Cancer care for people with dementia: Literature overview and recommendations for practice and research |
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Authors: | Laura Ashley PhD Claire Surr PhD Rachael Kelley RMN PhD Mollie Price PhD Alys Wyn Griffiths PhD Nicole R Fowler MHSA PhD Dana E Giza MD Richard D Neal MBChB FRCGP PhD Charlene Martin PhD Jane B Hopkinson RGN PhD Anita O’Donovan PhD William Dale MD PhD Bogda Koczwara BMBS MBioethics Katie Spencer MB BChir FRCR PhD Lynda Wyld MBChB FRCS PhD |
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Institution: | 1. School of Humanities and Social Sciences, Leeds Beckett University, Leeds, UK;2. Centre for Dementia Research, Leeds Beckett University, Leeds, UK;3. Institute of Population Health, University of Liverpool, Liverpool, UK;4. Indiana University Center for Aging Research at Regenstrief Institute, Indianapolis, Indiana, USA;5. Joan and Stanford Alexander Division of Geriatric and Palliative Medicine, University of Texas McGovern Medical School, Houston, Texas, USA;6. Department of Health and Community Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK;7. Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK;8. School of Healthcare Sciences, Cardiff University, Cardiff, UK;9. Applied Radiation Therapy Trinity (ARTT), Discipline of Radiation Therapy, School of Medicine, Trinity St. James’s Cancer Institute, Trinity College Dublin, University of Dublin, Dublin, Ireland;10. Center for Cancer and Aging, City of Hope Comprehensive Cancer Center, Duarte, California, USA;11. Department of Medical Oncology, Flinders Medical Centre & Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia;12. School of Medicine, University of Leeds, Leeds, UK |
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Abstract: | As many countries experience population aging, patients with cancer are becoming older and have more preexisting comorbidities, which include prevalent, age-related, chronic conditions such as dementia. People living with dementia (PLWD) are vulnerable to health disparities, and dementia has high potential to complicate and adversely affect care and outcomes across the cancer trajectory. This report offers an overview of dementia and its prevalence among patients with cancer and a summary of the research literature examining cancer care for PLWD. The reviewed research indicates that PLWD are more likely to have cancer diagnosed at an advanced stage, receive no or less extensive cancer treatment, and have poorer survival after a cancer diagnosis. These cancer disparities do not necessarily signify inappropriately later diagnosis or lower treatment of people with dementia as a group, and they are arguably less feasible and appropriate targets for care optimization. The reviewed research indicates that PLWD also have an increased risk of cancer-related emergency presentations, lower quality processes of cancer-related decision making, accessibility-related barriers to cancer investigations and treatment, higher experienced treatment burden and higher caregiver burden for families, and undertreated cancer-related pain. The authors propose that optimal cancer care for PLWD should focus on proactively minimizing these risk areas and thus must be highly person-centered, with holistic decision making, individualized reasonable adjustments to practice, and strong inclusion and support of family carers. Comprehensive recommendations are made for clinical practice and future research to help clinicians and providers deliver best and equitable cancer care for PLWD and their families. |
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Keywords: | cancer comorbidity dementia geriatric oncology health disparities multimorbidity |
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