Curated Papers > Recent high-impact research on "Alzheimer's Disease" (IF≥30, last 5 years)

Cancer care for people with dementia: Literature overview and recommendations for practice and research.

Literature Information

DOI	10.3322/caac.21767
PMID	36512303
Journal	CA: a cancer journal for clinicians
Impact Factor	232.4
JCR Quartile	Q1
Publication Year	2023
Times Cited	8
Keywords	cancer, comorbidity, dementia, geriatric oncology, health disparities
Literature Type	Journal Article, Review
ISSN	0007-9235
Pages	320-338
Issue	73(3)
Authors	Laura Ashley, Claire Surr, Rachael Kelley, Mollie Price, Alys Wyn Griffiths, Nicole R Fowler, Dana E Giza, Richard D Neal, Charlene Martin, Jane B Hopkinson, Anita O'Donovan, William Dale, Bogda Koczwara, Katie Spencer, Lynda Wyld

TL;DR

As the population ages, patients with cancer are increasingly affected by dementia, leading to significant health disparities that complicate cancer care and outcomes. The research highlights that people living with dementia face advanced-stage diagnoses, suboptimal treatment, and higher caregiver burdens, emphasizing the need for person-centered cancer care that includes holistic decision-making and strong family support to improve treatment equity and quality of life.

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cancer · comorbidity · dementia · geriatric oncology · health disparities

Abstract

As many countries experience population aging, patients with cancer are becoming older and have more preexisting comorbidities, which include prevalent, age-related, chronic conditions such as dementia. People living with dementia (PLWD) are vulnerable to health disparities, and dementia has high potential to complicate and adversely affect care and outcomes across the cancer trajectory. This report offers an overview of dementia and its prevalence among patients with cancer and a summary of the research literature examining cancer care for PLWD. The reviewed research indicates that PLWD are more likely to have cancer diagnosed at an advanced stage, receive no or less extensive cancer treatment, and have poorer survival after a cancer diagnosis. These cancer disparities do not necessarily signify inappropriately later diagnosis or lower treatment of people with dementia as a group, and they are arguably less feasible and appropriate targets for care optimization. The reviewed research indicates that PLWD also have an increased risk of cancer-related emergency presentations, lower quality processes of cancer-related decision making, accessibility-related barriers to cancer investigations and treatment, higher experienced treatment burden and higher caregiver burden for families, and undertreated cancer-related pain. The authors propose that optimal cancer care for PLWD should focus on proactively minimizing these risk areas and thus must be highly person-centered, with holistic decision making, individualized reasonable adjustments to practice, and strong inclusion and support of family carers. Comprehensive recommendations are made for clinical practice and future research to help clinicians and providers deliver best and equitable cancer care for PLWD and their families.

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Primary Questions Addressed

1. What specific strategies can be implemented to improve cancer treatment accessibility for patients with dementia?
2. How do the decision-making processes differ for cancer treatment in patients with dementia compared to those without?
3. What role do family caregivers play in the cancer care of individuals with dementia, and how can their burden be alleviated?
4. What are the implications of late-stage cancer diagnoses in patients with dementia on overall treatment outcomes and survival rates?
5. How can healthcare providers better support the unique needs of patients with dementia throughout the cancer care continuum?

Key Findings

1. Research Background and Objectives

As global populations age, the intersection of cancer care and dementia becomes increasingly significant, given that older cancer patients often present with multiple comorbidities, including dementia. This report aims to provide a thorough overview of the prevalence of dementia among cancer patients and to synthesize existing literature on the challenges and disparities faced by people living with dementia (PLWD) in cancer treatment. The ultimate goal is to identify areas for improvement in cancer care for this vulnerable population, ensuring equitable and effective treatment outcomes.

