Navigating Cancer Care Decisions for Older Adults

A cancer diagnosis is never easy, but it may be even more challenging for older adults who may already be managing issues related to aging, such as decreased mobility, vision or hearing. Unfortunately, aging is also a risk factor for cancer, with the National Cancer Institute reporting rates of diagnosis increasing steadily with age. From 2013 to 2017, more than 1,000 per 100,000 people aged 60 and over were diagnosed with some form of cancer, while those under 20 faced rates below 25 per 100,000 people, and those aged 45 to 49 only faced rates of 350 per 100,000 people.

In this guide, older adults will  learn how a cancer diagnosis may affect their senior living options. This guide also offers detailed information about how to find assisted living and nursing care facilities that  provide cancer care to aging adults.

Older adults may face barriers that younger persons aren’t subjected to when seeking care after a cancer diagnosis. This includes barriers to screening prior to receiving a diagnosis, as well as treatment and cancer therapy obstacles.

Unfortunately, there’s a lack of clinical trials and resulting data when it comes to cancer screening for seniors. According to Hopkins Medicine, the most likely reason for this is that it can be difficult to assess the efficacy of screenings in older adults. Researchers may also struggle to qualify or quantify risks vs. benefits of screenings in older adults. 

Unfortunately, the problems mentioned above aren’t something that older adults can control when it comes to cancer screenings. However, there are factors that often influence seniors’ decisions about screenings that are within their control. Although recommendations suggest that adults over 65 should have regular screenings, including mammograms, PSA testing, gynecological checkups and colonoscopies, many make a conscious decision not to have these screenings.

While reasons to delay screenings differ, there are some common personal barriers that older adults face. That includes: 

• A lack of education about the benefits of cancer screenings
• Concerns about the health impacts and side effects of cancer treatments, such as radiation and chemotherapy, should test results come back positive
• Personal preferences regarding their quality of life
• Religious beliefs and family values

Although cancer prognosis tends to worsen with age, instances of delayed diagnosis continue to occur among seniors. Often, symptoms are excused as aging or being related to other health conditions instead of being checked by a doctor immediately, and unfortunately, by the time the patient seeks care and raises concerns to their health care provider, the prognosis has worsened. This barrier, along with several others, can create a significant delay in receiving timely and accurate diagnoses and opportunities to obtain effective treatment. 

Aside from a delay in obtaining a proper diagnosis, older adults may also struggle to access appropriate diagnostic testing to determine the original source of cancers that have spread throughout their bodies. This is often the result of denial in the patient or their family members as well as pessimistic attitudes about treatment or test results.

Once cancer has been diagnosed, seniors may face further barriers when it comes to obtaining adequate care for their condition. Unfortunately, the most common barrier in this scenario is ageism — whether subconscious or intentional — among health care providers. Examples of this include: 

• Assuming that, as a senior, the patient is unable to afford appropriate cancer care
• Assuming the patient may have personal beliefs about accessing advanced or experimental therapies
• Attributing discomfort and symptoms to aging and other medical conditions instead of investigating cancer symptoms appropriately
• Underestimating the patient’s ability to withstand treatment options, such as chemotherapy or radiation
• Underestimating the patient’s life expectancy and assuming they won’t want to undergo treatment

When it comes to making decisions about cancer therapy after a proper diagnosis and initial treatment has begun, many barriers can stand in the way of making the right choices. These may come as a result of patient or caregiver opinions and beliefs, caregiver or family stress, or the beliefs of the patient’s primary health care provider.

The most common barrier to cancer therapy for older adults is the beliefs or stress of their family caregivers, who are typically spouses and/or adult children. Because a cancer diagnosis is a lot to take in, most older adults opt to bring a family member to their appointments to help them remember medical instructions and ask questions, but in some cases, this companion’s concerns and beliefs may overshadow those of the patient, resulting in:

• Patients acting less assertive when discussing treatment options or asking questions about their condition and prognosis
• Caregivers feeling overprotective and making harsh decisions on the patient’s behalf
• Physicians providing less information in an attempt to calm patients and their family members, which can lead to a lack of education for patients as well as a lack of treatment options

More than 15% of the U.S. population is aged 65 or older and according to 2019 data published by the National Center for Health Statistics, more than 2 million of those seniors reside in assisted living facilities or nursing homes. While some of these long-term care facilities don’t provide specialized care for residents with cancer, many do offer services that can make living with cancer easier, and in some cases, these facilities may offer on-site oncology care and cancer-focused nursing services.

