Living with cancer in old age : a qualitative systematic review and a narrative inquiry

‘Living with Cancer in Old Age’ is an exploration of older people’s experiences of living with cancer, using qualitative research methods. A qualitative systematic review of international literature found that the experience of living with cancer in old age is characterised by ambiguity. There are sources of suffering, imposed by cancer itself, by treatments for cancer and by co-morbid disease. At the same time older people have access to sources of comfort and strength, both internal (attitudes of mental fortitude) and external (strong relationships with family, friends, communities and health professionals) which mitigate the worst effects of suffering. This literature study synthesised and interpreted findings from 11 studies covering a heterogeneous population of people aged 55-90+, representing a wide range of cancers at different stages of progress and treatment, across four countries (Israel, Canada, Sweden, USA) and using a range of qualitative methods. A subsequent empirical study using narrative methods focused on a more homogenous population of older people aged 74-87, all resident in the same geographical region (NW England), with one of the four most common cancers (breast, colon, prostate and lung) at different stages of progress and treatment, but treated at the same cancer centre. In this study a biographical/narrative method of interviewing was used, in which 20 participants (13 men and 7 women) were invited to tell the ‘story’ of their life both before and after cancer. Interpretation of life history data reported by participants in this study suggests that the overriding features of life with cancer for people in their 70s and 80s are hope and hardiness, together forming a kind of resilience which appears to be psychologically protective and which fosters a determination to continue living positively, even at an advanced stage of illness. Whereas this ‘fourth age’ has been presented by sociologists as a life stage of inevitable decline, findings from the two studies conducted in this doctoral study indicate a quality of continuing robustness in the lives of some older people which runs counter to common assumptions about their vulnerability and frailty