Cancer Care Decisions for Older Adults

Cancer is one of the most common chronic diseases in the United States, with more than 1.7 million new cases diagnosed in 2020, the latest year for which the Centers for Disease Control and Prevention have data available on this disease’s incidence. This represents 436 new cancer cases for every 100,000 people in the country. The National Cancer Institute reports that breast cancer is the most common cancer, followed by lung and bronchus cancer, prostate cancer and cancers of the colon and rectum.

Cancer is especially common among older adults, as seniors account for about 50% of all cancer cases. The incidence rate for cancer also increases steadily with age, rising from 350 cases per 100,000 people in adults between the ages of 45 and 49 to more than 1,000 cases per 100,000 people in adults who are 60 and older.

For seniors, a cancer diagnosis may make it difficult to prepare meals, shop for groceries and perform activities of daily living, leading many older adults to need some type of paid care while receiving treatment. Because some cancers aren’t diagnosed until their later stages, some seniors need hospice care to keep them comfortable.

This guide explains how a cancer diagnosis affects your options for care and provides information to help you find an assisted living community that offers services to help residents with cancer improve their quality of life. It also explains some of the most common barriers that prevent seniors from accessing cancer screenings, diagnostic services and cancer treatment.

Challenges in Accessing Cancer Care

Many seniors have difficulty accessing cancer-related care due to a unique combination of age-related factors. This makes it challenging to participate in cancer screenings, get a timely diagnosis of cancer and access effective cancer treatments, leading to poorer outcomes. Senior care doesn’t eliminate these challenges entirely, but it can increase access to cancer care, which helps older adults maintain a high quality of life for as long as possible.

Difficulty Accessing Screening Services

Cancer screening is important because it can detect cancer even before a senior experiences symptoms, making it possible to undergo treatment before it spreads to other parts of the body. Unfortunately, many seniors don’t receive appropriate screening services, preventing them from receiving timely diagnosis.

For some seniors, the out-of-pocket costs associated with screening are a major barrier to getting care. Medicare pays for many screening tests, but the coverage rules can be confusing, and there may be limits on what’s covered. For example, a senior who needs a colonoscopy can only get Medicare to cover the test once every 120 months if they have an average risk of developing colon cancer. Medicare covers the test once every 24 months for high-risk beneficiaries.

The basic test doesn’t have any out-of-pocket fees when covered by Medicare, but if the provider finds a polyp and removes it to perform a biopsy, then the beneficiary must pay a facility copay and 20% of the Medicare-approved amount for the doctor’s services. Older adults with private health plans may have to pay deductibles, copays and other fees to get certain cancer screenings, making it difficult for seniors with limited financial resources to access this type of care.

Poor communication with health care providers and a lack of knowledge about the screening guidelines also prevents some seniors from accessing cancer screening services. If a doctor doesn’t recommend a screening, a senior may not be aware that it’s needed, leaving them to miss out on a valuable opportunity to detect cancer in its earliest stages. Even when a health care provider does recommend screening, they may not communicate clearly, leaving seniors unsure of whether they really need the recommended test. Many seniors are also concerned about their comfort and risk for complications when it comes to screening procedures.

Difficulty Accessing Diagnostic Services

Some seniors also have difficulty getting biopsies and accessing other services to diagnose cancer and determine the extent of its spread. For seniors who live alone and are somewhat isolated from the community, it can be difficult to find transportation to and from medical offices or get help after a diagnostic procedure is over. This is especially true if the senior needs to see multiple doctors.

Even if they’re concerned about their risk, some seniors avoid seeking diagnostic care because they’re worried about how it will impact their financial situation. Medicare, Medicaid and other types of insurance all have different rules regarding coinsurance, deductibles and other out-of-pocket costs. Depending on the level of coverage available, it may cost several thousand dollars to get an accurate diagnosis. Health plans with lower monthly premiums tend to have higher out-of-pocket costs, leaving seniors with inexpensive plans even more reluctant to seek care.

Poor doctor-patient relationships also contribute to delays in accessing diagnostic services. Seniors who don’t believe their doctors have their best interests in mind may put off care or refuse to undergo recommended procedures. Many providers now have patient portals with built-in messaging features, which are supposed to improve communication between health care professionals and their patients. Unfortunately, communicating via one of these portals may result in information overload for seniors, making it difficult for them to understand what kind of care they need. If a senior corresponds with more than one provider, they may also receive conflicting information, resulting in misunderstandings that delay access to important diagnostic services.

