Dementia and comorbid cancer: challenges and implications for nursing practice
Intended for healthcare professionals
Evidence and practice    

Free Dementia and comorbid cancer: challenges and implications for nursing practice

Kay de Vries Professor of older people’s health, School of Nursing and Midwifery, Faculty of Health and Life Sciences, De Montfort University, Leicester, England
Fiona Chaâbane Consultant Admiral Nurse and clinical nurse specialist, specialist in younger onset dementia and Huntington’s disease, University Hospital Southampton NHS Foundation Trust, Southampton, England
Karen Harrison Dening Head of research and publications, Dementia UK, London and professor of dementia nursing, School of Nursing and Midwifery, Faculty of Health and Life Sciences, De Montfort University, Leicester, England

Why you should read this article:
  • To be aware of the challenges in care that can arise when a person living with dementia develops cancer

  • To recognise the importance of cancer screening and assessment in people living with dementia

  • To consider how the treatment and care of people living with dementia and comorbid cancer could be improved

Data regarding the prevalence of dementia and the prevalence of cancer suggest that a relatively large number of older people living with dementia may also have unsuspected comorbid cancer. Research into dementia and comorbid cancer is limited. The existing literature shows that people living with dementia have much lower cancer survival rates than people who do not have dementia, perhaps due to advanced age and cancer being diagnosed at a late stage or not at all. In people with dementia, investigating and managing cancer is complicated by cognitive impairment, atypical presentation, communication difficulties and potential behavioural issues – all of which may deter healthcare professionals from conducting patient assessments and screening tests. In this article, the authors use a case study to illustrate the challenges that can arise when a person living with dementia develops cancer, particularly in relation to diagnosis, pain assessment, decision-making and carer involvement.

Cancer Nursing Practice. doi: 10.7748/cnp.2023.e1836

Peer review

This article has been subject to external double-blind peer review and checked for plagiarism using automated software


Conflict of interest

None declared

de Vries K, Chaâbane F, Harrison Dening K (2023) Dementia and comorbid cancer: challenges and implications for nursing practice. Cancer Nursing Practice. doi: 10.7748/cnp.2023.e1836

Published online: 21 March 2023

As a result of increases in longevity and advances in the management of long-term conditions, people are living longer and a growing number of older people are living with several comorbid conditions. Dementia and cancer are likely to make substantial contributions to the burden of comorbidity in older people. An estimated 944,000 people in the UK live with dementia, about 593,200 of whom have severe dementia (Wittenberg et al 2019), and modelling suggests that by 2040 there will be 1.2 million people in the UK living with dementia (Livingston et al 2020). Meanwhile, Cancer Research UK (2023) reported that each year more than one third (36%) of all cancer cases in the UK are diagnosed in people aged 75 years and over. Earlier detection and more effective treatments have resulted in cancer increasingly becoming a long-term condition, and most older people diagnosed with cancer can be expected to live five years beyond their cancer diagnosis (Rowland and Bellizzi 2014).

These prevalence data suggest that a relatively large number of older people living with dementia may have undetected comorbid cancer. However, research on older people living with dementia and comorbid cancer is limited. Little is known about their disease trajectory, about the effects of dementia on their cancer treatment and outcomes, and about the experiences of their family and informal carers. Furthermore, there are no guidelines on how to manage comorbid cancer in people living with dementia, as well as a lack of autopsy data that could inform research and practice.

For nurses who support people living with dementia and their families and informal carers, the presence of comorbid cancer poses significant challenges. This article uses a case study to illustrate the challenges regarding diagnosis, pain assessment, decision-making and carer involvement, and discusses them in relation to the literature. The case study is based on a combination of the experiences and circumstances of several patients that the authors have encountered in their practice.

Key points

  • It is likely that many older people living with dementia have comorbid cancer, but this may remain undetected and untreated due to suboptimal screening and assessment

  • Investigating and managing cancer in people with dementia can be complicated by cognitive impairment, atypical presentation, communication difficulties and potential behavioural issues

  • Comprehensive history taking, appropriate screening tests and the use of dementia-specific pain assessment tools are essential so that people living with dementia who have comorbid cancer receive adequate care and treatment

  • Cancer care in people living with dementia is complex and requires collaborative decision-making from a range of specialists, as well as the involvement of family and informal carers

Case study

Peter was diagnosed with Alzheimer’s disease at the age of 65 years. He lived with his wife Jan; their two daughters having left the family home a few years earlier. By the age of 69 years, he started to experience abdominal pain as well as increasing distress and agitation, which meant that he could no longer be left alone at home. He was supported by local mental health services, which helped develop a programme of support that included assistance for Jan as a carer and arranging a befriender for Peter.

