Providing cancer treatment and care to people living with cancer and dementia: challenges and research-based recommendations
Intended for healthcare professionals
Evidence and practice    

Providing cancer treatment and care to people living with cancer and dementia: challenges and research-based recommendations

Rachael Kelley Senior Research Fellow, Centre for Dementia Research, Leeds Beckett University, Leeds, England
Claire Surr Professor, Centre for Dementia Research, Leeds Beckett University, Leeds, England
Alys Griffiths Senior Research Fellow, Centre for Dementia Research, Leeds Beckett University, Leeds, England
Laura Ashley Reader, Leeds School of Social Sciences, Leeds Beckett University, Leeds, England
Amanda Procter Centre Head, Maggie’s Leeds, Leeds, England

Why you should read this article
  • To learn about the emerging UK evidence base on cancer and dementia

  • To increase your awareness of challenges experienced by people with dementia in accessing cancer care

  • To source strategies for reducing complications created by dementia in all aspects of cancer care

A growing number of people live with cancer and dementia. Dementia creates a particular set of challenges in all aspects of cancer treatment and care, including diagnosis, decision-making, access to appointments, monitoring of signs and symptoms of cancer and side effects of cancer treatment, and management of self-care tasks. People with cancer and dementia often require extensive support from family carers, and those without family support face additional challenges. This article uses the emerging UK evidence base on cancer and dementia to discuss the challenges that arise when providing cancer treatment and care to people with dementia and their families, and to make research-based recommendations on how to improve service provision for that population.

Cancer Nursing Practice. doi: 10.7748/cnp.2021.e1754

Peer review

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

@kelley_rach

Correspondence

r.kelley@leedsbeckett.ac.uk

Conflict of interest

None declared

Kelley R, Surr C, Griffiths A et al (2021) Providing cancer treatment and care to people living with cancer and dementia: challenges and research-based recommendations. Cancer Nursing Practice. doi: 10.7748/cnp.2021.e1754

Published online: 15 February 2021

In the UK, an estimated 850,000 people live with dementia (Prince et al 2014) and around 370,000 people are newly diagnosed with cancer each year (Cancer Research UK 2020). Both conditions are strongly associated with older age: more than a third of cancer diagnoses in the UK are in people aged 75 years or more (Cancer Research UK 2020) and 7% of people aged over 65 years have dementia (Prince et al 2014).

The high prevalence of cancer and of dementia in older people means a considerable number of them are likely to live with both conditions. A recent study using UK GP records estimated that 7.5% of patients aged 75 years or more with a cancer diagnosis also have dementia (Collinson et al 2019). This is likely to be an underestimation, considering that dementia is underdiagnosed – only 64% of people aged 65 years or more in England who are estimated to have dementia actually have a diagnosis of dementia (NHS Digital 2020). The progressive increase in the number of older people, coupled with improvements in cancer survival rates, mean that oncology staff care for a growing number of people with cancer and dementia.

Dementia has a range of effects that are likely to make cancer treatment and care more challenging, including impairments in memory, judgement, reasoning ability, language, visual perception, finding one’s way around and managing daily tasks (Alzheimer’s Society 2017). People with dementia who require cancer treatment and care may find it challenging to understand information about diagnosis and treatment, attend multiple oncology services and appointments, make decisions regarding treatment and undergo treatment (Ashley et al 2020).

Until recently there had been little research into people living with cancer and dementia, so little was known about their experiences of cancer services and how to provide them with effective cancer treatment and care (Hopkinson et al 2016). However, several recent UK-based studies have explored the topic, the largest and most recent one being Ashley et al (2020). This article uses this emerging UK evidence base to discuss the challenges that arise when providing cancer treatment and care to people with dementia and their families, and to make research-based recommendations on how to improve service provision for that population, in four areas:

  • Awareness of dementia in oncology services.

  • Decision-making about treatment.

  • Provision of cancer treatment and care.

  • Involvement of families.

