Academic journal article The Qualitative Report

Living with Cancer Aged 75 and Older: A Biographical Narrative Case-Study

Academic journal article The Qualitative Report

Living with Cancer Aged 75 and Older: A Biographical Narrative Case-Study

Article excerpt

Context

On the morning of Thursday March 24, 2011, I sat in the spring sunshine outside the library of the University of Glasgow, Scotland, preparing for oral examination of my doctoral dissertation. I was already well-prepared but to keep my focus I decided to listen again to my research interview with 76-year old Henry Jameson (not his real name), who had told me in the fall of 2008 about his experience of colorectal cancer. As I listened to Henry one more time I realised that there was a coherence, a wholeness in the way he told his story that I had not been able to capture in the cross-case analysis which I had used in my dissertation. I decided that I wanted at some point to write more fully about this one story, this one person, this one life.

In my dissertation, I used two levels of narrative analysis--one investigating the narrative arc of the cancer journey across interviews with 20 men and women and the second investigating the whole life contexts of the cancer stories told by the participants. In this article I concentrate on the first level of analysis, the narrative arc of the cancer journey, and I want to show in more detail than is possible in a cross-case analysis some of the nuance and subtlety of an individual journey through the experience of cancer in old age. I want to maximise the sound of the participant voice, the co-creator of the data whose voice is usually subsumed under the researcher/analyst voice. This story is particular, it is unique--it has been suggested to me by one cancer care practitioner that Henry's positive attitude and apparently successful self-management are not typical experiences among older people with cancer. Nevertheless, I think and hope that health care providers, and narrative analysts, will find this uniquely individual story interesting and illuminating.

Background

Despite increasing longevity and generally improving health in Western populations, the process of aging is associated with greater incidence of disease and illness, in particular of degenerative conditions such as musculoskeletal disorders, ischaemic heart disease, neurological impairments, and cancers. Comorbidity is common in individuals aged 70 and older (Extermann, 2000; Stevenson, Abernethy, Miller, & Currow, 2004) and the incidence of cancer is higher in older populations (Cancer Research UK, 2014). There is extensive literature reporting the incidence and prevalence of cancers in older age groups along with approaches to treatment and the effects and management of comorbidity (Bennahum, Forman, Vellas, & Albarede, 1997; Extermann, Overcash, Lyman, Parr, & Balducci, 1998; Satariano & Silliman, 2003). There is also a large body of literature on patients' experiences of illness. However, the subjective perceptions of older individuals undergoing the experience of cancer remain largely unknown.

The case-study reported in this article is derived from my doctoral studies, which investigated the experiences of older people of living with cancer (Hughes, 2011). My specific focus of interest was the experience of people aged 75 and older since this appears to be a hidden population whose experiences are largely undocumented. For example, individuals aged 75 and older are rarely represented in cancer research or policy documents. A rigorously conducted literature search (Hughes, Closs, & Clark, 2009) discovered that from an international sample of 262 papers only two studies focused exclusively on the experience of people aged 75 and older. In the United Kingdom, Department of Health cancer publications since 2000 focus predominantly on the under 75s (Department of Health, 2000, 2005). Moreover there has been continuing concern that older people's specific needs, both physical and psychosocial, are not sufficiently considered, independently of their chronological age, when prescribing treatment and care for cancer (Bailey et al., 2003; Kagan, 2008; National Cancer Intelligence Network, 2013; Porock et al. …

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