The way someone reacts to cancer largely depends on their personal characteristics. One of them, without a doubt, is age. From a psychosocial standpoint, a patient’s age brings with it specific connotations.

Older people’s reactions to cancer can be observed at various stages of the disease:

PREVENTION AND EARLY DIAGNOSIS:

The only proven prevention method in oncology involves tobacco. Various studies show that while even if they don’t actively try to, about 70% of adult smokers want to give up smoking, yet from age 65 the number of people who want to stop smoking decreases. In general, the beliefs tied to these attitudes reflect an apathy or pessimism, as if resigned to the idea that giving up isn’t worth the bother anymore. Even if it’s true that if you have smoked for years the risk of getting cancer might be the same, giving up smoking is always a great way to improve your health. Your quality of life improves: after two weeks of not smoking, you can already feel better, your lung capacity expands, you’ll breathe easier and you’ll be able to do more exercise and feel more independent. TRY IT, and if you can’t do it on your own, GET PROFESSIONAL HELP.

Regarding early diagnosis, studies also show that seniors choose to not take part in health campaigns or stop getting their regular check-ups.For example, with regards to mammogram campaigns or gynaecological check-ups, studies attempting to determine what stops women from attending their appointments consistently show that one of the most common barriers is age. Hidden behind these choices are pessimistic attitudes and erroneous convictions, like the ones that follow:

• To think it’s a given that cancer cannot be cured, and so there’s nothing you can do about it. It makes sense that if you are 65 or older then you have lived your whole life with the idea that there is no cure for cancer and, if it arises, there’s nothing you can do about it. It’s also possible that you remember some family member of yours that has died of cancer and, for this reason, their experience makes you not want to think about the disease. But things have changed a lot, and age is not a legitimate reason for giving up leading a healthy lifestyle. If you have a tumour, the sooner it’s detected, the greater the possibilities of curing it or receiving effective treatment for it.
• If we refer to breast cancer and screening campaigns, many older women think that because of their age, there’s no point in keeping a watchful eye on their breasts, as they are inaccurately associated with motherhood, youth and sexuality. You should continue to have your breasts examined, as it’s precisely in your later years that the risk of cancer increases, not the other way around. Regardless of your age, you are always a woman and that’s why your breasts are important and you should take care of them. This is also true for the techniques involved in self-examination, which many older women don’t want to learn. Being familiar with them is important. WATCH OUR VIDEO THAT SHOWS YOU THE CORRECT WAY TO PERFORM A SELF-EXAMINATION, AND CONTACT US IF YOU HAVE ANY QUESTIONS ABOUT IT.

REMEMBER: REGARDLESS OF YOUR AGE, IT’S WORTH THE EFFORT TO CONTINUE LEADING A HEALTHY LIFESTYLE AND HAVING A CAN-DO ATTITUDE. YOUR HEALTH AND QUALITY OF LIFE WILL IMPROVE. HAVE A LOOK AT OUR EUROPEAN CODE AGAINST CANCER ADAPTED FOR SENIORS.

– Less awareness: Seniors tend to be less aware about health matters, and specifically, about cancer. This will most likely change in the future, as younger generations will be better informed by the time they become seniors, with easier access to information and more awareness about where to find it (Internet, for example, will be able to be consulted in the future by wider sectors of the population than today). Whatever the reason, seniors nowadays are generally less aware about cancer. FILL OUT OUR QUESTIONNAIRE ON AWARENESS AND ATTITUDES ABOUT CANCER FOR PEOPLE 65 AND OLDER.

FACING THE DISEASE:

Once cancer has been diagnosed, there are also differences between seniors and younger adults:

– Less information:

When a cancer is diagnosed, some studies show that older people have less information. This is partly due to the fact that they belong to a generation dominated by a paternalistic model in which the doctor made decisions without consulting the patient. That’s why many older people don’t ask their doctor questions, but instead do exactly what the doctor orders. Besides that, doctors often refrain from providing certain information to older patients because they are afraid of offending them or that they won’t understand the explanations. In addition, many doctors already assume this and tend to not fully inform their older patients.

A patient’s family reinforces this situation, often creating a kind of “bubble” around their ill family member, protecting them from information they think might be damaging. This attitude usually has good intentions, but many times leaves the patient feeling isolated. ASSERT YOUR RIGHT TO BE INFORMED WHENEVER YOU THINK IT’S NECESSARY.

• More tolerance and higher expectations: FROM PATIENTS AND THEIR FAMILIES. In general, seniors have some other illness or ailment, which is precisely why they tend to already be taking some type of medication. For this reason, it’s quite often assumed that it’s normal for a senior to have certain complaints. This can often lead to a delay in diagnosis.

SPECIFIC PSYCHOLOGICAL ASPECTS:

• Deeper depression: older adults with cancer tend to have higher levels of depression than younger adults. This is due to the fact that the disease is associated with death, so negative thoughts, feelings of hopelessness and a lack of a perspective future logically increase. That said, these feelings are already common among seniors even without cancer. These people have often already lost loved ones and frequently feel alone and sad. They also increasingly feel physically weak or drained of energy, and this can just get worse as a result of cancer treatment. Here various aspects at the different stages of depression can be increasingly seen. In these circumstances, it may be difficult to differentiate between the causes that eventually lead to a patient being “labelled” depressed. If there’s doubt as to whether or not a senior with cancer is suffering from depression, it’s a good idea to turn to a specialized medical professional for diagnosis. To the contrary, it can be assumed that such feelings are normal and a patient who could benefit from treatment to alleviate their depression might never get it.