Key points

  • Oncology services care for a growing number of people with cancer and dementia

  • Dementia complicates all aspects of cancer treatment and care

  • People with cancer and dementia have extensive support needs and many rely on family carers

  • Better awareness of the specific needs of patients with cancer and dementia is needed, as well as more flexibility in service provision

  • Family carers of people with cancer and dementia need to be recognised and supported

  • People with dementia and cancer who do not have family support must be identified and adequately supported

Awareness of dementia in oncology services

The first step in addressing the cancer treatment and care needs of people with dementia is being aware that they have dementia. However, research suggests that oncology staff are not always aware that someone has dementia (Courtier et al 2016, McWilliams et al 2018a, Martin et al 2019, Ashley et al 2020). In oncology services, the documentation of dementia diagnoses is inconsistent (Courtier et al 2016, Ashley et al 2020), many assessment forms do not consider dementia and staff do not systematically enquire about dementia or about memory problems – a potential alternative term for beginning enquiries about dementia (Courtier et al 2016, Cook and McCarthy 2018, Ashley et al 2020). During clinic appointments, which are often time limited and involve imparting information that many patients find challenging to process, it may not always be apparent that someone has dementia (Ashley et al 2020, Hopkinson et al 2020) and people with dementia and/or their families may compensate for, and thus mask, their difficulties (Courtier et al 2016).

People with dementia and/or their families may not disclose a diagnosis of dementia to oncology staff (Hopkinson et al 2020) to avoid embarrassment, negative effects on treatment decisions or providing potentially irrelevant information (Solomons et al 2013). They may also presume that this information has already been conveyed (Surr et al 2019), or they may not have had their dementia formally diagnosed. Consequently, people’s cognitive status may not be known to oncology staff either before the appointment (McWilliams et al 2018a) or at all (Courtier et al 2016).

Most oncology staff report they have had little or no training in how to identify, communicate with and support people with dementia (Courtier et al 2016, Ashley et al 2020). Many are unaware of the prevalence of dementia among oncology patients and of the benefits of identifying this for improving patient care (Courtier et al 2016). Several studies have highlighted the need for dementia training for oncology staff (Courtier et al 2016, McWilliams et al 2018a, Ashley et al 2020). Although many general hospitals have introduced initiatives to improve dementia awareness and training, these have not been consistently implemented in oncology, particularly in outpatient services (Ashley et al 2020).

Box 1 features research-based recommendations for improving awareness of dementia in oncology services.

Box 1.

Recommendations for improving awareness of dementia in oncology services

  • Routinely ask about dementia or memory problems at initial appointments and include this information on referral and assessment forms; simple memory screening questions used on inpatient wards can be replicated in oncology services

  • Clearly document dementia or memory problems in patient records, including information on how the person is affected and the support they may need

  • Ensure staff have access to optimal information and training on dementia, so that they are able to identify and support people with dementia and recognise the importance of doing so

(Adapted from Courtier et al 2016, McWilliams et al 2018a, Martin et al 2019, Ashley et al 2020)

Decision-making about treatment

Making decisions about cancer treatment can be particularly challenging for people living with dementia (Griffiths et al 2020). Treatment decisions often require careful consideration and many patients – not just those with dementia – find it challenging to understand their prognosis and treatment options (Courtier et al 2016). Dementia creates additional difficulties, since people’s comprehension and decision-making ability may be affected (Zafar et al 2009). Some people with dementia will be able to make informed decisions, but in others the ability to do so will fluctuate. Some may need support to understand and retain information about treatment options so that they are able to make informed decisions. Some may require other people, often relatives, to make decisions on their behalf (Courtier et al 2016, McWilliams et al 2018a, 2018b, Witham et al 2018, Griffiths et al 2020). Difficulties are amplified if the information is not delivered in a way that takes into account people’s communication needs and level of comprehension (McWilliams et al 2018a, Griffiths et al 2020, Hopkinson et al 2020).

Another challenge is a higher prognostic uncertainty. Diagnostic investigations may be more challenging for people with dementia to undergo; for example, they may misunderstand instructions or not be able to sit still long enough for optimal imaging results. This will reduce the amount and/or quality of diagnostic information available (Torke et al 2013) and therefore make diagnosis, prognosis and decision-making more difficult. Risk-benefit judgements are particularly complex (Hopkinson et al 2016). In addition, there is little understanding of whether cancer treatments affect dementia symptoms or treatments, or why complications from some cancer treatments are more likely in people with dementia (Hopkinson et al 2016).