One weekend, Peter developed severe abdominal pain and Jan called the GP, who visited them at home. Peter did not let the GP undertake a physical examination and the GP, suspecting constipation, recommended treatment with enemas. A few hours later Jan called an ambulance because Peter appeared to be highly distressed, clutching his abdomen and retching when fluid or foods were offered. At the general hospital where he was admitted, Peter did not cooperate with physical examinations but did let staff take a blood sample, which revealed no abnormalities, and undertake an abdominal X-ray, which showed faecal impaction in the colon. He was discharged home with more enemas to continue to clear his bowel.

Over a period of three or four months, Jan observed how Peter writhed about as if ‘in agony’, retching when drinking water and pushing food and fluids away. He would clutch his abdomen and say things like ‘I’m dying, you’re trying to poison me’. He steadily lost weight, broke out in a sweat most nights and was highly tense and irritable. The GP prescribed sedatives to address his symptoms, with no apparent effect aside from making Peter drowsy, distressed and agitated. For a period of six weeks, Peter experienced frequent bouts of agitation and apparent pain, with repeated admissions to the emergency department and discharges home.

At the hospital, Jan was told that no invasive investigations could be undertaken because of Peter’s dementia and the doctors and nurses made it clear that they thought Peter’s behaviours were caused by agitation as a symptom of dementia. After another admission, having lost almost three stone in weight within three months, Peter died in hospital. A post-mortem showed that he had advanced colorectal cancer. Jan felt that Peter’s dementia had overshadowed his undetected cancer and had prevented him from receiving adequate supportive care and pain management.

Challenges in care


Dementia is a progressive condition affecting people’s memory, mood and movement, as well as their language and understanding (Prince et al 2016). In the advanced stages of the disease, individuals experience severe cognitive and physical impairment and are likely to be unable to communicate verbally, while they may also develop urinary and/or faecal incontinence and require extensive support for activities of daily living (Sampson and Harrison Dening 2021).

There is little research on the presentation, assessment and treatment of cancer in people living with dementia. Several reviews have shown that people living with dementia have much lower cancer survival rates than people who do not have dementia (Drageset et al 2014, Hopkinson et al 2016, McWilliams et al 2018a, Caba et al 2021, Ashley et al 2022). The reasons for this may include advanced age, cancer being diagnosed at a late stage and cancer diagnosis being missed altogether, even after controlling for factors such as age, tumour type and tumour stage (Robb et al 2010, Caba et al 2021, Ashley et al 2022). A missed cancer diagnosis is a significant cause of adverse events in any patient (Singh et al 2007, Tørring et al 2013, Aaronson et al 2019). Aaronson et al (2019) found that missed cancer diagnoses – most commonly of lung, colorectal, prostate and breast cancer – represented 46% of diagnostic errors made in primary care.

Gupta and Lamont (2004) found that, in a cohort of around 17,500 patients who were newly diagnosed with colon cancer, the prevalence of dementia was almost 7%. After adjusting for possible confounders, the researchers concluded that people living with dementia were twice as likely than people who do not have dementia to have colon cancer diagnosed after their death (Gupta and Lamont 2004). People living with dementia who have colon cancer have also been shown to be less likely to undergo surgery or chemotherapy than people with colon cancer who do not have dementia (Gupta and Lamont 2004, Baillargeon et al 2011, Fleming et al 2014). Similar findings have been described in patients with breast cancer (Gorin et al 2005, Kimmick et al 2014), while Attner et al (2010) concluded that cancer is likely to be underdiagnosed in people living with dementia. Considering the different tumour types identified in the literature on cancer and dementia, patients may present with a wide variety of signs and symptoms. Atypical signs and symptoms may mask the presence of comorbid cancer in people living with dementia.

