remembering a conversation we had 10 minutes prior. She has become increasingly confused over the last year and it seems like she never has any idea what she is talking about. She tried to tell me I was in my 30s and would not budge when I told her I am only 20. Sometimes it is like she goes back in time and thinks we are in a different year. She has had friends of different ethnicities all her life but is all of a sudden becoming more and more racist, almost as though she is back in her childhood when racism was "normal". It is becoming harder and harder to take her out in public. She is angry all the time and although I know it is mostly frustration with herself she takes it out on those trying to help her. She said to me yesterday for the first time "I always feel confused." This holiday season was also the first time that my cousins started to notice a large shift in her. She asked about my cousin who "ran the Boston marathon last year" which my cousin DID do, but about 14 years ago.


Finally, sorry for making you read all that. Is chemotherapy a good idea? She is terrified of it (and does NOT want to lose her hair) but if it is only for microscopic cells is it worth it? They said the cells could take aprox. 5 years to grow into another aggressive cancer but I am unsure she will still be functioning in five years. I am afraid chemo will do more damage than good for her.

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Dear concernedpatron,

First of all, how great of you to have the generosity and maturity to take on the caring of your grandmother! Caregiving is a very tall task for anyone, but very specially for someone so young. Most people your age (and many people of all ages) are all about their lives, not wanting the “burden” of caring for an elderly loved one. May God bless you for your kind heart!

Now, about chemotherapy, my answer will be brief and to the point. What would I do? No chemotherapy. Period.

My mom received chemo and radiotherapy plus many other things about eight years ago, she had very aggressive breast cancer, and yes, I have the blessing of still having her with me, but AT WHAT COST? A cost or a price that is not for many to pay.

Your grandma is tired, VERY tired. She is depressed, ill, in pain, frustrated, confused and feels lonely. Add the severity of chemotherapy (which she is pretty familiar with) to that mix and I think what you get is like a cruel punishment. I think she is ok with dying Concernedpatron, and it is ok to go when our time comes, no matter how hard it is for our loved ones that wish we never left, we will all go at some point, and maybe she will have many more years with you, one never knows! but with my most honest heart I would tell you don’t make her go through all that again now that her strength is not even half of what it was before!

God bless both of you and hope you obtain the blessing of wisdom, so you get to clearly see the answer! A hug!
Helpful Answer (18)

When all is said and done I think the Quality of life is better than the Quantity of life.
If she has to spend the last years of her life hooked up to chemicals that will make her sick, weak and vulnerable to other infections....
As far as surgery for the spinal stenosis...With the dementia, anesthesia is not a great thing for people with dementia. She will probably not be able to participate well in rehab.
The chemo and I would imagine surgery for the breast cancer will be difficult to manage then adding the surgery for the spinal stenosis...
What I would do if this were my Mom, my Grandma, my Sister and Myself...
I would opt not to have surgery for any of it.
I would opt not to have chemo.
I would contact Hospice and prepare. If at all possible I would contact friends and schedule visits with people that I have not seen in a while. I would eat stuff that I know I shouldn't, I would read books that I should have read before.
(sort of like the Tim McGraw song)..
I would love deeper
I would speak sweeter
I would give forgiveness I'd been denying..
Live like you were dying

And one more thought..If she does not want surgery, she does not want chemo and she is "forced" or pushed into she probably would not do as well as if she wanted to "fight" this. Again Quality VS Quantity.
Helpful Answer (15)
Thank said it perfectly. Especially the tim mcgraw song reference....
Oh. H- no. Sorry. This is just a way to milk Medicare and fill pocketbooks. Let her live out her life and keep her comfortable. Hugs to you in your delima.
Helpful Answer (14)

Cancer has become big business & profit seem to override the ethical side of prescribing chemo to the over 80 population. My frail 85 year old father was coaxed into trying “one more round “ of chemo & radiation after the doctor told him he’d only live another 6 months if he didn’t do it. He had no business convincing him of that but my father took the advice, spent his remaining time in pain & misery & died 5 weeks later. BTW the Drs wasted no time sending us an enormous bill for the failed treatment. It is beyond unethical.
Helpful Answer (12)
How awful I'm so sorry! The doctor who did her surgery is convinced she removed all the cancer but the oncologist still wants her to do chemo. Seems like a sham to me.
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I worked in a Cancer Center and witnessed many families insisting that their family member do Chemo even when the family member did not want. Please please do not put her through this. Enjoy your time the best you can and pat yourself on the back for taking care of her at this difficult time.
Helpful Answer (12)
busymom Jan 2019
Thank you for sharing your expert advice. I'm glad there are people from all "walks of life" on this site who are willing to share their knowledge and compassion to those who are facing very difficult decisions.