Because of this lack of evidence, treatment decisions are often made based on how people are expected to cope with treatment and its side effects and consequences; for example, on how well they are expected to cope with being an inpatient following surgery, with not remembering why one of their breasts has been removed (Griffiths et al 2020) or with monitoring treatment side effects (Courtier et al 2016). Treatment decisions are also often based on the level of cognitive impairment and its effect on life expectancy (Courtier et al 2016, McWilliams et al 2018a).

Quantity versus quality of life becomes an important consideration. Patients and their families are often keen to maintain their current quality of life in the context of the dementia and are concerned about the potential adverse effects of cancer treatment on cognitive health and well-being (McWilliams et al 2018b, Griffiths et al 2020). There are often challenges in identifying the optimal decision in a complex and uncertain set of circumstances (Griffiths et al 2020) and some relatives believe that the ‘bigger picture’ of dementia and other co-morbidities is not always sufficiently taken into account (Griffiths et al 2020).

The presence of dementia can create ethical dilemmas around what the ‘right’ decision is. Challenges include establishing people’s decision-making ability, determining who should make decisions, and balancing the wish to involve people in their care against the wish to avoid distressing them by repeatedly reminding them of a cancer diagnosis they may have forgotten about (Griffiths et al 2020). The literature emphasises the central role played by families in decision-making (Courtier et al 2016, Griffiths et al 2020). Some, but by no means all, people with dementia depend on relatives – or staff – to make best-interest decisions on their behalf. Relatives can be informally recruited, or formally appointed through a lasting power of attorney, to assist in making decisions on behalf of someone who lacks mental capacity (National Institute for Health and Care Excellence 2018), in establishing the person’s preferences, and in determining which treatment is in the person’s best interest. Assessing mental capacity in people with dementia is governed by the Mental Capacity Act 2005, and there are specific resources on assessing mental capacity in dementia – for example, from the Alzheimer’s Society (2020a, 2020b) or the Social Care Institute for Excellence (2020).

Involving families in decision-making creates its own challenges, including balancing the involvement of the patient against that of the family and managing potentially differing views (Harrison-Dening et al 2016) and power imbalances (Zafar et al 2009). These power imbalances, and decision-making in general, can be particularly challenging in people who lack mental capacity (Feinberg and Whitlatch 2002, Griffiths et al 2020). Seeking consent for treatment is likely to be more complicated (McWilliams et al 2018b). Oncology staff may not recognise that someone cannot provide informed consent, particularly if they are unaware that the person has dementia (Courtier et al 2016, Witham et al 2018). Relatives are often relied on to assist in decision-making, but may lack the information and support they need to make complex and emotionally charged decisions (Martin et al 2019), feel excluded from decision-making (McWilliams et al 2018a, Witham et al 2018, Martin et al 2019) or fail to understand treatment options (McWilliams et al 2018a).

Optimal decision-making about cancer treatment for people living with dementia is likely to assist in reducing the inequalities in cancer outcomes, such as increased mortality, experienced by this patient group (Raji et al 2008, Robb et al 2010). Box 2 features research-based recommendations for improving decision-making about treatment.

Box 2.

Recommendations for improving decision-making about treatment

  • Decision-making about cancer treatment in people with dementia may require longer and/or additional appointments and repeated evaluations

  • Information about diagnosis and treatment options needs to be summarised clearly and provided in easy-to-understand formats

  • It may be helpful to pace conversations (slowing down information delivery), use simple language and repeat important information to aid recall; the latter needs to be balanced against the potential distress caused by repeatedly reminding the person of a cancer diagnosis they may have forgotten about

  • The person living with dementia needs to be involved as much as possible in the discussions about treatment and healthcare professionals need to be mindful of their body language and tone of voice

  • Careful balancing of the views of the person living with dementia and those of their family, and of differing views within the family, will assist in ensuring that all views are heard

  • Treatment options need to be considered within the ‘bigger picture’ of the person’s dementia and other co-morbidities, including how these could affect the response to, and side effects from, cancer treatment

  • If the person living with dementia cannot recall important clinical information, it is important to involve their support network, such as relatives, community services and care home staff

