My mother has an aggressive form of breast cancer at 90. She is stage 3 according to the breast surgeon we met with. The doctor said chemo and radiation would not be recommended. I am holding out hope that the oncologist will have a drug concoction that can treat the cancer. The surgeon says she does mastectomys on women in their 90's all the time. My mother lives in her own home with my autistic brother. If we go the surgery route it seems that I will have to move in with her for weeks or months. Other option would be to hire care. When I asked the about care options she said she would refer to a "social worker". What would that entail? Another issue is my mother has dementia with psychosis. She has the delusion that "crazies" come into her house and they put animals inside her. This is her reality. No getting away from it. Other than that she is normal and can do the ADL's but spends most of the time in her delusion. I have heard that anesthesia can cause dementia patients to become worse and some never come back to where they were.
My mother had a mastectomy in her late seventies. She doesn't have dementia but she did experience paranoia in the hospital as a side effect of the anesthesia and or pain meds.
She was sent home with a couple of drains but developed complications which involved a second minor surgery and six weeks of daily nurse visits at home to heal a wound about the size of a shirt pocket large enough to fit an iPhone in. It had to be packed with gauze and flushed.
The thought of having to explain staples, drains, and God forbid, wound care to someone with your Mom's fears is concerning.
The surgeon may be too focused on the procedure itself.
My Mom went on to have chemo and radiation treatments. She is doing well now, eight years later, but he treatments and their side effects consumed a year and half of on and off unpleasantness. Note that a port may need to be implanted and later removed for chemo.
Please investigate further. I wish you well in making the best choices for your family.
- her delusions: already cause her to think someone is tampering with her body...what will she think if she wakes up to stitches? Can she truly make a rational, informed decision about this surgery? Or are you making it for her?
- the anesthesia: yes it can definitely impact her dementia and it may be permanent.
- the treatment: will be very unpleasant for her and what if she's not compliant? No quality of life for either of you.
- the recovery: will be totally in your hands. Do you have the financial and emotional resources to survive caring for both her and your autistic brother for who knows how long? There is no 100% financial support for this unless she is on Medicaid and even then it probably won't cover all the care giving she needs in her home (but it probably would in a NH).
- what is the gain? If she somehow makes it through this surgery, she needs to be cancer-free for 5 years to maybe be free of it "for the rest of her life" but what if that only means 1 or 2 more years? If it returns surely no doc in their right mind would suggest further treatment.
I see no upside or high-enough percentage of gain in this situation. I agree with minimal amounts of medications that help her quality of life and don't go after the cancer. May you have peace in your heart as you work through your decision!
What I would do though is consult with a different oncologist or breast surgeon to ask about nominal meds that might ease her symptoms if she's in discomfort. A surgeon who said she's performed mastectomies on 90 year old women "all the time" would not be my first choice for an oncologist.
Another question I would ask is the extent of the metastasis. Has the cancer spread to other organs, to her spine or brain?
A social worker would just tell you what other options are available, such as home care vs. institutional care.
I would also consider contacting and/or joining a local Gilda's Club, to meet with others dealing with cancer.
If it were me, I would not do the surgery because of the chance of further decline. Living longer would not be the goal. Quality of life should be. I would rather die relatively quickly from cancer than the long drawn out process of dying from dementia.