metastasized bladder cancer in 95 year old mother - 1260609

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lightbytheway1
metastasized bladder cancer in 95 year old mother - 1260609

Due to her advanced age/condition (bladder cancer metastasized to lung and pancreas) family is ambivalent about telling mother of her diagnosis. Doctor is suggesting only symptom care.
She is not asking any specific questions of why she had a bladder procedure to remove the tumors. This was successful in part. We would like to be completely open but we are afraid she will get into a depression and live the rest of her days with anxiety and fear.
In your experience what are the benefits and negative sides of telling a frail, deaf nonagenarian woman of her health problems?

Thanks for your answer!

catdander
Reply To: metastasized bladder cancer in 95 year old mother

I'm very sorry your mom has this diagnosis. Your question is understandable. My husband falls into the denial and ignorance is bliss category so is a similar matter. Most doctors are going to want to discuss this with their patients so I'd want to have the conversation with the doctor first so you can be on the same page. With my husband (I understand it's different) he accepted the basic info then let me understand he would trust us to do the right things for him. It was a new idea to me but it falls into denial and some people are able to move into that place, let family make decisions, and with the help of hospice live out their lives pretty comfortably, without much input.

Below are some posts on the subject. Perhaps you'll pick up some bits that you can use.
http://cancergrace.org/coping-with-cancer/2009/04/29/denial-coping-mecha...
http://cancergrace.org/coping-with-cancer/page/2/
http://cancergrace.org/forums/index.php?topic=1407.0

The very best to you and your mom,
Janine

Jazz
Reply To: metastasized bladder cancer in 95 year old mother

Does your Mom have a good quality of life otherwise, or is she having severe symptoms from the bladder cancer?

I had a friend whose 93 yr old father had bladder cancer on top of recurrent colon cancer (which was treated 21 years earlier). The oncologist said the father would die of old age before the bladder cancer took him, so they never mentioned it and sure enough he passed away in his sleep. I don't know that this applies to your Mom, but if she's of sound mind and inquisitive, wouldn't she ask what was going on, why all the procedures? If she doesn't ask and submits, then perhaps she's fine with not knowing and letting family make the decisions.

I hope you find the best way to handle this delicate situation. Best wishes to you and your Mom.

Jazz

catdander
Reply To: metastasized bladder cancer in 95 year old mother

Well said Jazz.

Dr West
Reply To: metastasized bladder cancer in 95 year old mother

The last thing I would do is suggest that a 95 year old should receive chemo, but for what it's worth, bladder cancer can be quite sensitive to chemo. The age of 95 is right up there among the highest I've ever considered treating with chemo, and we've generally decided it was a poor idea at the end of the day. But I mention it because its possible utility would make me a little wary about making a unilateral decision about it without the patient having some direct input. It also might be that giving her the autonomy to say "oh, heavens no" or "hell, yes" to the idea of chemo would enable her to exert some control in an otherwise minimally controllable situation.

Otherwise, the main approach I advocate is taking cues from the patient. I tend to favor more disclosure, but if a patient really expresses no interest in details and deflects discussions, I think it's reasonable to follow their lead. On the other hand, if they ask questions, I strongly favor being forthright. It is a patient's right to know as much as they want to know. I would just also say that if someone has a right to know, they also have a right to NOT know if that is their preference.

Good luck.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Medical Oncologist
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education

lightbytheway1
Reply To: metastasized bladder cancer in 95 year old mother

Thank you all for your input. I realize my post erroneously read "mother" instead of "mother-in law".

My mother in law saw the urologist that operated on her last week and contrary to the information we had at the hospital, he recommended 6 localized chemotherapy treatments and another cystoscopy after that to evaluate results. The doctor encouraged us then to tell her she has cancer, so she could decide by herself whether or not to have treatment. She did at that time, but keeps on changing her mind. The doctor says these focused treatments do not have the side effects as other chemo. The urologist says we shouldn't worry about the other sites, lung and pancreas, since he doesn't want to put her through biopsies for further study and it wouldn't be recommended at her age?
I'll appreciate receiving some of your comments. Thanks!

Dr West
Reply To: metastasized bladder cancer in 95 year old mother

It's absolutely true that local chemotherapy instilled into the bladder is a different situation than IV chemotherapy, and it shouldn't have systemic side effects. However, that approach is usually done for people who have disease limited to the bladder, not invading into the muscle wall of the bladder or spreading to other parts of the body. It isn't clear to me what value, if any, local instillation of chemotherapy into the bladder would offer if there is a high probability of it having spread to other parts of the body.

-Dr. West

+++++++++++++++++++++++++
Dr. Howard (Jack) West
Medical Oncologist
City of Hope Cancer Center
Duarte, CA

Founder & President
Global Resource for Advancing
Cancer Education