  • Collaboration with other parties such as GPs and carers is required, for example if there are changes to treatment regimens

  • Oncology staff may benefit from training and support in communicating with people with dementia and in assessing their decision-making capacity

(Adapted from Harrison-Dening et al 2016, McWilliams et al 2018a, 2018b, Martin et al 2019, Ashley et al 2020, Griffiths et al 2020, Surr et al 2020a, McWilliams 2020)

Provision of cancer treatment and care

People with dementia can experience challenges before, during and after their appointments in oncology services. Managing multiple appointments, treatment rounds and settings, as well as the journeys to and from services, can be particularly difficult (Ashley et al 2020, Hopkinson et al 2020). For people with dementia, finding their way between transport drop-off points and the correct department in large, busy and unfamiliar buildings will often be challenging (Ashley et al 2020, Surr et al 2020b). Oncology departments often lack dementia-friendly designs and features such as clear signage, use of colour to aid orientation, optimal lighting, removal of unnecessary equipment and provision of stimulating activities (Moyle et al 2008). Lengthy waiting for appointments and transport can also be particularly challenging for people with dementia, who may become frustrated or forget where they are or what they are waiting for, and attempt to leave (Ashley et al 2020).

Providing the individualised care that people with dementia need during oncology appointments can be difficult due to the involvement of multiple departments and staff often located in different sites, tight and protocol-driven treatment schedules, and large numbers of patients (Ashley et al 2020). Some people with dementia may find it challenging to drink pre-treatment fluids, self-administer enemas, understand treatment instructions (Ashley et al 2020) or dress and undress themselves (Surr et al 2020a). Recognising and reporting pain may also be more challenging for them: evidence suggests that people with cancer and dementia are less likely to proactively report pain and less likely to receive analgesia (Hopkinson et al 2016).

Between appointments, many people with dementia will need support to retain and understand information, undertake self-care tasks, monitor signs and symptoms of cancer and manage side effects of cancer treatment (Courtier et al 2016, Surr et al 2020a). Incorrect assumptions are sometimes made about people’s ability to manage their care independently, such as looking after catheters and attending follow-up appointments (Surr et al 2020a). The practical and emotional burden of managing multiple appointments and tasks is compounded if the person is simultaneously receiving treatment and care for other co-morbidities (Ashley et al 2020), as is often the case for people with dementia (Bunn et al 2014). Clear communication and coordination between all healthcare professionals involved is required, but does not always happen in practice (Ashley et al 2020).

Oncology staff do not always recognise these challenges in the provision of cancer treatment and care to people with dementia, and there can be limited consideration of how treatment pathways can be adapted to meet people’s needs (Witham et al 2018). Staff in oncology services need to be aware of the many challenges people with dementia may face in hospital – including distress, disorientation and difficulties with communication, eating and drinking (Bridges et al 2010, Kelley et al 2019) – and of the strategies they can use to improve service provision (Moyle et al 2008, Handley et al 2017).

Box 3 features research-based recommendations for improving the provision of cancer treatment and care.

Box 3.

Recommendations for improving the provision of cancer treatment and care

  • Offering continuity of staff, and of environments such as treatment and waiting rooms, to foster relationship building, recall and familiarity and reduce anxiety and unnecessary repetition of information

  • Offering pre-treatment visits and/or photos, diagrams or videos of locations and equipment to increase familiarity

  • Offering flexibility in timing and location of appointments

  • Using a simple tool for collecting information about people’s needs – such as ‘This is me’ (Alzheimer’s Society 2020c) – to create familiarity and build rapport

  • Dedicating additional time and support to people during appointments and treatment sessions

  • Adapting treatment pathways and regimens

  • Implementing guidance on dementia-friendly hospital environments, such as Developing Supportive Design for People with Dementia (King’s Fund 2020)

  • Providing dementia-friendly books, games and activities – for example, reminiscence materials – in waiting areas

  • Offering people opportunities to practise self-care tasks before they leave the hospital

(Adapted from Courtier et al 2016, McWilliams et al 2018a, Witham et al 2018, Martin et al 2019, Ashley et al 2020, McWilliams 2020)

Involvement of families

Families play many crucial roles in supporting – practically, cognitively and emotionally – people with dementia who receive cancer treatment and care (Courtier et al 2016, McWilliams et al 2018a, 2018b, Martin et al 2019, Surr et al 2020a). Alongside their roles in decision-making, family carers often ensure people attend their appointments, provide them with reassurance and support during appointments, monitor and report signs and symptoms of cancer and side effects of cancer treatment, relay information between patients and staff, support more effective consultations and care, and act as advocates (Courtier et al 2016, McWilliams et al 2018b, Surr et al 2020a).

