Mastetomy for 93 year old

Sandy5Pat
Sandy5Pat Member Posts: 5

I have survived BC twice but I am seeking info to help my 93 year old mother who was just diagnosed for second time with BC - I think it is estrogen, progesterone dependent. She had lumpectomy only 3 years ago. Now her surgeon is recommending mastectomy for this new or reoccurring cancer. My siblings and I are questioning whether this is a good idea at her age and want to get input and ask more questions about alternatives before she goes forward. Does anyone have any insight on mastectomy or radiation in a 93 year old?

Comments

  • ShetlandPony
    ShetlandPony Member Posts: 4,924
    edited September 2021

    My goodness. I would get a second opinion. There is a field called geriatric oncology, and it would be great to consult someone in that sub-specialty. I would want to know how aggressive this cancer appears to be, whether there could be a trial of a new drug with monitoring, whether a second lumpectomy is an option. Do women in your mom's family generally live to be 99? How is her health overall? What does your mom think about it all?

  • moth
    moth Member Posts: 4,800
    edited September 2021

    on the flip side, surgery is curative for the majority of pts and plenty of 90+ sail through surgeries. I'd probably really push for another lumpectomy if possible just because of way smaller/faster surgery but still, I'd consider it. This would give her the opportunity to die years later from something else.

    Of course lots depends on her health otherwise and outlook on life, activity level etc.

  • jhl
    jhl Member Posts: 333
    edited September 2021

    Sandy,

    I'd have a serious heart-to-heart with your sibs, an anesthesiologist & your mom. I really believe your mom's cancer is irrelevant in this circumstance. It is her brain that is the problem. She may physically recover from the surgery but her brain might not recover. I have seen this far too many times.

    Jane

  • Sandy5Pat
    Sandy5Pat Member Posts: 5
    edited September 2021

    Thanks so much all. We just got hit with this and I am heartbroken thinking of my mom dying of MBC but that is probably not going to be the case. Jane, she has a bit of dementia which the surgeon may not be aware of so would that increase the brain risk and be a no go if surgeon knew? They live in a small area so I doubt there is a geriatric oncologist but will check. She is still mobile and very alert and aware and an eternal optimist but now that you mention it we don't see her making it to 99. Has high blood pressure (treated). She told me she wants to make it to see all grands married but that may not be realistic. Thanks for helping me start to think about this.



  • ShetlandPony
    ShetlandPony Member Posts: 4,924
    edited September 2021

    You and your mom could probably do a second-opinion consultation by telehealth, especially with an oncologist in the same state as you. (I am guessing you are in the USA. If you want to post here or private massage me your state I will see if I can get you started with a couple resources.)

  • Chicagoan
    Chicagoan Member Posts: 728
    edited September 2021

    Did your mother also receive Hormonal suppressant therapy? I knew a woman who was diagnosed with BC at 91. She did not have surgery or radiation, just hormonal therapy. She lived until 96 and did not die of cancer. Definitely suggest a second opinion b/c a mastectomy sounds so extreme at her age.

  • Cowgirl13
    Cowgirl13 Member Posts: 1,936
    edited September 2021

    jhl, I'm not sure I understood what you were saying re: dementia. Did you mean that existing (early) dementia can be exacerbated by the surgery? Thanks.

  • jhl
    jhl Member Posts: 333
    edited September 2021

    Sandy,

    You & your sibs are really faced with a difficult proposition. Yes, anesthesia will indeed make an impact on your Mom's brain. It affects all of us but younger brains can adapt easier than the elderly. For now, you have a very happy, Grandma who has a goal - to see her grandchildren marry. Is she in any discomfort? I would encourage you to speak with her oncologist. The course of her illness may not end up as dire as you think and the prospects of an elderly person who must undergo surgery, rehabilitation & who knows what in this era of COVID is worrisome. My own mother had treated BC when she was in her 50's. In her 80's she had uterine cancer, treated. But, she said she would no longer test nor treat anything else. She passed away in 2020 at the age of 101 of old age, not cancer.

    I will keep you and your family in my thoughts,

    Jane

  • Sandy5Pat
    Sandy5Pat Member Posts: 5
    edited September 2021

    She had a lumpectomy 3 years ago. No further treatment. We are kicking ourselves now for not questioning that at the time.

  • jhl
    jhl Member Posts: 333
    edited September 2021

    Yes, Cowgirl, pre-existing dementia can indeed be exacerbated by anesthesia. This is a review article on the risks of surgery in patients with varying degrees of dementia:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC60290...

    Surgery is not easy for anyone & the risks, both physically & cognitively are real. The best advisors are the physicians who care for you or your loved one.

