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jenncren Asked December 12, 2023

What options are there for cancer patient with psychiatric illness/psychosis and what should we ask the doctors?

My aunt (70) has been diagnosed with multiple myeloma and was treated with radiation and ongoing chemo for the last 3+ months. My uncle (75) has been her caretaker, and he also takes care of my 40 year old cousin with Downs Syndrome. My mother (her sister) flies up to their home in TN from FL to help every few weeks and stays for a week or two. During the last few months, my aunt has become extremely difficult. She wants my uncle at her constant beck and call, will yell throughout the house if he is gone for more than 30 seconds. Attempts at having in home care have not gone well, she gets physical and combative, is anxiety ridden and hateful to all. She calls my mother just to yell at her. She doesn't care who is around. She had a meltdown at the physical therapist office and had to be taken home. My uncle is about to break. He cannot continue to care for her physically or emotionally. We are told she doesn't qualify for hospice. My mother and I suspect that my uncle has been downplaying her struggles with the doctors, but when he did ask them about possible rehabs or assisted living options, at least temporarily, they said she didn't need it because her cancer is improving. We don't know if her behavior is caused by her treatment or if it is a separate issue affected by her diagnosis (we have a history of psychiatric issues in our family, and she has always had anxiety issues.) My mother is hoping to have a meeting with her doctors in the next few days, and I am wondering what questions we should be asking the doctors and what options there may be for assisted living facilities that will treat someone with cancer and psychiatric issues? She does have some funds available if self-pay is needed.

Evamar Dec 13, 2023
Uncle’s well being should be priority here. Caregivers abuse exists. So far only one article was written about it, it is ignored or regarded as something normal.
It is so often overlooked by drs and others but caregivers stress, exhaustion are real.
If aunt can pay find any facility that would take her to give him a break.

againx100 Dec 12, 2023
Sounds like she, and the people around her, could benefit from her taking some anti-anxiety meds. Your uncle needs to have her placed somewhere. Her current behavior seems like too much for AL to deal with and perhaps a SNF would be a better fit at this time. They would evaluate her anyways to make sure if AL is doable.

Best of luck.

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lealonnie1 Dec 12, 2023
Your aunt is likely suffering from chemo brain. Chemo brain is a common term used by cancer survivors to describe thinking and memory problems that can occur during and after cancer treatment. Chemo brain can also be called chemo fog, cancer-related cognitive impairment or cognitive dysfunction. This mimics dementia which your aunt is clearly exhibiting. Emotional and mental health challenges such as depression, anxiety, stress, and having trouble sleeping can add to that foggy feeling. Chemo brain can also intensify feelings of frustration or anger. 

How long does chemo brain usually last?
Does chemo brain ever go away? For most patients, chemo brain improves within 9-12 months after completing chemotherapy, but many people still have symptoms at the six-month mark. A smaller fraction of people (approximately 10-20%) may have long-term effects.

Here is a useful link to the American Cancer Society's site discussing in detail managing side effects from chemotherapy, mainly mood changes and thinking difficulties:

https://www.cancer.org/cancer/managing-cancer/side-effects/changes-in-mood-or-thinking/confusion.html

Assisted Living facilities do not "treat" residents for anything. They just provide care for elders who are fairly independent, honestly, or who require help with activities of daily living *ADLs*

Speak to her doctor about chemo side effects, chemo brain, and whether antidepressants (or other meds) may help your aunt get through these difficult treatments.

Best of luck to you.
Midkid58 Dec 13, 2023
I hadn't even thought of chemo brain! Boy, was I glad when I realized that I no longer was suffering from it.

I'm sure, like anything else, the older you are, the harder it is to throw of the side effects of something like chemo.
Midkid58 Dec 12, 2023
Your aunt probably would qaulify for Hospice. If not, at least Palliative Care and she sounds like she needs to be in a facility.

Sit down with mom and make a list of questions for the doc & write them down beforehand.

You aren't responsible for your aunt, be careful, you could get sucked into a long term caregiving situation! So could your mom.

I personally think that auntie would get better care for both her physical and psychological problems in one setting with many caregivers. Then uncle can be a supportive hubby, but not be killling himsef out of kindness.

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