This can place a considerable burden on families, which they may not always mention during appointments and which oncology staff may not always consider (Courtier et al 2016, McWilliams et al 2018a). Consequently, families’ support needs may be overlooked despite the fact that family carers are heavily relied on to support people with dementia (Courtier et al 2016, Surr et al 2020a). Adverse effects of this cumulative burden include stress, worry and guilt (Surr et al 2020a), compounded by efforts to support the person for their dementia with potentially limited support from stretched dementia services (Surr et al 2020a) and for one or more additional co-morbidities (Nelis et al 2019).

Not everyone has a relative to accompany them to hospital appointments (Surr et al 2020a). In that situation, accessing cancer treatment and care can be particularly difficult for people with dementia. Unaccompanied people with dementia can experience increased difficulties with all aspects of cancer treatment and care (Witham et al 2018), resulting in missed appointments, compromised care, distress and additional challenges for patients and staff (Witham et al 2018, Ashley et al 2020, Surr et al 2020a). In such circumstances, it is often unclear who should assume responsibility for providing the significant additional support required (Ashley et al 2020). The need for staff to support unaccompanied people may not be recognised or planned for, and the provision of support may rely on individual staff members recognising people’s needs and providing assistance beyond their normal work (Surr et al 2020a). In the absence of family carers or of services that can replicate their support, other carers such as bank staff or students may have to be relied on, but this can create its own challenges, as they may not know patients well enough to provide effective assistance (McWilliams et al 2018a, Surr et al 2020a). Without sufficient support, the ability of people living with dementia to undergo cancer treatment may be severely compromised (Surr et al 2020a).

Box 4 features research-based recommendations for facilitating the involvement of families.

Box 4.

Recommendations for facilitating the involvement of families

  • Assess the person’s support network to determine who, in that network, can provide support and what support they may need, and to identify patients without family support

  • Identify who may be able to assist patients without family support – for example, hospital staff or volunteers

  • Include families in discussions and information provision, consider sending a nominated relative copies of hospital letters, and ensure family carers understand the self-care tasks required at home and are able to support the person to undertake them

  • Involve families, if required and agreeable to all parties, as ‘relayers of information’ between patients and staff, including information about the person’s known or likely preferences regarding treatment and care if they cannot express these preferences themselves

  • Strengthen support for families

  • When possible, allow family carers to be present during treatment to provide reassurance and communicate complex instructions to the person living with dementia

(Adapted from Courtier et al 2016, Martin et al 2019, McWilliams et al 2018a, 2018b, Ashley et al 2020, Griffiths et al 2020, McWilliams 2020, Surr et al 2020a)

Conclusion

Dementia complicates cancer treatment and care and people living with dementia and their families are likely to face many challenges when accessing treatment and care. However, there are several strategies that can help reduce these complications. The crucial role of family carers in enabling people with dementia to access cancer treatment and care requires greater recognition and support from oncology services, who also need to be more attentive to the needs of people without family support. Further work is needed to establish practice guidelines for the management of cancer in people living with dementia.

