If anyone asks me, “What part of oncology do you hate the most?” I would definitely answer without much thought, “geriatric oncology.” I think that’s the most difficult specialty because it needs extraordinary skills and patience to deal with elderly patients dealing with cancer. Although cancer is much more prevalent in the elderly, their needs are quite different compared to other adult patients. They are mostly very weak and malnourished, have multiple co-morbidities and complex medical histories, are already on a lot of medications, and may have very limited activity of daily living. They are the most difficult patients to treat because you have to think a lot before starting them on any kind of treatment. It needs a lot of experience and foresight to look at all the treatment options for them because they might not tolerate your treatment at all and may even end up in intensive care units. Sometimes I feel as if they are just like fragile flowers that can wilt with just a little extra sunlight. They need tender love and care, a harsh word or slight insensitivity in their treatment may lead to negative outcomes. That’s why I hate it because this specialty needs a lot of patience and extra empathy.
Today, a very elderly patient diagnosed with bladder cancer came to our OPD. He was 97 years old and was accompanied by two of his sons and two grandsons. He was too fragile and weighed only 45 kg. He was diagnosed after having two episodes of frank hematuria. The urologist did his transurethral resection of the bladder tumor and referred him to oncology to decide further treatment for him. He was such a cute and sweet gentleman, a retired banker who had led a very productive life and was still active enough to offer his prayers and go to the washroom on his own. When I was examining him and I touched his hands, his skin was as soft as if they were the hands of a child. Sometimes when I see very elderly patients, I complain to God, why does He make them suffer at such an age when they have already gone through many trials of life all those years? Why does He test them so much, even in the end? When they have spent their whole life independently, why does He make them dependent on others during their treatment at such an age? Maybe that’s why life is called a test because that test never ends, even till your last breath.
We decided to give him palliative radiation to his bladder only to control the bleeding, as he was in such a delicate age and health state that it would be very cruel to subject him to bladder surgery, chemotherapy, or a definitive long course of radiation treatment. When we explained the treatment process of a few days of radiation treatment to him, which is a very simple and painless treatment, he smiled and asked me, “Doc, can you please tell me you would be able to complete my century? I am really looking forward to it.”
At that moment, I felt as if I should do my best in my limited abilities to help him achieve his goal. We decided on a very nice protocol for him, which would not only control his disease for a long time but would maintain his quality of life as well. I can just hope and pray that his dream comes true and that he may live a healthy and happy life with his grandchildren and even their children, who were so hopeful and worried for him at the same time. I think dealing with such cases is a lot difficult for the oncologist because it tests our skills to choose the best possible well-crafted treatment for our elderly patients while maintaining their quality of life. And we have to put an extra effort to keep them in high spirits so they don’t get demotivated or exhausted during the treatment.
“To care for those who once cared for us is one of the highest honors.”
– Tia Walker
Damane Zehra is a radiation oncology resident in Pakistan.