People living with dementia are screened for cancer less often than people who do not have dementia (Kuwata et al 2021). The few studies on cancer screening in people living with dementia have shown that a diagnosis of dementia is negatively associated with routine cancer screening (Smyth 2009, Walter et al 2009, Mehta et al 2010, Torke et al 2013, Ashley et al 2022). Overall, in people living with dementia, cancer is diagnosed at a later stage than in people who do not have dementia (Tammemagi et al 2003, Gupta and Lamont 2004, Gorin et al 2005, Bradley et al 2008, Raji et al 2008, Hopkinson et al 2016, Caba et al 2021, Abdel-Razeq et al 2022, Ashley et al 2022). Furthermore, effective treatment and monitoring of comorbid cancer is often compromised by diagnostic overshadowing, whereby signs and symptoms indicative of pain due to a physical health condition – for example cancer – are misinterpreted as behavioural and psychological symptoms of dementia (Shefer et al 2014, Dillane and Doody 2019).

In Peter’s case, there were several points at which healthcare professionals could have considered whether he had an underlying condition. When Peter first presented with severe abdominal pain, taking a comprehensive patient history would have revealed that he had a family history of colorectal cancer – his father and one of his uncles had died in their late 50s from this disease. However, Peter’s family history was not considered at any stage. The healthcare professionals involved in Peter’s case assumed that his agitation was caused by dementia and that his pain was caused by constipation, and they treated these issues with sedatives and enemas. Taking a family history is a crucial part of patient assessment and care (Guttmacher et al 2004, Ginsburg et al 2019, Bylstra et al 2021).

After finding out about Peter’s family history of colorectal cancer, healthcare professionals could have undertaken screening tests. A colonoscopy, which is the preferred screening test where there is a family history of colorectal cancer (Henrikson et al 2015), may not have been feasible or appropriate in Peter’s case. However, a faecal immunochemical test – a non-invasive investigation that involves taking and analysing a sample of faeces – could have been undertaken. The use of this test is feasible in people with dementia, as demonstrated by Law et al’s (2018) meta-analysis, which found that the rates of screening for colorectal cancer using the faecal immunochemical test were not significantly lower in people with cognitive impairment or dementia than in people without cognitive impairment or dementia.

Pain assessment

Assessing pain in people living with dementia is challenging given the presence of cognitive impairment, people’s difficulties in explaining their pain and potential behavioural issues such as verbal or physical aggression (Achterberg et al 2013, Dooley et al 2015). Diagnostic overshadowing can also occur (Dillane and Doody 2019).

Research has shown that pain in people living with dementia is under-reported, under-detected and undertreated (Monroe et al 2012, 2013, Achterberg et al 2013, Corbett et al 2014, Hadjistavropoulos et al 2014, Lichtner et al 2014, 2016, Husebo et al 2016). It has also identified that, in people living with dementia and cancer, reported pain and the administration of analgesics decrease as the severity of dementia increases (Iritani et al 2011, Monroe et al 2012, 2013). In a systematic review of cancer-related symptoms among nursing home residents with and without dementia, Drageset et al (2014) found a high prevalence of pain in both groups, but reduced prescribing for pain in those with severe dementia. The reviewers asserted that caring for nursing home residents diagnosed with cancer is challenging and requires expertise in dementia care, cancer care and palliative care (Drageset et al 2014).

Peter showed obvious signs of pain and one of his prevalent behaviours – clutching his abdomen – gave a clear indication of the site of his pain. Because doctors and nurses believed that Peter’s behaviour was caused by agitation as a symptom of dementia, they focused on constipation as the cause of his pain. At no stage of Peter’s encounters with healthcare professionals in primary care, emergency care and acute hospital settings was a pain assessment tool used, despite several pain assessment tools specific to people living with dementia being available (Box 1).

Box 1.

Examples of pain assessment tools specific to dementia

In their systematic review of pain assessment for people with dementia, Lichtner et al (2014) identified 28 tools that could be used in clinical practice; however, the reviewers could not recommend a specific tool due to the lack of thorough evidence on the reliability, validity, feasibility and clinical efficacy. Hadjistavropoulos et al (2014) emphasised that the ideal method for assessing the subjective experience of pain is to ask the person about it, which can be done even in people with cognitive impairment if communication is adapted accordingly.

Decision-making and carer involvement

Peter’s case illustrates the challenges for healthcare professionals – particularly those working in oncology – in understanding the effects of dementia on how people present when they have cancer and the implications for screening and treatment (McWilliams et al 2018b). Making decisions regarding the care and treatment of people living with dementia is complex and the benefits and risks specific to that population need to be considered (Hirschman et al 2004, Moye and Marson 2007). Cancer care in people living with dementia is equally complex and requires collaborative decision-making from a range of specialists (Guthrie et al 2012), as well as the involvement of family and informal carers (Pu et al 2023). Informal carers should have a central role in decision-making at all stages, but this does not appear to have been the case for Peter’s wife Jan.

