Let’s recap where we are in my story: When I last wrote, I talked about learning my diagnosis with esophageal cancer and working through the process of making care and treatment decisions. I opted for additional scans to test for metastatic disease (cancer that’s spread beyond the original tumor), and I was able to do so for several important reasons: I decided, took charge, and planned for the possibility that a spot on my liver could be confirmation of metastatic disease.
Much to my amazement, I was informed that, in fact, the liver spot was simply a hemangioma (noncancerous growth due to an abnormal collection of blood vessels), and the oncology team was recommending a full blast treatment approach with a way more optimistic outcome than I believed possible. Thus, I weighed the possibility of better quality of life against the risk of treatment just making things worse.
I decided to go forward with treatment—a combination of 5 weeks of daily radiation, chemotherapy, and then surgery if the response to treatment was good. Surgery being the reward, as it is only done when cure of current disease is noted.
This entire process at my age (a few months from 60) made me realize that, no matter what age one is when diagnosed with a potentially life threatening disease, decisions around treatment are tough. Did I have things to look forward to? Of course: a recently awarded research project grant from the National Institutes of Health, a fourth grandchild on the way, and many other professional and personal goals I still wanted to achieve.
Many older adults have an equally expansive list of things they’re looking forward to. They will tell me they still enjoy playing bridge, want to finish a professional paper or book they are working on, and want to continue going to dinner with friends and seeing family. I will never again assume that an older adult does not want to pursue a treatment option when faced with a new and what might be life-ending diagnosis.
I have always believed my responsibility to patients was to inform them of the pros and cons of treatment options to help them decide on an approach most consistent with their goals. For older adults, cancer treatment or surgical interventions for cardiovascular disease may make their quality of life worse and even hasten death, but the decision to forego the treatment may still be difficult.
Whether you are a healthcare provider or a friend or relative of someone having to make these decisions: be open and supportive. and try to empathize. I still don’t know the outcome of my decision…but I am living with the consequences, doing the best I can to cope with the daily challenges, pulling on my own resilience and the resilience I have learned over the years in doing geriatrics, and hoping that I will come out on the other side and say it was a good decision!