REMEMBER: IF YOU ARE A SENIOR WITH CANCER OR HAVE A FAMILY MEMBER WHO DOES, DO NOT ACCEPT FEELINGS OF HOPELESSNESS, DEPRESSION OR WEEPING AS NORMAL. IF YOU ARE NOT SURE ABOUT THE SYMPTOMS OF DEPRESSION, TURN TO A SPECIALIZED MEDICAL PROFESSIONAL. FEFOC ALSO GIVES YOU THE CHANCE TO EVALUATE YOUR LEVEL OF DEPRESSION: GERIATRIC DEPRESSION SCALE (GDS)

• Less anxiety: In general, seniors tend to experience lower levels of anxiety, including when facing cancer. It’s said that the stimuli that were able to provoke anxious reactions fade with time due to a supposed mechanism that helps one to adapt better. When facing cancer, younger people have more profound feelings of rage, hostility and incredulity, and maybe more fear. When anxiety levels are measured, all of the mentioned factors result in lower scores for senior cancer patients. That said, as in the case of depression, it should not be thoughtlessly assumed that this is always the case. The fact that older people might not have the same obvious symptoms as young people does not mean they don’t have others. They might suffer less from physiological reactions (palpitations, sweating, stomach knots), but they might have feelings of fear just the same. These feelings are important and should not be brushed aside.

REMEMBER: A SENIOR’S ANXIETY OR NERVOUSNESS MIGHT NOT BE AS OBVIOUS AS A YOUNGER PERSON’S, BUT THAT DOES NOT MEAN THAT THEY ARE SUFFERING ANY LESS. TALK TO YOUR DOCTOR IF NECESSARY.

• Insomnia: in cases of depression as well as anxiety, the affected person might have difficulties sleeping. Again, here we run into the difficulties of diagnosing the problem, as on average older people don’t need to sleep as much, or they sleep more during the day, so they sleep less at night. Once again we recommend trying, if necessary, an appropriate medicine, and/or introducing some healthy routines that might help ease the sleeplessness.
• Differences regarding quality of life / sexuality:
  • QUALITY OF LIFE: Quality of life is a subjective concept that takes a patient’s well-being into account, equally combining both one’s physical condition and their mental health. Different areas of the patient’s life are covered, like the following:
    • General well-being: this refers to the patient’s satisfaction with his general health. Included here is the general sum of one’s various emotional states, specifically anxiety and depression.
    • Psychosocial aspects: this one of the areas included in the quality of life concept. It refers to the social isolation from which patients sometimes suffer. This is very often due to breakdowns in communication caused by friends or loved ones who sometimes don’t know what to say to their ill friend, but also by the patients themselves, as they sometimes prefer to abstain from explaining what’s going on. This can be observed even more clearly in older people if their social circle has already been reduced (maybe they live with a child and are far away from their usual contacts, or in later years, perhaps some of their peers have died and they feel alone). Feelings of loneliness can be common among older people, but that doesn’t necessarily mean they must be accepted as natural if the person doesn’t feel good about it. LOOK FOR SENIOR CENTERS WHERE SOCIAL ACTIVITIES ARE HELD. IF YOU FEEL WELL DESPITE HAVING THE DISEASE, YOU MIGHT FEEL LIKE GOING ON EXCURSIONS, GOING TO CONCERTS, THE THEATRE, ETC. ALL OF THIS HELPS TO IMPROVE YOUR QUALITY OF LIFE.
    • Cognitive issues: the anxiety and depression that follow a diagnosis of cancer and its treatment commonly induce loss of memory and concentration, which can increase the sensation of feeling distracted and make the patient feel worse, or like a failure. Even so, at certain ages this can all be considered normal. If the loss of concentration and memory is very apparent and if people around you say so, consult your doctor. That said, we recommend that you train your memory, memorizing telephone numbers, doing crosswords, etc. As an organ, your brain needs to be kept active to keep it working well.
    • Sexual aspects: one of the aspects of life that can change as a result of the disease and treatment is the patient’s relationship with their partner. Some patients find it difficult to talk about their fears and doubts about what’s happening to them. One of the problematic issues that has been documented is sexual relations. Some tumours can cause a loss of libido and even real physical problems that make it impossible to have sexual relations (for example, prostate cancer patients who have gone through a complete extirpation of the prostate might suffer from erectile dysfunction -SEE OUR WEB SITE ABOUT PROSTATE CANCER). EVEN SO, WE DON’T RECOMMEND ASSUMING THAT GOING WITHOUT SEXUAL RELATIONS “AT YOUR AGE” IS NORMAL. EVERY INDIVIDUAL AND EVERY COUPLE IS UNIQUE. A SATISFACTORY SEX LIFE IS DEFINED AS ONE THAT YOU CONSIDER SATISFACTORY.