Further Resources

Information from Macmillan on cancer and dementia

www.macmillan.org.uk/cancer-information-and-support/supporting-someone/cancer-and-dementia

Guidance from the Society and College for Radiographers about caring for people with dementia in radiography services

www.sor.org/sites/default/files/document-versions/sor_dementia_academic_doc_llv2.pdf

Online forum and expert Q&As on living with cancer and dementia hosted by the Alzheimer’s Society

https://forum.alzheimers.org.uk/forums/caring-for-a-person-with-dementia-and-cancer.81/ ?_ga= 2.55787566.48853787. 1596053312-453310375.1486554788

References

  1. Alzheimer’s Society (2017) What is Dementia? Factsheet 400LP. http://www.alzheimers.org.uk/sites/default/files/2018-10/400%20What%20is%20dementia_0.pdf (Last accessed: 16 December 2020.)
  2. Alzheimer’s Society (2020a) The Mental Capacity Act and Dementia. http://www.alzheimers.org.uk/get-support/daily-living/making-decisions-mental-capacity-act (Last accessed: 16 December 2020.)
  3. Alzheimer’s Society (2020b) Mental Capacity Act 2005. Factsheet 460LP. http://www.alzheimers.org.uk/sites/default/files/2019-05/460lp-mental-capacity-act-2005-190521.pdf (Last accessed: 16 December 2020.)
  4. Alzheimer’s Society (2020c) This Is Me: A Support Tool to Enable Person-Centred Care. http://alzheimers.org.uk/get-support/publications-factsheets/this-is-me (Last accessed: 16 December 2020.)
  5. Ashley L, Kelley R, Griffiths A et al (2020) Understanding and identifying ways to improve hospital-based cancer treatment and care for people with dementia: an ethnographic study. Age and Ageing. doi: 10.1093/ageing/afaa210
  6. Bridges J, Flatley M, Meyer J (2010) Older people’s and relatives’ experiences in acute care settings: systematic review and synthesis of qualitative studies. International Journal of Nursing Studies. 47, 1, 89-97. doi: 10.1016/j.ijnurstu.2009.09.009
  7. Bunn F, Burn AM, Goodman C et al (2014) Comorbidity and dementia: a scoping review of the literature. BMC Medicine. 12, 1, 192. doi: 10.1186/s12916-014-0192-4
  8. Cancer Research UK (2020) Cancer Incidence Statistics. http://www.cancerresearchuk.org/health-professional/cancer-statistics/incidence#heading-Two (Last accessed: 16 December 2020.)
  9. Collinson M, Mason E, Ashley L et al (2019) Effective clinical cancer treatment, care and management for people with comorbid cancer and dementia: understanding population demographics and intervention priorities and outcomes (CanDem-Int). Abstracts from the NCRI Cancer Conference 2019, Brighton.
  10. Cook PS, McCarthy AL (2018) Cancer treatment decision-making with/for older adults with dementia: the intersections of autonomy, capital, and power. Health Sociology Review. 27, 2, 184-98. doi: 10.1080/14461242.2018.1466187
  11. Courtier N, Milton R, King A et al (2016) Cancer and dementia: an exploratory study of the experience of cancer treatment in people with dementia. Psycho-oncology. 25, 9, 1079-1084. doi: 10.1002/pon.4212
  12. Feinberg LF, Whitlatch CJ (2002) Decision-making for persons with cognitive impairment and their family caregivers. American Journal of Alzheimer’s Disease and Other Dementias. 17, 4, 237-244. doi: 10.1177/153331750201700406
  13. 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
  14. Handley M, Bunn F, Goodman C (2017) Dementia-friendly interventions to improve the care of people living with dementia admitted to hospitals: a realist review. BMJ Open. 7, e015257. doi: 10.1136/bmjopen-2016-015257
  15. Harrison-Dening K, King M, Jones L et al (2016) Advance care planning in dementia: do family carers know the treatment preferences of people with early dementia? PLoS ONE. 11, 7, e0159056. doi: 10.1371/journal.pone.0159056
  16. 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
  17. Hopkinson J, King A, Courtier N et al (2020) Potential for identification of memory problems in the cancer clinic to enable improved treatment experience and outcomes: mixed methods case study research. European Journal of Oncology Nursing. 48, 101777. doi: 10.1016/j.ejon.2020.101777
  18. Kelley R, Godfrey M, Young J (2019) The impacts of family involvement on general hospital care experiences for people living with dementia: an ethnographic study. International Journal of Nursing Studies. 96, 72-81. doi: 10.1016/j.ijnurstu.2019.04.004
