Cancer in the Lives of Older Americans: Blessings and Battles

By Sarah H. Kagan

The "oldest old," individuals aged 85 and above, are the most rapidly growing segment of American society. And although more than a third of cancer occurs in people over 75 years of age, their tumors are less fully diagnosed and often less fully treated than those in younger patients. Ageism may account for this discrepancy—why intervene if an older man or woman with cancer doesn't have long to live anyway? Yet older people often tolerate chemotherapy, surgery, and radiation as well as younger patients, while continuing to maintain their quality of life for years to come.

The lack of clinical trials among this age group results in a deficit of knowledge regarding how to treat cancer in older adults. Little has been written to guide clinicians, social scientists, families, and individuals. In Cancer in the Lives of Older Americans: Blessings and Battles, Sarah H. Kagan writes from the perspective of more than twenty years of practice, inquiry, and education as a nurse. She uses anecdotes and case studies to illustrate important points about cancer among older adults.

The book follows the story of Mrs. Eck, a woman in her 80s diagnosed with pancreatic cancer. Mrs. Eck's situation sets the stage for a discussion of cancer, which too often focuses on cells and drugs, diagnoses and prognoses, without looking more closely at the people who experience the disease. Chapters offer varied assessments of what it means to be old and have cancer in our society, as Kagan explores other real experiences of cancer for older adults alongside information that will prove essential to patients, their families, scholars, and clinicians.

• Language: English
• Publisher: University of Pennsylvania Press
• Release date: Feb 23, 2012
• ISBN: 9780812202403

Book preview

Chapter 1

Champagne and Hot Dogs

Mrs. Eck is perched on a sofa across from a fire that crackles and smells somehow quintessentially of what this home in this neighborhood on this day should. She is tiny, and my first impression is of her lovely and carefully coiffed red hair and of her tasteful outfit—slacks and a cheerfully cozy sweater—as she greets me rather formally by today’s standards of etiquette. We are to have tea and cookies baked by one of her daughters. Mrs. Eck seems precarious and somewhat off balance in the small space she occupies on the sofa. She has a cane—an aluminum adjustable model from a medical equipment supply store, clearly not an affectation but a necessary support—close at hand. I perceive that she is a softly spoken woman, and the sounds of the fire create a washed quiet in the room. I move close to her, sitting carefully on the edge of the sofa cushion, to hear her and gain permission to record her story for this book. In the initial exchange, I tell her that I believe her story might open my book about what it means to be old and have cancer. We talk briefly about how our society seems to struggle with the manner in which her state of being is understood. Her story, I say, will almost certainly ameliorate and teach better than my academic writings would ever do alone. And so convinced, Mrs. Eck begins easily and surprises me with her fluid descriptions and attention to detail.

"Yes, it really started last October, when I—I just was walking down the driveway, and my leg just froze. . . . And I thought, now how am I going to get back to the house? So I pondered that for a bit and then I just started picking it up, picking it up, like this. And I got it so that it [the leg] would move again. That happened to me twice. And then I decided to go to an orthopedist. And they took the X ray, and then the doctor said, you have to have a hip replacement. So I said, well I don’t want to have a hip replacement, and, you know, I’m eighty-five years old. And, so they said, well we’ll try therapy. So for the whole month of December [2004], I went three days a week through the month, and on my birthday, the thirtieth of December, was my last session. And the therapist said, I don’t usually tell people this, but, she said, you have to have a hip replacement. So I said I would consider. So we then started searching for a surgeon. And that got into January [2005]. Suddenly I start itching all over. Every place. Every place on my body, I could just tear it apart. And I, I’ve got my husband going out getting Solarcaine® and spraying me. . . . And nothing is helping. And so at the end of January, my daughter looked at me one day, I had been to the hairdresser. And she was here, the one that’s the nurse. She looked at me and she said, ‘You’re yellow.’ And she said, she called the doctor, and he said I was to go to the hospital and have a blood test taken. So her husband took me the next day to the hospital. And we’re walking in and I said to John, ‘This won’t be anything, John. We’ll be in and out of here in a minute, they’re only going to take some blood.’ Well it wound up I was eight hours in the . . . in the emergency room, with him still staying there. And I’m saying, ‘John, I’m fine, just leave, you know.’ But he wouldn’t do it. So it got to be about five o’clock in the evening, and the doctor finally came and he said, ‘We’re going to tuck you in.’ So they found a bed for me, and that was my first stay in the hospital. And then they came in the day after and told me they thought I had a blocked bile duct, and that I would have to have a stent [small tube placed in the duct to reopen it] put in. And then I saw them all talking, and all that, you know. Then I heard one of them say, ‘She might die on the table.’ So I,