Smyth (2009) found that healthcare professionals’ recommendations influenced screening practices in older women living with dementia who had developed breast cancer. Family and informal carers’ views regarding screening and treatment varied widely, except when the person had severe dementia, in which case comfort care was consistently preferred to active cancer screening and treatment (Smyth 2009). Similarly, Torke et al (2013) conducted focus groups with 32 carers of people with comorbid dementia and cancer, finding that as dementia progressed, many carers wanted to stop cancer screening tests and treatment and were relieved when healthcare professionals mentioned that option. Carers were open to the idea of stopping tests and treatment to focus on quality of life (Torke et al 2013). According to Kuwata et al (2021), when making decisions about cancer screening in people living with dementia four main factors should guide decision-making: the person’s prognosis, the person’s cognitive abilities, possible behavioural barriers to investigations, and the goals of care.

People with dementia and comorbid cancer rely on supportive social networks to access treatment and care, so it is vital to consider how those with no such networks can be appropriately cared for in specialist services (Griffiths et al 2020, Surr et al 2020).


People living with dementia are likely to have comorbid conditions such as cancer, but screening and assessment are often suboptimal, so many of these comorbid conditions remain undetected and untreated. Nurses in various settings have a central role in the assessment and management of people living with dementia and comorbid cancer. Comprehensive history taking, appropriate screening tests and the use of dementia-specific pain assessment tools are essential so that people living with dementia who have comorbid cancer receive adequate care and treatment, including supportive care and pain relief. In people with these comorbid conditions, the benefits of screening and treatment need to be weighed against the risks and the goals of care need to be determined, while recognising the crucial role of family and informal carers in decision-making.


