While facing a diagnosis of cancer at any age is difficult, older people may face different challenges related to physical health, support systems, financial status, and access to health care. These issues can make living with cancer more stressful and complicated for older people. The strategies discussed below may help address the additional problems that arise after a cancer diagnosis.

Managing your care

Because cancer treatment can be complex and the amount of information may feel overwhelming, it may be helpful to enlist a family member or friend to help you understand and organize the information from the doctor. For example, this person could accompany you to doctors' appointments to take notes or think of additional questions. Learn more Helpful Hints for Doctor Visits. Other tips for managing your care include the following:

Develop a good relationship with your doctor and other health-care providers. Most people with cancer say that having an open and trusting relationship with their doctors, nurses, and other health-care providers is important. This includes being able to talk to the health-care team and ask questions. If you are meeting with the doctor for the first time, you may feel anxious about how well you will be able to voice your questions and concerns. Several suggestions in Questions to Ask Your Doctor may help. Good communication with your doctor not only helps you, but also helps the doctor take better care of you.

Organizing your cancer care. Good organization allows you to make the best decisions you can about cancer treatment and recovery and gives you a sense of control. Keep it simple and don't be afraid to ask friends or family members for help. Although you may want to rely on your memory, remember that it is easy to feel distracted, and writing notes and keeping accurate records can help reduce stress and anxiety.

Many people find it helpful to develop a medical diary or journal. This can also be a useful tool after treatment. Some people find that a small binder divided into different sections provides easy access to the information they need. Some components of the medical journal could include:

• A monthly chart or calendar to record appointments, keep notes about phone calls, or track symptoms and side effects
  
  
• Copies of important tests and records
  
  
• A current list of all your medications so that each doctor will know exactly what you are taking
  
  
• Phone numbers and addresses of your doctor, doctor's office, and other health-care providers

Read more tips about Organizing Your Cancer Care.

Organizing transportation. Transportation back and forth from doctors' appointments and treatment sessions may require the assistance of another person. If friends or family members are not available to help, talk to your doctor, nurse, or social worker about arranging alternate means of transportation.

Updating legal medical documents. While no one at any age wants to face the possibility of life-threatening events or terminal illness, it is better to be prepared. Living wills and health-care proxies are among the legal documents that designate the person who will make medical decisions for you and outlines your wishes regarding medical care in case you are unable to make these decisions. Learn more about Understanding Advance Directives.

Financial concerns

Older adults, especially those on a fixed income, commonly have limited financial resources. Depending on a person's age and insurance coverage, treatment for cancer and other related costs (transportation; over-the-counter medications; and extra support, such as nursing or housekeeping services) can be expensive. In addition, knowing what your insurance policies cover and what, if any, out-of-pocket expenses are your responsibility, is important. To learn more, read about managing the cost of cancer care.

Medicare

Since its start in 1965, Medicare has been the primary insurance resource for people age 65 and older. Medicare has different “parts” that serve different, sometimes complementary, purposes.

• Medicare Part A covers inpatient care (such as hospital care), skilled nursing care, hospice care, and a limited scope of home care services.
  
  
• Medicare Part B provides financial coverage for doctor services, outpatient care, physical and occupational therapy and selected medically necessary supplies.
  
  
• Medicare Part C, also called Medicare Advantage plans, are insurance plans managed by private Medicare-approved companies. It combines Medicare Parts A and B and may include prescription drug coverage.
  
  
• Medicare Part D is a new benefit that people can enroll in that covers prescription drugs. The Medicare Modernization Act of 2003 (MMA) provided this prescription drug benefit. A common barrier in obtaining active cancer care is the lack of drug benefit for cancer-associated treatment.

Medicare only pays part of these costs, and the patient is often required to pay a co-pay, although the co-pay varies in different parts of Medicare. Over the past several years there have been many revisions to the Medicare laws about what outpatient treatments are covered. Depending on a patient’s Medicare plan, they may be responsible for a 20% co-payment (a fixed fee for medical service) if no other insurance is available. For some types of cancer care, this 20% co-payment can be costly and can be another possible barrier to obtaining treatment.

Because of the financial gap in Medicare coverage, some eligible persons have supplemental insurance to cover this co-payment. Supplemental insurance helps cover expenses not covered by Medicare. Supplemental policies generally cover deductibles (the amount of money you are responsible for before insurance begins paying), co-insurance (the proportion of a health-care bill you are responsible for paying), co-payments, and other out-of-pocket expenses.

For more information about Medicare’s coverage of costs, please visit www.medicare.gov.

Other insurance

Medicaid, a federally funded, state-run, health insurance program, is available to people over age 65 who have limited financial resources and low incomes, including those who live in a nursing home. More information can be found at www.cms.hhs.gov/medicaid.

Unfortunately, many older adults do not have any other supplemental insurance and may not have prescription drug coverage. Financial counseling or social work intervention may be necessary and should be discussed with your doctor or nurse. Local service organizations may have grants available to cover the costs of transportation or treatment. A more complete guide to finding financial help can be found in the section on managing the cost of cancer care.

Caregiver support

Cancer doesn't just happen to one person. It affects the person's family and friends, especially those who take the primary responsibility for caring for them. Family caregivers increasingly provide more care to ill, disabled, or older family members and friends. In fact, family members and friends are often responsible for administering medications, monitoring symptoms, advocating for appropriate medical care, and participating in end-of-life issues. Often, these caregivers are an important link between the person with cancer and the health-care team.

Caring for a family member or friend with cancer requires tremendous dedication and commitment. In return, the reward for the caregiver can be tremendous as well, knowing that they have been able to help and support a family member or friend when it matters most. In some circumstances, an older person with cancer may already have a debilitating illness that has required the support and care of their family and friends. Sharing caregiving responsibilities with family can provide the necessary mutual support to effectively cope with the stresses of caring for an older person with cancer.

The older spouse as the primary caregiver

In many cases, the spouse of the person with cancer does most of the caregiving. Spouses in this situation may also require emotional support. People with cancer and their spouses may need assistance with the following:

• Driving the spouse with cancer back and forth for appointments, tests, and treatments
  
  
• Preparing meals or buying groceries
  
  
• Housekeeping
  
  
• Caring for pets

In addition, if the primary caregiver also has health issues and is not able to effectively care for the person with cancer, help from other family members, neighbors, or social workers is probably needed. Talk to the doctor or nurse about finding solutions to these problems. Read more about Relationships and Cancer.

Coping with caregiving responsibilities

Because caring for a family member or friend with cancer takes a tremendous amount of commitment, caregivers report that this responsibility significantly affects their lives. For example, caregivers may experience emotional distress, financial hardship, an inability to maintain their normal routine, and an inability to socialize. Often, caregivers experience feelings of depression and social isolation, especially if the person they are caring for becomes progressively sicker. Many caregivers often neglect their own health-care needs. Learn more about How Caregivers Can Take Care of Themselves.

Family members or friends of older adults with cancer may want to check in with the caregiver as well as the person with cancer to offer some relief. In addition, there may be other options and resources for family caregivers that can help relieve the stress and demands of caregiving. Please see Exploring New Caregiver Options.

Finally, support networks are available to both the person with cancer and the caregiver. These are available over the phone, on the Internet, and in person. The Internet can provide virtual places for people with cancer and caregivers to seek advice, talk about their experiences, and acknowledge that they are not alone in what they are going through. For more information, please see Online Resources for Caregivers.