FACING TREATMENT:

The repercussions of cancer treatment can undoubtedly effect a patient’s quality of life, sometimes even more than the disease itself. In general, the following characteristics have been found among seniors, when compared to younger cancer patients:

• More pessimistic: Seniors commonly have very negative experiences regarding cancer as well as regarding the possibility of treating or curing it. Their memories of someone living with cancer, as devastating as they might be, are from an age in which there were few therapeutic options, and in the case of the later stages, there were fewer pain-relieving resources. This is why an older person often tends to believe that if they have cancer, there’s no need to receive treatment for it as it’s useless and often believed that it won’t help them at all, and the only thing they’re going to do is pointlessly suffer only to die in the end anyway. This kind of pessimism is also common among a patient’s family members, who often indirectly or quite directly express their doubts as to whether it’s worth the effort going ahead with a pointless treatment. LET US REMIND YOU THAT IN TODAY’S WORLD, LIFE EXPECTANCY HAS INCREASED AND THE AGE UNTIL WHICH SENIORS CAN ENJOY A HIGH QUALITY OF LIFE HAS INCREASED AS WELL AS THE DESIRE TO DO SO. THIS IS WHY WE NEED TO VALUE THE PROPOSED TREATMENT METHODS, THEIR SIDE EFFECTS AND HOW THEY MIGHT AFFECT YOU. IF YOU ARE NOT SURE ABOUT THE NECESSITY OF A PRESCRIBED TREATMENT, CONSULT OUR MEDICAL TEAM (FEFOC RESPONDS AT www.fefoc.org), WE WILL PROVIDE YOU WITH ARGUMENTS REGARDING YOUR APPROPRIATE THERAPY PLAN, BUT WE NEVER BASE OUR ADVICE SOLELY ON AGE. IF YOU DON’T KNOW HOW TO USE THE INTERNET, ASK YOUR FAMILY FOR HELP OR SIGN UP FOR A COURSE. IT’S NEVER TOO LATE TO LEARN!
• Less hope: Related to the preceding section, older people and the people around them tend to be less hopeful about the necessity and effectiveness of receiving treatment.
• More abandoned treatments: Pessimism regarding the effectiveness of receiving cancer treatment at a certain age can lead seniors to decide to abandon treatment. At this age, the attributions regarding the chances of fighting the disease tend to be external (the feeling that they can’t do anything about what’s happened) and this leads patients, especially those with depression, to lose the will to actively fight and to decide to quit treatment. This also depends on the side effects that the given treatment might have, as one of the psychological paradoxes involving cancer is that the treatment might have worse effects on the patient’s life than the cancer itself. IF YOU WANT TO STOP YOUR TREATMENT, IT’S IMPORTANT THAT YOU TALK ABOUT IT WITH YOUR LOVED ONES AND HEALTH PROFESSIONALS. ASK FOR INFORMATION ABOUT THE NEED FOR TREATMENT TO HELP YOU MAKE YOUR DECISION.
• Less active decision-making: Patients are going to be provided with more and more treatment options and the idea for the 21st century is that a well-informed patient can decide which one is best-suited for them and their general lifestyle. This decision should be based on physical concerns but also on psychological ones and quality of life. Although the reality is that this doesn’t totally happen yet, there are indeed cases of active decision-making. That said, among seniors there are few such cases. Older patients are normally used to a paternalist model in which the doctor makes absolutely all the decisions regarding a patient’s treatment. This model, in which the ill person is more passive (from which the word “patient” originates), was the over-riding norm for certain generations who still prefer the doctor to tell them what to do. Even so, even among the young, there are people who feel great anxiety when faced with making a choice. You should feel comfortable making your own decisions, and if you feel like you can’t decide for yourself, call on your loved ones. If that is what you prefer, you are already making a kind of choice.

CHANCES OF RECOVERY:

• Breast reconstruction: it is often thought that if a person has breast cancer after a certain age, it’s not worth worrying about the aesthetic aspects. In the case of breast cancer, family members tend to assume that their mother or grandmother won’t be going back into the operating room to reconstruct her breasts. That said, various studies show that this doesn’t necessarily reflect patients’ feelings and it’s being recommended that the general population as well as health professionals not consider old age a reason for stopping reconstruction. IT SHOULD ALWAYS BE THE WOMAN’S RIGHT TO CHOOSE. See our web site on breast cancer:www.cancermama.org.
• Penile implant (prosthesis): following prostate cancer and extirpation (removal), men lose their physical ability to have an erection, but not necessarily their libido (sex drive). Some men find it to be a very depressing situation, as they feel like their life is over because of their age or the disease. One option is to discover a new kind of sex life in which intercourse is neither the most important thing nor the most sought after. If the anxiety is too great to get over, another option is a penile implant. That said, remember that this is a new kind of surgical procedure. Talk to your partner, as maybe she’ll surprise you and see it differently. Consult a psychologist, or if you’ve made up your mind, get informed about an implant. Look for reliable information and be aware of the advantages and drawbacks before making a decision. Consult our web site on prostate cancer: www.cancerdeprostata.org.