  1. Aaronson EL, Quinn GR, Wong CI et al (2019) Missed diagnosis of cancer in primary care: insights from malpractice claims data. Journal of Healthcare Risk Management. 39, 2, 19-29. doi: 10.1002/jhrm.21385
  2. Abbey J, Piller N, De Bellis A et al (2004) The Abbey pain scale: a 1-minute numerical indicator for people with end-stage dementia. International Journal of Palliative Nursing. 10, 1, 6-13. doi: 10.12968/ijpn.2004.10.1.12013
  3. Abdel-Razeq H, Abu Rous F, Abuhijla F et al (2022) Breast cancer in geriatric patients: current landscape and future prospects. Clinical Interventions in Aging. 17, 1445-1460. doi: 10.2147/CIA.S365497
  4. Achterberg WP, Pieper MJ, van Dalen-Kok AH et al (2013) Pain management in patients with dementia. Clinical Interventions in Aging. 8, 1471-1482. doi: 10.2147/CIA.S36739
  5. Ashley L, Surr C, Kelley R et al (2022) Cancer care for people with dementia: literature overview and recommendations for practice and research. CA: A Cancer Journal for Clinicians. doi: 10.3322/caac.21767
  6. Attner B, Lithman T, Noreen D et al (2010) Low cancer rates among patients with dementia in a population-based register study in Sweden. Dementia and Geriatric Cognitive Disorders. 30, 1, 39-42. doi: 10.1159/000315509
  7. Baillargeon J, Kuo YF, Lin YL et al (2011) Effect of mental disorders on diagnosis, treatment, and survival of older patients with colon cancer. Journal of the American Geriatrics Society. 59, 7, 1268-1273. doi: 10.1111/j.1532-5415.2011.03481
  8. Bradley CJ, Clement JP, Lin C (2008) Absence of cancer diagnosis and treatment in elderly Medicaid-insured nursing home residents. Journal of the National Cancer Institute. 100, 1, 21-31. doi: 10.1093/jnci/djm271
  9. Bylstra Y, Lim WK, Kam S et al (2021) Family history assessment significantly enhances delivery of precision medicine in the genomics era. Genome Medicine. 13, 1, 3. doi: 10.1186/s13073-020-00819-1
  10. Caba Y, Dharmarajan K, Gillezeau C et al (2021) The impact of dementia on cancer treatment decision-making, cancer treatment, and mortality: a mixed studies review. JNCI Cancer Spectrum. 5, 3, pkab002. doi: 10.1093/jncics/pkab002
  11. Cancer Research UK (2023) Cancer Incidence Statistics. (Last accessed: 23 February 2023.)
  12. Corbett A, Husebo BS, Achterberg WP et al (2014) The importance of pain management in older people with dementia. British Medical Bulletin. 111, 1, 139-148. doi: 10.1093/bmb/ldu023
  13. Dillane I, Doody O (2019) Nursing people with intellectual disability and dementia experiencing pain: an integrative review. Journal of Clinical Nursing. 28, 13-14, 2472-2485. doi: 10.1111/jocn.14834
  14. Dooley J, Bailey C, McCabe R (2015) Communication in healthcare interactions in dementia: a systematic review of observational studies. International Psychogeriatrics. 27, 8, 1277-1300. doi: 10.1017/S1041610214002890
  15. Drageset J, Corbett A, Selbaek G et al (2014) Cancer-related pain and symptoms among nursing home residents: a systematic review. Journal of Pain and Symptom Management. 48, 4, 699-710. doi: 10.1016/j.jpainsymman.2013.12.238
  16. Fleming ST, Mackley HB, Camacho F et al (2014) Clinical, sociodemographic, and service provider determinants of guideline concordant colorectal cancer care for Appalachian residents. Journal of Rural Health. 30, 1, 27-39. doi: 10.1111/jrh.12033
  17. Ginsburg GS, Wu RR, Orlando LA (2019) Family health history: underused for actionable risk assessment. The Lancet. 394, 10198, 596-603. doi: 10.1016/S0140-6736(19)31275-9
  18. Gorin SS, Heck JE, Albert S et al (2005) Treatment for breast cancer in patients with Alzheimer’s disease. Journal of the American Geriatrics Society. 53, 11, 1897-1904. doi: 10.1111/j.1532-5415.2005.00467
  19. Griffiths AW, Ashley L, Kelley R et al (2020) Decision-making in cancer care for people living with dementia. Psycho-Oncology. 29, 8, 1347-1354. doi: 10.1002/pon.5448
  20. Gupta SK, Lamont EB (2004) Patterns of presentation, diagnosis, and treatment in older patients with colon cancer and comorbid dementia. Journal of the American Geriatrics Society. 52, 10, 1681-1687. doi: 10.1111/j.1532-5415.2004.52461
  21. Guthrie B, Payne K, Alderson P et al (2012) Adapting clinical guidelines to take account of multimorbidity. BMJ. 345, e6341. doi:10.1136/bmj.e6341
  22. Guttmacher AE, Collins FS, Carmona RH (2004) The family history – more important than ever. New England Journal of Medicine. 351, 22, 2333-2336. doi: 10.1056/NEJMsb042979
  23. Hadjistavropoulos T, Herr K, Prkachin KM et al (2014) Pain assessment in elderly adults with dementia. The Lancet Neurology. 13, 12, 1216-1227. doi: 10.1016/S1474-4422(14)70103-6
