To want my grandmother not to refuse cancer treatment

[soppymoo]

My grandmother has just been diagnosed with cervical cancer, she's 89 but to date still very fit and physically active, fiercely independent, takes solo holidays, etc.

The process of getting diagnosed has been a traumatic one for her, particularly due to internal vaginal exams and a fairly painful biopsy on her cervix, then a very long MRI session - but the upshot was that the cancer hasn't spread, and treatment would be radiotherapy, both external and internal. She was given some leaflets to this effect, describing treatment and side effects, but was due to see the oncologist to discuss treatment plan in proper detail. However, she has now decided not to go to this appointment and is saying she doesn't want to go through the indignity and rigours of treatment, she wants to let things take their course. She is currently pretty well, though obviously upset and shocked by the diagnosis.

I want to support her in whatever she decides, and I have not said anything to her directly as a result, but at the moment I'm feeling very torn. I understand why she does not want to go through the indignity and discomfort/pain of treatment, further internal exams and internal radiotherapy etc - yet I'm finding it difficult to accept - because she is getting her information from leaflets, which presumably give worst case scenario on treatment length and side effects (admittedly I haven't seen the leaflets myself); because the cancer seems to be early stage, and she currently enjoys great quality of life; but mainly because I do not know what "letting things take their course" will look like, and I am worried it will mean a more painful end of life...

I'm not sure what advice I'm after really, but just wondered if anyone else had experience they could share, or helpful links etc. Perhaps it is just a case of a bit more time to digest and come to terms with things. I forgot to mention that there is already a very helpful Macmillan nurse who has promised to speak to the oncologist on my grandmother's behalf and report back, I think, with more detail on potential treatment plan, although my grandmother is not likely to change her mind.

Thanks for listening x

Could you encourage her to go for the appointment, not in order for anyone to try and persuade her to accept treatment but so that she (and the people who love her and will be caring for her) can gather information about the consequences of her choice not to have treatment.

Just to add, we too were told cancer progresses slowly in the elderly, MIL had breast cancer in her 80s, had a masectomy, but no other treatement as they were concerned about the side effects.

Just wanted to say OP, although different, my mum had chemo (life prolonging only though) which unfortunately accelerated her cancer. It also had horrendous side effects.

The best thing she did was refuse further treatment whereupon the palliative care team took over and she was offered a bed in a hospice. The hospice were amazing and she had a peaceful death and was cared for with so much empathy and attention to her well being and wishes.

Sorry for that morbid story but am trying to get across that as other people have said, you must allow your grandmother to make her own choices. My mum did see the consultant though and unfortunately she did feel very pushed into the Chemotherapy and regretted it immediately.

This is such a difficult situation and my heart goes out to you.

I'm so so sorry for all of you.

I personally think that if your grandmother knows both the benefits and the draw-backs, she has every right to turn down treatment, she's a grown woman. I'm sorry to put it bluntly, but she is 89. I'm sure she's led a very full life and realistically, she would probably only have 10 years at the absolute most left. My grandad was very fit and healthy right up until he was 92, then within a year, he really went downhill.

I think she has every right to take control over how and when she dies. It must be so hard for you, but i really don't think you can or should try and change her mind, it might put her in a very difficult situation. And i'm sure the doctors will do everything they can to make her final months comfortable.

My mum, 20 years younger died from cancer in the spring. She had chemo, rather than radio therapy - but I am not sure the 2.5 years of treatment did much for her in the end. It did prolong her life (probably), but the quality of that life for that time was not good. I think in a similar situation I maybe would not have the treatment.

At 89 I think I would probably not have the treatment - I (think) would think I had had a good innings, the treatment is unlikely to cure me. I think I would take my chances as I am and hope that my end would be as dignified as possible.

I would probably want to know the treatment options in detail.

But - as you say - it is her choice - and all you can do is support her in what she wants.

At 89, if I was still fit and able, I would probably take the cancer as the sign that I should get all my savings and blow them in a fantastic trip all over the world with the people I love.

If she has been in good health until 89, she probably does not want to spend her last days being treated. She will have seen it all before. FIL refused treatment because it would only have given a few weeks more and he had already undergone major operations. MIL died a year later from cancer. The oncologist was trying to get her to come into hospital for a biopsy, for chemo on the Friday, when she died on the Sunday, so I think she knew best.
The best thing would be to support her to find out how the disease will progress, then you will be in a position to know what the best paliative care would be for her and you will be best prepared to help her get it.