  • jhl
    jhl Member Posts: 333
    edited September 2021

    Sandy,

    Can you recall what your Mother indicated at the time of her lumpectomy? Did you ever discuss what her choices were? Is she cognitively intact enough to express her desires? Please, do not worry about choices in the past. AI's probably would not have made a significant difference and chemotherapy/radiation might have been far more than she was willing to do and perhaps not indicated. The last 3 years have been 3% of her life. Hopefully, she'll have lots more happy and fulfilling years ahead with you, your sibs & the grands. But, really, ask her what she wants. It would be best if her surgeon gives her a complete disclosure of all the pros and cons. Let her make her choice of what she wants done. Even with a bit of dementia, she may still have agency with which to express her own desires.

    Best of luck,

    Jane

  • sbelizabeth
    sbelizabeth Member Posts: 2,889
    edited September 2021

    My 93-year-old mom was active and (mostly) sharp when she fell and broke a small bone in her pelvis. She was given anesthesia to place a pacemaker. She never walked again, and her mild dementia immediately escalated to the point where she needed skilled nursing in a memory care unit.

    Is your mom's new cancer particularly aggressive? Are her physicians concerned it will cause intractable pain or break through the skin?

    It's a risk-benefit decision, and if factors are described clearly and simply to your mom, hopefully she can be the one to decide.

  • Cowgirl13
    Cowgirl13 Member Posts: 1,936
    edited September 2021

    jhl and sbelizabeth, thank you for responding. I had no idea.

  • Rambros
    Rambros Member Posts: 78
    edited September 2021

    My 99 year old grandmother recently had a 2nd lumpectomy. She was originally diagnosed at 90 - lumpectomy & radiation but no pills taken due to her age. Unfortunately the cancer came back around 95 and due to her age & non-aggressive cancer it was decided to skip surgery and just take anti-hormone therapy. Unfortunately the tumor ended up being 2 tumors which slowly grew (she tried all the variations of AI’s, tamoxifen, and faslodex). We were concerned it would break through her skin so had to do surgery. The surgeon did a lumpectomy as quickly as she could - no real concern for margins or aesthetics - just get the cancer out quickand close. I do think the anesthesia affected her brain unfortunately - she was very confused afterwards and hasn’t been the same since. She aged a lot between 93 and 99 though, thinking back 6 years ago I think she could have handled a 2nd lumpectomy just fine back then. Good luck with your family’s decision- I know it’s not easy.

  • bcincolorado
    bcincolorado Member Posts: 5,758
    edited September 2021

    I have been diagnosed with dementia my self and would seriously question going under anesthesia again at this point. I am on medication to help preserve my memories and speech at this point and they do affect brain function already. If I were to be diagnosed again with another cancer I do not know I would treat it. My primary doc would not even consider the relaxing medicine for a colonoscopy and said was not necessary at this point and did the kit instead you send in. I would talk to her doctors about your concerns. f you do not have a medical POA I would recommend you get one as well for your mom because of HIPPA.

  • sbelizabeth
    sbelizabeth Member Posts: 2,889
    edited September 2021

    bcincolorado, I'm sorry to hear of your diagnosis. My SIL also has early dementia but is not on meds. Have you noticed that they are helpful?

    As a side note, you make an excellent point regarding medical POA and HIPAA. I'm mostly retired but I still do data extraction for prehospital cardiac arrest incidents. It happens distressingly often that an elderly individual, or someone with an end-stage terminal disease, collapses at home and the family has no idea what their wishes would have been. There's no written documentation anywhere. Paramedics are obligated to provide resuscitation attempts (CPR, sometimes intubation, IV starts, meds) that are almost always futile. Cardiac arrest resuscitation care for the very ill or elderly is undignified, very invasive, distressing for the onlookers, and unnecessarily interrupts what should have been a peaceful transition from life.

    Everyone, everywhere should have an advanced directive and a medical power of attorney (POA). Young, old, big family, no family...everyone should have written directions as to what medical care should be provided if they're unable to decide for themselves.

    Those who are elderly or in frail health should also have a POLST (Physicians Orders for Life Sustaining Treatment) https://deathwithdignity.org/polst/. This document takes the place of a Do Not Resuscitate (DNR) order, although both are valid. A POLST provides more detailed information as to an individual's wishes for end-of-life care. These documents vary from state to state, so look it up online for your own state's requirements.

  • AliceBastable
    AliceBastable Member Posts: 3,461
    edited September 2021

    Sandy5Pat, How large is the tumor and where is it located in her breast? If it's small and not too deep, would the lighter anesthesia be possible? I don't remember what it's called, but it was used when I had a small hernia repaired and also for my lumpectomy resection. It's just done through a vein and I was brought out of it while still in the OR both times as the doctor was finishing up. What little grogginess was there vanished in just a few minutes. I don't think there was even any recovery room time - I know for the resection I was home before 11:00 a.m.