  19. King’s Fund (2020) Developing Supportive Design for People with Dementia. http://kingsfund.org.uk/projects/enhancing-healing-environment/ehe-design-dementia (Last accessed: 16 December 2020.)
  20. Martin C, Shrestha A, Burton M et al (2019) How are caregivers involved in treatment decision-making for older people with dementia and a new diagnosis of cancer? Psycho-oncology. 28, 6, 1197-1206. doi: 10.1002/pon.5070
  21. McWilliams L (2020) An overview of treating people with comorbid dementia: implications for cancer care. Clinical Oncology. 32, 9, 562-568. doi: 10.1016/j.clon.2020.06.014
  22. McWilliams L, Farrell C, Keady J et al (2018a) 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
  23. McWilliams L, Swarbrick C, Yorke J et al (2018b) Bridging the divide: the adjustment and decision-making experiences of people with dementia living with a recent diagnosis of cancer and its impact on family carers. Ageing and Society. 40, 5, 944-965. doi: 10.1017/S0144686X18001411
  24. Moyle W, Olorenshaw R, Wallis M et al (2008) Best practice for the management of older people with dementia in the acute care setting: a review of the literature. International Journal of Older People Nursing. 3, 2, 121-130. doi: 10.1111/j.1748-3743.2008.00114.x
  25. National Institute for Health and Care Excellence (2018) Decision-making and Mental Capacity. NICE Guideline 108. NICE, London.
  26. NHS Digital (2020) Recorded Dementia Diagnoses May 2020. https://digital.nhs.uk/data-and-information/publications/statistical/recorded-dementia-diagnoses/may-2020 (Last accessed: 16 December 2020.)
  27. Nelis SM, Wu YT, Matthews FE et al (2019) The impact of co-morbidity on the quality of life of people with dementia: findings from the IDEAL study. Age and Ageing. 48, 3, 361-367. doi: 10.1093/ageing/afy155
  28. Prince M, Knapp M, Guerchet M et al (2014) Dementia UK: Update, Second edition. Alzheimer’s Society, London.
  29. Raji M, Kuo Y‐F, Freeman J 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
  30. 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, 219-224. doi: 10.1016/j.critrevonc.2009.07.002
  31. Social Care Institute for Excellence (2020) Decision-making Capacity in Dementia. http://scie.org.uk/dementia/supporting-people-with-dementia/decisions/capacity.asp (Last accessed 16 December 2020.)
  32. Solomons L, Solomons J, Gosney M (2013) Dementia and cancer: a review of the literature and current practice. Aging Health. 9, 3, 307-319. doi: 10.2217/ahe.13.27
  33. Surr CA, Griffiths AW, Kelley R (2019) The Cancer Care Needs and Experiences of People Living with Dementia (webinar). http://www.youtube.com/watch?v=IS4z_iUQbcM&feature=youtu.be (Last accessed: 4 December 2020.)
  34. Surr CA, Kelley R, Griffiths AW et al (2020a) Enabling people with dementia to access and receive cancer treatment and care: the crucial role of supportive networks. Journal of Geriatric Oncology. doi: 10.1016/j.jgo.2020.03.015
  35. Surr CA, Griffiths AW, Kelley R et al (2020b) Navigating cancer treatment and care when living with comorbid dementia: an ethnographic and interview study. Supportive Care in Cancer. doi: 10.1007/s00520-020-05735-z
  36. 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
  37. Witham G, Haigh C, Mitchell D et al (2018) Carer experience supporting someone with dementia and cancer: a narrative approach. Qualitative Health Research. 28, 5, 813-823. doi: 10.1177/1049732317736285
  38. Zafar SY, Alexander SC, Weinfurt KP et al (2009) Decision making and quality of life in the treatment of cancer: a review. Supportive Care in Cancer. 17, 2, 117-127. doi: 10.1007/s00520-008-0505-2

Share this page

Related articles

Survey evaluates quality of patient information at end of treatment
A patient experience survey was undertaken by the South West...

Community choir enhances coping skills and quality of life
This article explores the development of the Tenovus Sing...

Effectiveness of a neutropenic sepsis clinical pathway
This article reports the findings of a re-audit across a...

Management of a patient with secondary lymphoedema
Women undergoing surgery and/or radiotherapy for treatment...

Developing a clinic to meet patients’ pre-operative needs
This article describes a practice development project at a...