Cancer care management is a complex and multifaceted process, especially when patients also have Alzheimer's disease and related dementia (ADRD) or intellectual disabilities (IDs).1 The patients present unique challenges that necessitate a more nuanced and specialized approach to care. Globally, people with IDs and related disabilities experience health inequalities, including lower rates of access to primary health care than the general population, unmet health needs, and their views and experiences frequently overlooked in research, policy, and practice.2,3 Patients with these conditions often have difficulty understanding their diagnosis and treatment options. This can lead to delays in treatment, poorer outcomes, and increased distress for both the patient and their caregivers.4 Furthermore, these patients may have other comorbidities that complicate cancer treatment, making care management a delicate balancing act. Accurately assessing and effectively managing these issues necessitates a collaborative approach involving oncology nurses, advanced practice nurses, and a well-informed healthcare team.
Oncology nurses play a pivotal role in recognizing and addressing cancer pain in patients with ID and ADRD. Advanced assessment techniques, tailored to a patient's cognitive abilities, are crucial. Traditional pain scales may not be reliable for this population. Behavioral changes, facial expressions, and physiological cues become crucial indicators. Expertise in nonpharmacological pain management techniques such as massage, music therapy, and relaxation exercises becomes invaluable. Similarly, delirium, a state of acute confusion often triggered by illness or medications, can be a significant hurdle in cancer treatment for patients with ADRD. The diagnostic assessment of delirium requires assessing cancer diagnosis, comorbidities, and goals of care before the initiation of nonpharmacological approaches that are considered effective in managing delirium among patients.5 Nurses adept at delirium assessment and management can implement environmental modifications, maintain consistent routines, and minimize medication changes to create a calming environment and optimize treatment tolerance.
The behavioral symptoms associated with ID and ADRD can further complicate cancer care. Patients with ID may exhibit aggression, self-injury, or withdrawal in response to unfamiliar procedures or discomfort. For patients with ADRD, disorientation and agitation can pose challenges. A comprehensive behavioral assessment by nurses, incorporating communication adaptations and understanding potential triggers, is essential. This involves assessing the patient's overall health status, the severity of symptoms, their personal goals and preferences, and the potential benefits and risks of different treatments. Effective symptom management can significantly improve the patient's quality of life and their ability to tolerate treatment. Prioritization of care is another crucial aspect of managing these complex patients. Given the multitude of issues, it's essential to identify which issues need immediate attention and which can be addressed later. Effective communication strategies with caregivers and families become paramount in tailoring interventions and ensuring continuity of care.6
Nursing Education must prioritize caring for patients with ID and ADRD. Curriculums should integrate communication strategies, understanding of cognitive limitations, and adaptation of pain and delirium assessment tools. Special training of oncology nurses should be developed as a subspecialty focusing on providing person-centered care that meets the special needs of people with disabilities and toward enhancing nurses’ confidence and improving the quality of care delivery.7
Patients with ID or ADRD, along with their families and caregivers, may struggle to understand the complexities of cancer diagnosis and treatment options. Oncology nurses and advanced practice nurses can play a crucial role in shared decision-making. Utilizing clear, concise language, using visual aids, and involving familiar caregivers in discussions can empower patients with ID and ADRD, or their appropriate surrogates to participate as much as possible in treatment choices. Fostering trust and open communication with families, and addressing anxieties and ethical concerns is essential to ensuring informed consent and promoting patient care.
Investing in ongoing nursing education is paramount in optimizing cancer care for this complex patient population. Educational programs and workshops should equip nurses with the knowledge and skills to effectively assess pain, delirium, and behavioral symptoms. Healthcare organizations should arrange appropriate in-service education to increase the healthcare workers’ knowledge and skills in caring for these patients.8 Furthermore, training in communication strategies, cultural sensitivity, and ethical considerations specific to these populations is crucial. Research efforts should focus on developing and validating reliable assessment tools, exploring the efficacy of nonpharmacological pain management techniques, and investigating the impact of tailored interventions on treatment outcomes. By prioritizing these areas, we can ensure that patients with ID and ADRD receive equitable, compassionate, and evidence-based cancer care.
Ethics statement
Not required.
Funding
This study received no external funding.
Declaration of competing interest
The authors declare no conflict of interest. The corresponding author, Dr. Chinomso Ugochukwu Nwozichi, serves as a member of the editorial board of the Asia-Pacific Journal of Oncology Nursing. The article has undergone the journal's standard publication procedures.
Declaration of generative AI and AI-assisted technologies in the writing process
No artificial intelligence tools or services were utilized to prepare this work.
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