  24. Henrikson NB, Webber EM, Goddard KA , et al (2015) Family history and the natural history of colorectal cancer: systematic review. Genetics in Medicine. 17, 9, 702-712. doi: 10.1038/gim.2014.188
  25. Hirschman KB, Xie SX, Feudtner C et al (2004) How does an Alzheimer’s disease patient’s role in medical decision making change over time? Journal of Geriatric Psychiatry and Neurology. 17, 2, 55-60. doi: 10.1177/0891988704264540
  26. Hopkinson JB, Milton R, King A et al (2016) People with dementia: what is known about their experience of cancer treatment and cancer treatment outcomes? A systematic review. Psycho-Oncology. 25, 10, 1137-1146. doi: 10.1002/pon.4185
  27. Husebo BS, Achterberg W, Flo E (2016) Identifying and managing pain in people with Alzheimer’s disease and other types of dementia: a systematic review. CNS Drugs. 30, 6, 481-497. doi: 10.1007/s40263-016-0342-7
  28. Iritani S, Tohgi M, Miyata H et al (2011) Impact of dementia on cancer discovery and pain. Psychogeriatrics. 11, 1, 6-13. doi: 10.1111/j.1479-8301.2010.00344
  29. Kimmick G, Fleming ST, Sabatino SA et al (2014) Comorbidity burden and guideline-concordant care for breast cancer. Journal of the American Geriatrics Society. 62, 3, 482-488. doi: 10.1111/jgs.12687
  30. Kovach CR, Noonan PE, Griffie J et al (2001) Use of the Assessment of Discomfort in Dementia protocol. Applied Nursing Research. 14, 4, 193-200. doi: 10.1053/apnr.2001.26784
  31. Kunz M, de Waal MW, Achterberg WP et al (2019) The Pain Assessment in Impaired Cognition scale (PAIC15): a multidisciplinary and international approach to develop and test a meta-tool for pain assessment in impaired cognition, especially dementia. European Journal of Pain. 24, 1, 192-208. doi: 10.1002/ejp.1477
  32. Kuwata C, Goldhirsch SL, Rodríguez V (2021) Navigating the cancer screening decision for patients with dementia. Current Oncology Reports. 23, 8, 90. doi: 10.1007/s11912-021-01083-1
  33. Law M, Dhillon S, Herrmann N et al (2018) Rates of screening for breast, colorectal, and cervical cancers in older people with cognitive impairment or dementia: a meta-analysis. Gerontology and Geriatric Medicine. 4, 2333721418799446. doi: 10.1177/2333721418799446
  34. Lichtner V, Dowding D, Allcock N et al (2016) The assessment and management of pain in patients with dementia in hospital settings: a multi-case exploratory study from a decision making perspective. BMC Health Services Research. 16, 1, 427. doi: 10.1186/s12913-016-1690-1
  35. Lichtner V, Dowding D, Esterhuizen P et al (2014) Pain assessment for people with dementia: a systematic review of systematic reviews of pain assessment tools. BMC Geriatrics. 14, 138. doi: 10.1186/1471-2318-14-138
  36. Livingston G, Huntley J, Sommerlad A et al (2020) Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet. 396, 10248, 413-446. doi: 10.1016/S0140-6736(20)30367-6
  37. McWilliams L, Farrell C, Grande G et al (2018a) A systematic review of the prevalence of comorbid cancer and dementia and its implications for cancer-related care. Aging and Mental Health. 22, 10, 1254-1271. doi: 10.1080/13607863.2017.1348476
  38. McWilliams L, Farrell C, Keady J et al (2018b) Cancer-related information needs and treatment decision-making experiences of people with dementia in England: a multiple perspective qualitative study. BMJ Open. 8, 4, e020250. doi: 10.1136/bmjopen-2017-020250
  39. Mehta KM, Fung KZ, Kistler CE et al (2010) Impact of cognitive impairment on screening mammography use in older US women. American Journal of Public Health. 100, 10, 1917-1923. doi: 10.2105/AJPH.2008.158485
  40. Monroe T, Carter M, Feldt K et al (2012) Assessing advanced cancer pain in older adults with dementia at the end-of-life. JAN. 68, 9, 2070-2078. doi: 10.1111/j.1365-2648.2011.05929.x
  41. Monroe TB, Carter MA, Feldt KS et al (2013) Pain and hospice care in nursing home residents with dementia and terminal cancer. Geriatrics and Gerontology International. 13, 4, 1018-1025. doi: 10.1111/ggi.12049
  42. Moye J, Marson DC (2007) Assessment of decision-making capacity in older adults: an emerging area of practice and research. Journals of Gerontology Series B: Psychological Sciences. 62, 1, 3-11. doi: 10.1093/geronb/62.1.p3
  43. Prince M, Comas-Herrera A, Knapp M et al (2016) World Alzheimer Report 2016: Improving Healthcare for People Living with Dementia. (Last accessed: 23 February 2023.)
  44. Pu L, Chen H, Jones C et al (2023) Family involvement in pain management for people living with dementia: an integrative review. Journal of Family Nursing. 29, 1, 43-58. doi: 10.1177/10748407221114502
