the Health Challenges of a 90-Year-Old Cancer Patient

Grandma is 90 years old and was diagnosed with stomach cancer four and a half years ago?

About two weeks ago (the last weekend before the Lunar New Year), my grandmother caught a cold around the New Year, which led to throat inflammation and swelling, making it difficult for her to eat.
She would keep food in her mouth for a long time.
After a period of time, possibly due to swallowing difficulties, she experienced nutritional deficiency and lethargy, prompting a visit to the emergency department at National Taiwan University Hospital on January 14.
The hospital conducted a series of tests, including blood tests, X-rays, CT scans, and MRIs, all of which returned normal results.
However, my grandmother's mental state did not improve, and she remained in a constant state of drowsiness.

As a result, the hospital considered several possibilities: one was a minor stroke, but my grandmother's responses and reactions were still normal; another was the spread of cancer cells; and the third was a bacterial infection, as her forehead temperature was slightly elevated.
Given these symptoms, the hospital called our home on January 15 at 6 AM to inform the family that, due to my grandmother's lack of improvement, they recommended a lumbar puncture to further investigate whether there was an infection or cancer cell spread in her brain.

On January 16, around noon, the report indicated that everything was normal, and she could return home, but she needed to continue using a nasogastric tube for feeding to address her eating difficulties.
On January 23, around 11 PM, my grandmother removed the nasogastric tube herself, and we took her to Chungli Lianxing Hospital to have it reinserted.
Starting January 23, she began experiencing shortness of breath while lying down, but not when sitting up.
She also continued to exhibit drowsiness.
After researching online, I became concerned about the possibility of heart failure.

On the morning of January 26, my grandmother reported chest discomfort to the caregivers.
Therefore, I am asking the doctor whether my grandmother's condition could be due to cancer and aging, along with prolonged bed rest, leading to heart failure.
If further examination is needed, which department should we consult? The elders in our family believe that my grandmother is simply experiencing phlegm, which is causing her breathing difficulties.
However, despite our efforts to help her cough and pat her back, she has not coughed, and her energy levels fluctuate; sometimes she is even able to walk to the living room to watch television.

Mr. Huang, 20~29 year old female. Ask Date: 2023/01/26

Dr. Hu Ziren reply Oncology

If there is a suspicion of heart problems, one can consult a cardiologist; if there is a suspicion that organ function decline (such as swallowing or coughing up phlegm) is caused by aging (dementia), one can see a neurologist.

Reply Date: 2023/01/26

More Info

Understanding the health challenges of a 90-year-old cancer patient requires a comprehensive approach that considers both the physical and psychological aspects of their condition. In the case of your grandmother, her recent health issues, including difficulty swallowing, persistent fatigue, and potential respiratory problems, are concerning and warrant careful evaluation.

Firstly, it’s important to recognize that elderly patients, especially those with a history of cancer, often face multiple health challenges simultaneously. The symptoms you described—difficulty swallowing, lethargy, and respiratory distress—could be indicative of several underlying issues. These may include complications related to her cancer, such as metastasis or treatment side effects, as well as age-related physiological changes that can affect her overall health.

The initial assessments conducted at the hospital, including blood tests, X-rays, CT scans, and MRIs, are crucial in ruling out acute conditions such as infections or strokes. The fact that these tests returned normal results is reassuring, but it does not eliminate the need for ongoing monitoring and evaluation. The suggestion of a lumbar puncture (spinal tap) was a prudent step to investigate potential central nervous system involvement, which can occur in advanced cancer cases.

Given your grandmother's symptoms of persistent sleepiness and respiratory issues, it’s essential to consider the possibility of heart failure, especially in the context of her age and cancer history. Heart failure can manifest as shortness of breath, fatigue, and fluid retention, and it can be exacerbated by prolonged bed rest and decreased mobility. The concern about her heart health is valid, and it would be wise to consult a cardiologist for a thorough evaluation, including an echocardiogram to assess heart function.

In addition to potential cardiac issues, her swallowing difficulties could lead to nutritional deficiencies, which can further exacerbate her overall health status. The use of a nasogastric tube for feeding is a temporary solution, but it’s important to address the underlying cause of her dysphagia (difficulty swallowing). A speech therapist or a swallowing specialist can provide valuable insights and interventions to improve her swallowing ability and nutritional intake.

Moreover, the psychological aspect of her condition should not be overlooked. Cancer patients often experience anxiety and depression, particularly when facing significant health challenges. Engaging a mental health professional who specializes in geriatric care can help address any emotional distress she may be experiencing.

As for your question regarding the appropriate medical specialty for further evaluation, I recommend starting with a geriatrician, who specializes in the care of elderly patients and can coordinate the management of multiple health issues. Depending on the findings, referrals to specialists such as a cardiologist, oncologist, or pulmonologist may be necessary.

In summary, the health challenges faced by your grandmother are multifaceted and require a collaborative approach involving various healthcare professionals. Continuous monitoring, appropriate referrals, and supportive care are essential to improve her quality of life and address her health concerns effectively. It’s crucial to maintain open communication with her healthcare team and advocate for her needs as her condition evolves.

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