  • LillyIsHere
    LillyIsHere Member Posts: 830
    edited September 2021

    A second opinion would make sense, especially from a general doctor. Also, mastectomy may be helpful as cancer goes however, a bigger picture of overall health is as important. I would never think estrogen-positive cancer can start in a woman her age where estrogen is already less than most of us who take anti-estrogen medications.

  • ThreeTree
    ThreeTree Member Posts: 709
    edited September 2021

    bcincolorado - Are you sure the Femara isn't causing some of your cognitive problems? It can do a real number on your brain and I think that some of the consequences of it could be mistaken for early or mild dementia. Just a thought.

    sandypat - I would really ask your mother what she would like to do if it is at all possible. I would also underscore the things sbelizabeth has said about POST forms, etc. I work in an area that brings me in contact with POLSTS quite often, and they do help, although what I have found is that often when a crisis event occurs, a whole new picture can emerge and what seemed sensible with the POLST might not be anymore. I work in guardianship and sometimes we need to change them on the spot when the doctor calls with a crisis issue.

  • Sandy5Pat
    Sandy5Pat Member Posts: 5
    edited September 2021

    Thank you all so much. I am working thru all this info, web site and testimonies. It is so helpful. And I'm starting to communicate with sibs (5 of us scattered around but all willing and able to go home to help). I realize I need to know about POST etc. I think Mom and Dad and two other sibs have that well in hand. I got recruited now because I am the BC survivor in the family. I wasn't very involved 3 years ago because I was a triple negative survivor and Mom's cancer was different. Thank you and bless you all and I will no doubt be in touch.

  • LivinLife
    LivinLife Member Posts: 1,332
    edited September 2021

    Soooo feel for you going through all of this with your mom! I agree with many of the other comments about either anesthesia negatively impacting your mom's brain and/or the surgery and recovery process impacting your mother's dementia....these are separate processes. even a hospitalization for someone with mild dementia can be disorienting and worsen dementia. anesthesia as we get older puts us at greater risk for delirium which the hospital then thinks is the dementia though it's different - went through that with my mom others.... the large changes just push their brains too much and they can't deal with such change with dementia.

    I had an aunt whose breast cancer came back for a 3rd time. She was 93 or 94 and it was already in her lymph nodes. They didn't do any surgery or chemo. They (aunt and cousin) did some palliative care radiation (not treatment radiation) to help with her arm pain and went the palliative route. Your mom is not metastatic at this time though - I really like the suggestions of geriatric oncologist and telehealth to make that possible!!!

  • Irishlove
    Irishlove Member Posts: 82
    edited September 2021

    I just wanted to add my grandmother's story to this conversation. She was 93 when she was diagnosed with breast cancer. Overall, she was in fairly good health and thrived in her environment. The surgeon felt that a lumpectomy would suffice. She was put under a general anesthesia and did wonderfully well, living another 6 years. She passed from old age/heart failure. Grammy never showed signs of dementia both before and after surgery, but then again it doesn't seem to run in the family. Her b.c. was hormone positive. Hard to believe as she had a complete hysterectomy 60 years before. I, too had hormone positive b.c., even though I had a complete hysterectomy 30 years before my diagnosis. She never rec'd hormone replacement therapy. I did, low dose climara patch for 15 years.

    Given the choice of dying of breast cancer or old age/heart failure, we both picked the latter.

  • Sandy5Pat
    Sandy5Pat Member Posts: 5
    edited October 2021

    Hello all! I'm sorry I haven't gotten back to you. Mom had a lumpectomy last week. They were able to get one lymph node and clear margins around tumor. It was outpatient surgery due to C. According to SIL who was with her, Mom was pain free and back to her regular routine as soon as she got home! She is open to starting Tamoxifen and hopefully that will be enough to get her through this life without reoccurrence. Thank you all for your knowledge and sharing the experiences of your elderly loved ones. It was soooo helpful. She/we could have made a big mistake if we hadn't questioned the surgeon's initial plan. Mom made the decision after her 3 daughters and 2 dils discussed and presented her with the possibilities. Mom wanted us to all be on the same page which we were and then she decided from there. The POST etc are all up to date. Anyway, thanks again and take care.

  • bcincolorado
    bcincolorado Member Posts: 5,758
    edited October 2021

    i am not hormonal bc meds at this point and my MO stopped mine early because of side effects of bone loss for me was getting to point I needed Prolia regularly. Hormonal meds did not cause my dementia issues at all.

    trishlove I'm glad the famly was there for her and supported her.


  • ShetlandPony
    ShetlandPony Member Posts: 4,924
    edited October 2021

    Sandy5Pat, thank you for posting to tell us what your mom decided. It sounds like an appropriate treatment plan and great family support. I'm so glad your mom is feeling well after her lumpectomy. Tamoxifen is not expected to cause bone loss in postmenopausal women -- may actually improve bone density -- and chances are good your mom will do fine on it.

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