2. Main Methods and Findings

The authors conducted a comprehensive literature review focusing on the intersection of cancer and dementia, analyzing existing studies on cancer care experiences among PLWD. Key findings indicate that PLWD often face several disadvantages in the cancer care continuum, including:

• Diagnosis and Treatment: PLWD are more likely to have their cancer diagnosed at advanced stages and, consequently, receive less aggressive treatment options.
• Survival Rates: There is a notable correlation between dementia and poorer survival outcomes post-cancer diagnosis.
• Healthcare Disparities: PLWD are at an increased risk for cancer-related emergencies, face substantial barriers to accessing cancer diagnostics and treatments, and often experience untreated cancer-related pain.
• Decision Making: The processes surrounding cancer treatment decisions are of lower quality for PLWD, exacerbating their treatment burden and caregiver strain.

These findings underscore that the disparities observed are not purely due to systemic failures in diagnosis or treatment but are deeply rooted in the complexities of managing dual diagnoses of cancer and dementia.

3. Core Conclusions

The report concludes that optimal cancer care for PLWD necessitates a shift toward a more person-centered approach. This involves:

• Individualized Care: Tailoring cancer management strategies to accommodate the unique needs and preferences of PLWD.
• Holistic Decision-Making: Incorporating the perspectives of patients and their families in treatment decisions to enhance care quality.
• Support for Caregivers: Recognizing and addressing the higher burden on caregivers is crucial for improving the overall care experience for PLWD.

4. Research Significance and Impact

This research is significant as it highlights the urgent need for improvements in cancer care paradigms for PLWD, emphasizing the integration of dementia care principles into oncology practices. The recommendations provided serve as a foundation for clinicians and healthcare providers to enhance the quality and equity of cancer care for this demographic. Future research should focus on developing and testing innovative care models that adequately address the complexities faced by PLWD, ultimately aiming to improve treatment outcomes and quality of life for both patients and their families. The findings advocate for a systemic change in how cancer care is approached for individuals with dementia, marking a critical step toward reducing health disparities in this growing patient population.

Literatures Citing This Work

1. An incidental finding of lung nodule in patient presenting with posterior chest wall trauma: A case report. - Yopi Simargi;Resley O Mulia;Apriliani P Dewi;Sugiarto K Lay;Anita F Puspasari; Ronny;Fenny Susilo - Radiology case reports (2023)
2. Key Considerations for the Treatment of Advanced Breast Cancer in Older Adults: An Expert Consensus of the Canadian Treatment Landscape. - Emily B Jackson;Lauren Curry;Caroline Mariano;Tina Hsu;Sarah Cook;Rossanna C Pezo;Marie-France Savard;Danielle N Desautels;Dominique Leblanc;Karen A Gelmon - Current oncology (Toronto, Ont.) (2023)
3. Clinical image: Cervicofacial rotation skin flap in PLWD patients. - C Politis;V Lenaerts;L Evrard;F Shall;D Gorlé - Clinical case reports (2024)
4. Exploring the Support Needs of Chinese Family Carers of People Living with Dementia in New Zealand during the COVID-19 Pandemic: A Resilience Resources Framework Perspective. - Fei Li;John Parsons;Gary Cheung - International journal of environmental research and public health (2024)
5. Identification of older adults with Alzheimer's and related dementias among patients newly diagnosed with cancer: A comparison of methodological approaches. - Tamra Keeney;Angela Miller;Joni Gilissen;Lorinda A Coombs;Christine S Ritchie;Ellen P McCarthy - Journal of geriatric oncology (2024)
6. Exploring the perceptions of New Zealand Chinese dementia carers on the adapted world health organization iSupport manual: A qualitative study. - Fei Li;John Parsons;Lily Dongxia Xiao;Gary Cheung - Dementia (London, England) (2025)
7. Understanding Cancer Care for Nursing Home Residents Living With Dementia: An Ethnographic Study. - Olivia Claire Robinson;Claire Surr;Laura Ashley - Psycho-oncology (2025)
8. Emergency colon cancer diagnosis in people with mental health conditions: a population-based cohort study in northern Italy. - Flavia Pennisi;Carlotta Buzzoni;Federico Gervasi;Antonio Giampiero Russo;Cristina Renzi - BMJ mental health (2025)

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