My dad had prostate cancer that wasn't diagnosed until he was in his late 80's. And yes, the cancer had likely spread to one of his kidneys, his hip, and eventually other places. His family doctor told me that it would "be a speedy demise." Dad lived under hospice care for nearly 4 years and lived to be a full 91½ years old. We did not choose to put him through chemo, radiation, or surgery, and I'm glad we didn't. He was an artist and some of his most beautiful paintings (in my opinion) came out of those final years of his life. He lived in a nursing care facility where he was loved and well-cared for. The employees encouraged him to continue painting and even set up a weekly art class for the residents and had Dad share his skill with them.

Letting our loved one enjoy their final days is so much better than having them experience the discomfort that comes with many of the treatments. This doesn't mean that I think everyone should forego cancer treatments, but I personally think that it should not be done to the elderly, especially when they don't desire it. My dad did not want these treatments, and I honored his wishes.
Her confusion could be caused by the anesthetic. She has gone under 2x since Sept. This is not good. I would hold off on the chemo till I saw a doctor well versed in Dementia. The chemo will make her sick and her immune system will be effected. She has gone thru a lot in the last few months, I wouldn't want her to go thru more. The elderly do not bounce back very well.

Like said, if its just confusion she can't make an informed decision. Since drs. feel it could be a while for cancer to grow, there is no emergency. Think about the side effects. Will they diminish her quality of life?
Helpful Answer (9)

As an alternative to aggressive treatment of the cancer, consider offering to take her for a consult with a hospice or palliative care team. It doesn't sound as though she'd be eligible for hospice at this point, but if she is going to refuse treatment (as is her right) she at least deserves to be comfortable.

Have you read Atul Gawande's On Being Mortal?
Helpful Answer (8)
I have not but will give it a go, looks like a good read from the reviews. Thank you for your help!!
I agree with everyone else. If she's had breast cancer before and it has recurred, she will not go into remission at age 80. . I find it astounding that a doctor worth his salt is suggesting chemo at all. She wasn't living a full life before the diagnosis and certainly will suffer more if she goes through chemo.
Have her primary care doctor prescribe Hospice and go from there. I believe that you will be doing right by her by letting her live the rest of her life without treating the cancer.
Helpful Answer (8)

If she were my grandmother I would not put her through chemo treatment. This treatment is very hard on the body of an otherwise healthy person. It also causes a condition that people who receive it call chemo brain, they eventually recover from it, I’m not sure your grandmother would. I would make her last days as happy as possible and only handle any pain she may have in the future.
Helpful Answer (8)

Dear Concernedpatron. I am 84 and have had breast cancer and chemo. Right now my husband's niece is undergoing chemo for aggressive metastasized breast cancer. And one of my girlfriends just finished it. I would not do it again myself. I did it the first time because I still had minor children and felt I had to do what I had to do.

The side effects of chemo can be inhumane as far as I am concerned. Remember, chemo is poison, they try to kill the cancer cells before the chemo kills you. Not only are you tired and sick, but depending on the meds they give you, you can lose your hair, have permanent bladder, kidney, and liver damage. My internal thermostat is so damaged that 36 years later I still have awful hot flashes and chills. Losing your hair is the least of it. You can have huge blisters on the inside of your mouth and throat. If the chemo has made you so anemic, by killing off your red blood cells, that you have to take their blood and bone building medicine it makes you sicker. My girlfriend just went through that regimen and our niece is doing it right now. Both of them get so sick they can't walk or hold food down. These women are 79 and 66 years old. I can't see any reason to put your Grandmother through this.
Helpful Answer (8)
skipperinos Jan 2019
Bless you for sharing your experience with us. You are a real survivor!!
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