Difficulty Accessing Cancer Therapies

Once a senior has been diagnosed with cancer, they may encounter barriers that make it difficult for them to access effective therapies, including radiation therapy, surgery and chemotherapy. One of those barriers is ageism from health care professionals. Some providers consider each patient’s age without thinking about their overall health and fitness, causing them to recommend the same treatment regimens to every senior with the same type of cancer. That does a disservice to seniors who are generally in good health and might be able to tolerate more intensive treatments. Busy health care providers may also dismiss a senior’s complaints regarding potential cancer symptoms or not spend enough time counseling seniors on how to prevent cancer and other diseases.

Financial Concerns

Financial concerns also make it difficult for many seniors to access comprehensive cancer treatment. The Cancer Action Network reports that people with cancer spent $5.6 billion on out-of-pocket costs for cancer care in 2020. A senior with cancer may have to pay hospital coinsurance, copays for laboratory tests and imaging studies, physician fees, facility fees for surgical procedures and copays for medications they receive as part of their treatment.

Seniors who haven’t retired yet may need to take time off from work, reducing available income to pay these expenses. Depending on the treatment’s side effects, some seniors even have to pay for help with household chores and other activities while recovering from cancer. These costs add up quickly, making it difficult for seniors to afford high-quality care.

Age-Specific Risks of Treatment

Approximately 60% of older adults have at least two chronic health conditions, according to the National Institute on Aging. The presence of other health conditions can make it difficult to develop a safe and effective treatment plan for a senior with cancer. Some of these conditions even increase the risk of complications from chemotherapy, surgery and other cancer therapies. For example, heart disease is associated with an increased risk of complications around the time of surgery. This includes during the surgical procedure, in the recovery room and at home following hospital discharge.

Many seniors also undergo age-related changes that affect how their bodies respond to certain cancer therapies. Due to these changes, some treatments are more toxic in older adults than in younger people. As a result, the options for effective treatment are more limited for seniors.

Types of Senior Living Options for Older Adults with Cancer

Seniors have several options for getting care while receiving treatment or recovering from cancer. For seniors who are well enough to stay at home, in-home care makes it possible to access services from home health agencies and personal care providers. Some seniors need more help than these professionals can provide at home, leading them to look for residential options.

Home Care

Aging in place refers to staying in your home as you age instead of moving to a non-community setting. For seniors with cancer, aging in place can be a little more difficult due to the physical and psychological effects of receiving a cancer diagnosis and undergoing intensive treatment. Home care makes it possible to continue aging in place without putting your health and well-being at risk.

Some cancer treatments cause nausea, fatigue and other side effects, leaving seniors feeling weak and unable to carry out their usual activities without a little help. Cancer itself also causes fatigue by damaging the organs, altering hormone levels, destroying red blood cells or releasing proteins that interfere with the body’s normal functions. This makes it difficult for seniors to groom themselves, prepare nutritious meals and clean and maintain their homes.

Depending on what type of help you need, you may be able to rely on family caregivers, or you may need to bring in a trained professional to help you while you’re receiving treatment or recovering from cancer. Family members can help by preparing meals, cleaning, grocery shopping and taking care of other chores. If you don’t live close to family members who can help, you have the option of hiring a personal care aide to help you with activities of daily living.

For seniors with increased medical needs due to their cancer diagnoses, home health agencies provide hands-on care by licensed health professionals. These agencies offer in-home nursing care, physical therapy, occupational therapy and other services to help you regain your strength and feel as well as possible while receiving cancer treatment.

Residential Care

Assisted living communities provide a safe environment for seniors who need a little help with certain activities and don’t require 24/7 medical care. These communities have a wide range of amenities, including housekeeping services, laundry services, meals and a full slate of social and recreational activities. Assisted living services are helpful for seniors with cancer because they take away the burden of having to prepare meals and care for a home while receiving cancer treatment or recovering from cancer. For seniors who previously lived alone, assisted living also provides meaningful opportunities to socialize and get as much physical activity as possible. Most communities also offer transportation to hospitals and medical clinics, enabling seniors to get comprehensive cancer care.