  45. Raji MA, Kuo YF, Freeman JL et al (2008) Effect of a dementia diagnosis on survival of older patients after a diagnosis of breast, colon, or prostate cancer: implications for cancer care. Archives of Internal Medicine. 168, 18, 2033-2040. doi: 10.1001/archinte.168.18.2033
  46. Regnard C, Reynolds J, Watson B et al (2007) Understanding distress in people with severe communication difficulties: developing and assessing the Disability Distress Assessment Tool (DisDAT). Journal of Intellectual Disability Research. 51, 4, 277-292. doi: 10.1111/j.1365-2788.2006.00875
  47. Robb C, Boulware D, Overcash J et al (2010) Patterns of care and survival in cancer patients with cognitive impairment. Critical Reviews in Oncology/Hematology. 74, 3, 218-224. doi: 10.1016/j.critrevonc.2009.07.002
  48. Rostad HM, Utne I, Grov EK et al (2017) Measurement properties, feasibility and clinical utility of the Doloplus-2 pain scale in older adults with cognitive impairment: a systematic review. BMC Geriatrics. 17, 1, 257. doi: 10.1186/s12877-017-0643-9
  49. Rowland JH, Bellizzi KM (2014) Cancer survivorship issues: life after treatment and implications for an aging population. Journal of Clinical Oncology. 32, 24, 2662-2668. doi: 10.1200/JCO.2014.55.8361
  50. Sampson EL, Harrison Dening K (2021) Palliative and end-of-life care. In Dening T, Thomas A, Stewart R et al (Eds) Oxford Textbook of Old Age Psychiatry. Third edition. Oxford University Press, Oxford, 395-408.
  51. Shefer G, Henderson C, Howard LM et al (2014) Diagnostic overshadowing and other challenges involved in the diagnostic process of patients with mental illness who present in emergency departments with physical symptoms – a qualitative study. PLoS One. 9, 11, e111682. doi: 10.1371/journal.pone.0111682
  52. Singh H, Sethi S, Raber M et al (2007) Errors in cancer diagnosis: current understanding and future directions. Journal of Clinical Oncology. 25, 31, 5009-5018. doi: 10.1200/JCO.2007.13.2142
  53. Smyth KA (2009) Current practices and perspectives on breast cancer screening and treatment in older women with dementia. Journal of the American Geriatrics Society. 57, Suppl 2, S272-S274. doi: 10.1111/j.1532-5415.2009.02510.x
  54. Snow AL, Weber JB, O’Malley KJ et al (2004) NOPPAIN: a nursing assistant-administered pain assessment instrument for use in dementia. Dementia and Geriatric Cognitive Disorders. 17, 3, 240-246. doi: 10.1159/000076446
  55. Surr CA, Kelley R, Griffiths AW et al (2020) Enabling people with dementia to access and receive cancer treatment and care: the crucial role of supportive networks. Journal of Geriatric Oncology. 11, 7, 1125-1131. doi: 10.1016/j.jgo.2020.03.015
  56. Tammemagi CM, Neslund-Dudas C, Simoff M et al (2003) Impact of comorbidity on lung cancer survival. International Journal of Cancer. 103, 6, 792-802. doi: 10.1002/ijc.10882
  57. Torke AM, Schwartz PH, Holtz LR et al (2013) Caregiver perspectives on cancer screening for persons with dementia: “why put them through it?” Journal of the American Geriatrics Society. 61, 8, 1309-1314. doi: 10.1111/jgs.12359
  58. Tørring ML, Frydenberg M, Hansen RP et al (2013) Evidence of increasing mortality with longer diagnostic intervals for five common cancers: a cohort study in primary care. European Journal of Cancer. 49, 9, 2187-2198. doi: 10.1016/j.ejca.2013.01.025
  59. Walter LC, Lindquist K, Nugent S et al (2009) Impact of age and comorbidity on colorectal cancer screening among older veterans. Annals of Internal Medicine. 150, 7, 465-473. doi: 10.7326/0003-4819-150-7-200904070-00006
  60. Warden V, Hurley AC, Volicer L (2003) Development and Psychometric Evaluation of the Pain Assessment in Advanced Dementia (PAINAD) scale. Journal of the American Medical Directors Association. 4, 1, 9-15. doi: 10.1097/01.JAM.0000043422.31640.F7
  61. Wittenberg R, Knapp M, Hu B et al (2019) The costs of dementia in England. International Journal of Geriatric Psychiatry. 34, 7, 1095-1103. doi: 10.1002/gps.5113
Related articles

Nurse-led home chemotherapy for patients with lung disease
This article describes the development of a service for...

Supporting patients with cancer and cognitive impairment
A weekly drop-in memory service for patients and carers is...

An overview of non-Hodgkin’s lymphoma
Non-Hodgkin’s lymphoma is a heterogeneous group of...

Qualitative review of satisfaction with a head and neck clinic
The aim of the survey reported here was to explore the...

Supporting delivery of the recovery package for people living with and beyond cancer
Survivorship is an important issue in cancer care in the UK....