Each of the facilities varies in what services they offer residents. That said, those that provide cancer care typically provide services such as 24-hour medical supervision, medication administration or assistance, personal care, transportation to and from medical appointments, and nutritional support.

There are several types of senior living options available for those seeking residential care.

Other services that are typically provided in assisted living facilities include: 

• Housekeeping
• Social activities
• Transportation to and from appointments, errands and family visits
• Daily meals
• Case management

Seniors with advanced cancer or other underlying disorders in addition to their cancer may want to consider nursing care. In a nursing home, residents are provided with 24/7 medical supervision by a registered nurse or physician, along with a team of caregivers and licensed practical nurses. 

Often, nursing facilities have doctors or oncologists on staff who can conduct regular wellness checks on cancer patients and provide other health care services on-site.

Home care enables older adults to age in place at home. It can provide a variety of services on a schedule that works best for the patient, whether that’s having a temporary live-in caregiver, weekly visits or something in between.

Home care agencies typically employ nurses and professional caregivers who visit seniors to provide personal care and homemaker services. When cancer care is provided, additional services may include medication administration, wound care and wellness checks as well as transportation to and from medical appointments.

Hospice care is reserved for those facing the end of their lives. When cancer has reached its final stages, hospice care ensures that the final days or months of a person’s life are comfortable by administering medication and treatments that address cancer symptoms or side effects from cancer therapies, as well as personal care and wellness services, as needed. Hospice care is typically provided in the patient’s home, but may also be administered in a facility.

After a cancer diagnosis, it’s important to select a care setting that’s most appropriate for your needs. That means finding a facility or home care agency that understands the care you need to remain comfortable and preserve your health, as well as one that’s equipped to provide that care. Following are some steps to help you and your loved ones find the right care setting:

• Understand the diagnosis: Meet with your oncologist or other health care practitioner and, if needed, bring along a spouse or family caregiver to help you take in the information they provide. Make sure to ask questions about your prognosis, treatment and medications as well as any additional symptoms or changes to watch for that require you to seek further care. 
• Make age considerations: When determining the right course of action, your age is a factor that should be considered. If you’re approaching or into your senior years, you may find it more difficult to navigate aging while battling cancer, making senior living options, such as assisted living, a more appealing option thanks to the extra help that’s offered in these facilities.
• Evaluate your options at home: If recovery at home feels like the best and most comfortable option for you, take time to review home care agencies that offer cancer care in your area. Medical equipment loans for beds, wheelchairs and other necessary supplies are available from charitable organizations in most areas across the United States to make healing at home a more affordable option.
• Re-evaluate regularly: As your condition changes or progresses, regularly and frequently re-evaluate your needs and reconsider whether you need to upgrade or downgrade the care you’re receiving.

There are many things to think about when selecting the right assisted living facility to move into, especially when cancer care plays a role in that decision. Follow the checklist below for guidance when selecting the right facility for your needs. You can view the checklist on your device or download it and bring it with you to community tours.

There are several national assisted living and nursing home chains that offer cancer care services. These facilities provide cancer care in addition to standard assisted living care or nursing care services, as outlined above.

The table below includes some of the top national assisted living and nursing home chains providing cancer care in the United States.

To learn more about the cancer care options available at the facilities listed above or to discuss senior living options, reach out to Caring.com’s trained Family Advisors by calling (800) 973-1540. This advisory service is completely free of charge to callers. 

When cancer reaches advanced stages, you may need to seek hospice care, which is designed to help control symptoms of cancer and side effects of cancer treatments with medications and other therapeutic techniques. Hospice care is specifically designed to provide comfort at the end of one’s life.

According to the Centers for Disease Control and Prevention, there are more than 4,300 agencies providing hospice care throughout the United States. These agencies provide varying services to patients, with most creating customized care plans centered on the patient’s exact condition and needs. Services provided in hospice care typically include:

• Regular visits from a physician and/or registered nurse to address pain, nausea and other symptoms
• Help with ADLs, such as bathing, grooming and eating
• Family bereavement counseling
• Spiritual care from a visiting or on-site chaplain
• Companionship from caregivers and/or volunteers
• Assistance with wills, personal directives and other legal issues if required
• Social worker visits to help family members access additional resources within the community
• Medication administration

Hospice care is only for those living with end-stage cancer or other illnesses with a life expectancy of 6 months or less.

The resources listed in the table below can provide you with help finding hospice care in the United States. These resources include organizations that provide education about hospice care, access to directories of registered hospice agencies and support in finding a hospice that suits you.