Everyone who has said that cancer develops more slowly in the elderly is right so please remember that. Internal radiotherapy is not the only option and she never HAS to have an internal examination. Lots of our patients decline and if she's been examined before it probably isn't necessary. A good oncologist will be appreciative of how your grandmother will feel and not do it unless its really necessary.

It may be possible for your grandmother to have external beam (like a large x-ray machine) to stop it developing.

Can you contact the oncologist yourself for a chat? They may be able to allay yours and your grandmother's fears.

If I were 89 I don't think I'd opt for cancer treatment myself.

I'm sorry you're in this situation, and think the advice about her speaking at least to a Macmillan nurse is a good one.

My dad was diagnosed lung cancer at the age of 73. He also didn't want any medical intervention.

It's her decision at the end of the day.

My dad was managed by a fantastic palative care team and ended his life in a dignified painfree way.

this is a very sad situation and I think you need to let granny decide. However I would insist that a family member goes with her to the oncologist. As much as it is important to understand what treatment options there may be, it is equally important for her(and her family) to understand what will happen if she doesn't get treated. The latter could be worse.

'However I would insist that a family member goes with her to the oncologist. '

Why? She's an adult of sound mind. If she wants someone to go with her, fair enough.

I think someone should go with her too, as, when the disease progresses, she will be more reliant on family and they will need to know what's likely to be in store.
I would recommend this for someone of any age.

FWIW, OP, I would probably be of the same mind as your grandmother. If her remaining time can be made as comfortable as possible, her passing may well be more peaceful. The cancer may progress slowly enough for her to have some real quality time.

Sorry you're going through this - I think our first instinct is to grab hold of treatments in a bid to prolong life - but I think in these circs I would hang fire and let your GM decide.

I'm sooty you are going through this I have been through something similar twice my grandmother was diagnosed with bowel cancer at 78 she took all the treatments going. Unfortunately this entirely consumed the last 6 months of her life and large parts of it were very miserable she had terrible nausea from the chemo and some pretty horrific burns from the radiotherapy. It was horribly sad to see someone who had been so active and well dragged so low.
My grandfather was diagnose with prostrate cancer at 84 he declined everything and to be frank he had fantastic quality of life in his own home till the last month of his life due in part to the wonderful palliative care team.
My grandmother lost all her dignity which for a lady such as her was terrible, she was a senior allied forces officer at the liberation of Belsen and likened what she was put through to what she saw there.
My grandfather retained his dignity until the end I saw him 7 days before he died and he was still very up beat.
As always my anecdotes, but working in the veterinary field I believe that just because we can doesn't always mean we should. Over 75 I will always choose my grandfathers route.

I completely understand your grans predicament. My grandad went through a similar one at 90. He was diagnosed with bowel cancer. He was fit & healthy ( walked 8miles up to the golfclub to play a round and fleece the young 'uns twice a week) and the hospital were quite honest that they wouldn't usually at his age do the surgery/treatment but he was fitter than some people half his age. He did find it difficult but was back on his feet remarkably quickly and when he finally died five years later it was due to a heart attack whilst with his younger girlfriend
Cancer is a word that frightens most people but treatment is ever changing, with quite different outcomes than even say 5-10yrs ago and there is huge support out there. Refusing treatment shouldn't be taken lightly and you should gently encourage her to discuss her choice with her doctors and other support networks such a Macmillan. Don't badger her though it has to be her decision just make sure she has all the information, support and love to make it.

It's a very personal decision. I worked in a hospice and we had several elderly patients who decided not to opt for treatment. One was a gentelman who was 86 with bowel cancer. He died very peacefully and with great dignity, and asked us all out into the garden the day he died, as he took a sherry and a had a cigarette every day out in the garden and he wanted us to toast his life for he was ready to leave it - he said he was tired and missed his wife greatly.

Sorry everyone, not been able to check back until now. Thank you so so much for all the really helpful advice, personal experience, book suggestions - you are all so lovely and kind.

Aurynne, yes, my mum has been with her for all the appointments so far (I'm unfortunately four hours' drive away). I loved your suggestion, it's just the sort of thing she would say herself!

Having not slept on it, I totally agree that it must be her decision, and the last thing I would want is for her to feel under any added pressure. Thanks again everyone for helping me come to terms with things a bit more and work out how I can support her in the best way.

xx