Some seniors have significant medical needs that make nursing home care a better option. In assisted living, the focus is on personal care and activities; in a nursing home, the focus is on providing health care services to seniors who need close supervision. Nursing homes typically have nurses and aides available 24 hours per day to administer medications, help with activities of daily living and monitor residents for changes in their health and mental status. Nursing homes also have physical therapists, occupational therapists and other health professionals on staff to help residents as needed.

Palliative and Hospice Care

Palliative care can begin at any point after someone is diagnosed with cancer. It’s designed to treat the whole person, not just the physical disease. In addition to nurses and other health care professionals, a palliative care team typically includes chaplains, social workers and other staff members trained to help seniors and their family members work through issues they face due to their cancer diagnosis. Palliative providers also pay special attention to each senior’s psychological well-being and spiritual needs. This type of holistic care can continue once someone enters hospice care.

Some seniors have advanced cancer that’s expected to limit their life expectancy. As a result, they decide to forgo treatment and focus on preserving their quality of life for as long as possible. Hospice care, provided at home or in a hospice center, aims to keep seniors with cancer and other terminal illnesses as comfortable as possible during the end-stages of terminal cancer.

How To Decide What Kind of Care You Need

It’s comforting to know that seniors with cancer have so many options for care, but it can be difficult to decide which option makes the most sense for your situation. As you prepare to choose a care setting, answer the following questions:

How old are you?

Age is one of the most important considerations when choosing a care setting. If you’re in your late 50s or early 60s, it may make sense to hire in-home care providers to help you during your treatment and as you begin to recover from cancer. Home care is appropriate if you’re able to live independently and don’t have any chronic health conditions that would impair your ability to age in place once your cancer is in remission.

Older seniors may benefit from residential care, especially if they have chronic health conditions that make it difficult to complete household chores, maintain good hygiene or perform other activities of daily living.

Even though age is important, remember it’s just a number. Some seniors are active well into their 70s and 80s, so you may not need residential care just because you’re a little older than other seniors with cancer.

What kind of cancer do you have?

Some cancers have higher survival rates than others, so the type of cancer you have makes a difference when it comes to choosing the right care option. You should also think about the extent of your cancer. Tumor staging provides important information about the size of a primary tumor and whether the cancer has spread into the lymph nodes. It also helps doctors determine if the cancer has moved from one area of the body to the other.

If your cancer is in its early stages, you may only need a few weeks or a few months of care while you receive treatment. Seniors with cancer that has spread into the lymph nodes or other organs and tissues may need more extensive care for a longer time.

Does your home meet your current needs?

It’s important to have a safe place to rest and recover from cancer. If your current home has known safety hazards or doesn’t have enough room for care providers and any equipment you might need during your treatment, it may not be the best place to receive care. Hazards may include slippery floors, rugs that aren’t secured to the floor, a bathroom that doesn’t have any grab bars or a bedroom on the second floor.

Have my circumstances changed?

It’s important to re-evaluate your decision from time to time, as your circumstances may change after your initial diagnosis. If the cancer responds better to treatment than expected, you may not need as much care as you anticipated. However, if you experience complications from treatment, you may need a different type of care.

Tips for Choosing an Assisted Living Community for Seniors with Cancer

Assisted living is ideal for seniors who want the peace of mind that help is available in an emergency. Many assisted living communities even offer services specifically for residents with cancer. Before you decide, research each local community carefully and review the list of medical professionals and amenities for each one. The checklist below can help you choose an assisted living community that meets your needs.

Cancer Care Available at National Assisted Living Communities

Many assisted living communities belong to chains with multiple locations throughout the United States. National chains tend to offer a wide range of amenities for residents with cancer and other health conditions. The table below lists some of the largest chains in the country, along with information about the services that can help residents with cancer stay as healthy as possible during their treatment.

Cancer Care in Hospice

Hospice is for people with life-limiting illnesses. Experts consider an illness life-limiting when it reduces a person’s life expectancy to no more than six months. When someone chooses hospice, the focus isn’t on treating the cancer; it’s on managing the symptoms and keeping the person comfortable. Family meetings are also an important aspect of hospice care. During these meetings, a nurse or social worker updates family members on their loved one’s care.

The resources below can help you learn more about hospice and choose the right provider to meet your needs.