Living with cancer in old age. Quality of life and meaning

Abstract: The overall aim of this thesis was to investigate quality of life in people aged 75 and older with cancer in relation to age, gender, presence and type of complaints, comorbidity, living conditions, perceived economic situation, sense of coherence, receiving help for daily living and social resources. The aim was also to investigate older people’s experiences and the meaning of living with cancer in old age. The samples in the first three studies were identified in a larger population study concerning the health situation in people aged 75 and older. The first study comprised interviews with 64 persons with cancer about their experiences of living with cancer. In the second study comparisons were performed, between a study group of people with cancer (n=150) and a comparison group of people without cancer (n=138), as regards quality of life, complaints and comorbidities. In the third study gender differences were investigated between women (n=74) and men (n=76) with cancer and women (n=64) and men (n=74) without cancer. In the fourth study nine persons aged 75 and older, who had just completed cancer treatment, were interviewed about their experience of the meaning of living with cancer in old age. Interviews with people with a more lingering cancer disease revealed four main categories: living with cancer means (a) bodily, mental, social and existential experiences, (b) being aware of the disease or not, (c) handling daily life, (d) feelings of affirmation and/or rejection in encountering health care professionals. The power to choose how to approach daily life with cancer, the disease and its treatment proved to be crucial for constructively handling and outcome. People with cancer had lower (poorer) scores in different domains of QoL (EORTC QLQ C-30, SF-12), more complaints, and more self-reported diseases than those without cancer. Irrespective of having cancer or not, the oldest old had more complaints than the youngest old. Significant differences in QoL and complaints among age groups between people with and without cancer were seen only between the youngest age groups (aged 75–79 years). Women with cancer were more vulnerable than their male counterparts in QoL, SOC, perceived economic situation and social resources. Receiving help for daily living from others and degree of complaints were associated with poor QoL for both physical and mental component scores (PCS, MCS) of the SF-12. In people with cancer the factors receiving help for daily living, comorbidity, degree of complaints and pain were associated with poor QoL. Interviews in study four revealed three essential themes: a disintegrated existence, a sudden awareness of the finiteness of life, painful insights into losses but also awareness of possibilities. The old persons who just had completed treatment lived under the pressure of being in a transition stage. In conclusion cancer has an additional negative effect on QoL in old age and in combination with other diseases and especially the complaints. The most vulnerable cancer patients among older people seems to be the youngest old and women and especially cancer-related complaints have negative implications for QoL. Fatigue and pain seem to be the most excruciating symptoms in older people with cancer and thus suggesting a clinically important reduction of their QoL. Comorbidity was most pronounced in the oldest age groups and these people also had the poorest QoL. Oncology nursing to older people requires understanding of what the patients problems and needs are, also including the unspoken ones, as well as specific knowledge about management of symptoms and response to treatment in old age. These old people with cancer present a complex situation and thus require comprehensive assessment and physiological and psychosocial support as well as encouragement to make use of individual strengths and resources to maintain equilibrium during illness and treatment.