88 year old Grandmom: To chemo or not to chemo...

All I can offer in the experience I had with my father.  The wanted to do chemo then surgery and then chemo for a tumor in his colon.  They went with that option.  He was so sick from the initial chemo and just wanted the tumor out so he prayed and prayed and the darn thing burst and it had to have emergency surgery to remove it.  As he was sickened by the initial chemo, he had a bit of trouble and  was in ICU after surgery for some time.  He came home but was so weak and still in much pain - and was back and forth in and out of the hospital until his body just gave up and he was gone.  He received the dx in August of 1999 and was gone November 4th, 1999 - I was talking him through chemo as I was going through it at the time with my initial dx. 

I am not meaning to scare you but I would consider her quality of life - if it is not agressive, why not a lumpectomy and a kinder treatment?  Or a kinder treatment.  If she is feeling fine and is hormonally positive and healthy, why mess with it?  Sometimes exposure to air sends the cells into freak out mode.  I wouldn't do anything until I had the pathology and then I would definately get a second opinion.

Just my thoughts...Hugs to you and to your grandmom...LowRider

Count me in the no chemo crowd. I might ask about the possibility of starting an aromatase inhibitor to try to shrink the tumor, if the surgeon really felt it needed to be smaller before surgery (assuming it's ER+). Otherwise, surgery alone should be sufficient at 88.  My aunt, at 82, opted for surgery and radiation, but no chemo or meds.

My aunt at 90 opted for no treatment.  At 100, she had some discomfort from the tumor so she had some palliative radiation which relieved it.  At 101, she died from unrelated causes.

I would get second and third opinions that took into account your Grandma's overall health, type of disease, and her wishes. 

All the best with this difficult decision.

Mandy 

I wouldn't hold the recomemendation for aggressive treatment against the Oncologist.  He/She is probably sitting there knowing that if the max treatment isn't recomended that the family will leave mad at him/her for giving up on her because she's 88.

Rather I'd think about going back and saying, "you recommended an aggressive approach, we'e concerned about Grannies QOL, what else could we do?" I suspect the Oncologist will turn on a dime and outline something more along the lines of what other posters here are thinking.

Here's the question that no one has asked--what does your grandmother want to do?  Personally, i think her wishes are the most important and should be considered first.  This doesn't mean that you can't have a discussion about it or that you can't help her make up her mind.  I'm not negating anything anyone has said at all in fact they have been very good.  Oh, diana i just saw your post as i was composing my post.  I so totally agree with your post.   

Please keep us posted, Colleen, and much love and an uneventful, safe journey for Grandmom, whatever is chosen.

Linda

i have a friend (then 91).. she chose to have surgery but no further treatment a couple years ago. She is still doing well.  She told me she was fine with dying if that is what her choice entailed.  I'm sorry to hear about your Grandmom and wish you both well.

There is ZERO way that I would do chemo at the age of 88. I'd have the surgery, and then go out and have as much fun as I could with the time I had left on this earth. I think that is a crazy thing for a doctor to even recommend!

I feel like i have to tell you this story. My best friends grandma was 95 when dx with breast cancer, they thought she  was well enough for surgery, so they did the surgery and thats all, no chemo, no pills nothing else.  She just passed away 2 weeks ago, one week after her 103rd birthday, and not from cancer. I say no chemo either.  Best Wishes!!!

My mother was dx stage IIIc ovarian cancer at 86.  She had surgery, then fairly intense chemo (but it was appropriate for her age and body weight -- note that her age was a factor).  NED for about 2 years.  When it came back she was 88 and *she* chose chemo again.   She wanted to live as long as possible and being 88 wasn't the issue for her.   The oncologist weighed QOL against effectiveness of chemo and made adjustments to her treatment so that the chemo would hopefully do some good (it did) without making her too weak to enjoy life (it didn't).  The end result was that she lived long enough to go to her first grandson's wedding (over a year after her cancer came back), which was something that was extremely important to her. She also lived about 2 years longer than all predictions. 

Her dementia actually was much harder for everyone to deal with (including her) the last year than her cancer was.

I know my younger brother asked me more than once (I was the caregiver at ground zero with her) if the dr was ever "holding back" because mom was elderly and they didn't feel someone her age needed the same level of treatment a younger person would -- but this was never the case.  And she was getting chemo, including at one point gemzar, which is truly nasty stuff.  So no matter what the drs. recommend, there's often going to be someone second-guessing the recommended treatment.  

Getting multiple drs opinions and going with your gut tells you is the best you can do.

This isn't the same as anyone else's situation, obviously, and I'm really glad your grandmother has someone skilled in working with the elderly.   I know he'll be balancing QOL issues, as our oncologist did.  Some drs do only go after treating the disease but I'm so glad to hear of the many that treat the whole person.  Best of luck to your grandmother, and to you!!

That's great to hear!  Two weeks to go -- being able to see that finish line is such a wonderful feeling!  And it sounds like your grandma has the right onc. 

Absolutely!

I was so excited when I went in for my last infusion.  Then the blood work came back.  Instead of my last chemo I got blood transfusion number 7.  And walked out of there knowing that I had another week to wait before that last chemo.  Boy, was I down.  Fast forward to two weeks later and I am there for the lab, doc visit, final chemo.  Platelets had continued to go down for the last two weeks.  So I said "that it - I'm done".  In this weird way I didn't feel like I had accomplished anything.  Wasn't what I was expecting to feel like at all. 

But as the weeks progressed and I started getting my taste back, my appetite back and my energy back then I realized what I had been missing for all those months.  With my energy came the good feelings.  Then I could start feeling very good about what I had accomplished. 

Give yourself some time.  You'll look back and think "Wow!" You'll realize that it really was a mountain and you climbed it.

Colleen, I was actually almost scolded by a health-care professional (not anyone as part of my team, fortunately!) for not being "happier" when treatment ended.  It's common for there also to be a feeling of abandonment -- all that attention for weeks on end and then, boom, you're out on your own again, so to speak.  I didn't feel abandoned (after chemo I had surgery and then radiation) but I was so numb and worn out that I sure didn't feel happy or much of anything else.  I was just putting one foot in front of the other.  Even after radiation was finally over I was a long way from feeling joy.  For me, it was like everything happened so fast:  dx, port, baseline muga, first chemo in a period of 10 days -- I was overwhelmed and didn't have time to digest everything until I was done with it all.   It takes time to get the energy and mojo back -- but you'll get there -- and you aren't alone!