An Occupational Therapist’s View
When Two Diagnoses Collide
Imagine being diagnosed with cancer at 83. You live alone, and you’ve been getting a little more forgetful lately — names, appointments, even what day it is. Then you’re told you’ll need to attend weekly treatments, manage complex medications, and keep track of how you’re feeling. It’s a lot. But older people do not have to manage it alone.
I’m an Advanced Practitioner Occupational Therapist working in the Cancer Older People’s Service (COPS) at the Beatson West of Scotland Cancer Centre. I work with older adults diagnosed with cancer, many of whom are also receiving active treatment. A large group of these individuals also live with, or are showing early signs of, dementia or cognitive impairment. Our role is to support them not just to survive treatment, but to live well while doing so.
Our most recent audit of our service showed that a large percentage of patients were referred from their wider medical team because of concerns about memory or how individuals were going to manage treatment alongside other diagnoses, such as dementia.
Occupational Therapy: The Hidden Treasure in Dementia-Inclusive Cancer Care
Many people don’t fully understand what occupational therapists do, especially in cancer services. We’re HCPC-registered professionals who focus on function. That means helping people do the everyday things that matter to them, from washing and dressing to managing meals, medications, hobbies, and social connections.
In cancer and dementia care, we work to answer this question:
How can we help this person live as independently, safely, and meaningfully as possible — at home, in hospital, and throughout their care journey?
In COPS, that means we assess:
- Daily functioning, mobility, fatigue, and mood
- Memory, attention, and executive functioning
- Home environments and equipment needs
- Coping strategies for managing change and uncertainty
- Family and caregiver dynamics
We also coach people in reablement and self-management skills by using meaningful routines to support identity and autonomy. Recently, our occupational therapy interventions have included standardised cognitive assessments, specialised telecare, and collaborative memory strategies. In fact, 60% of the patients we assessed showed moderate to severe cognitive impairment. This insight supported further cognitive screening and helped inform treatment decisions.
When Cancer and Cognitive Impairment Intersect
Cancer treatment is often complex, unfamiliar, and exhausting, even more so for people with cognitive impairment or dementia. We have noticed that many older people referred to our team are experiencing things like undiagnosed memory or executive function difficulties, increased confusion due to hospitalisation or treatment side effects, and added stress on family members who are trying to cope with these changes. We often recognise these challenges when individuals begin struggling with appointments, medications, or self-care. That’s why every patient referred to our team receives a Comprehensive Geriatric Assessment (CGA). This multidisciplinary tool allows us to identify risks, understand the person’s baseline function, and tailor support to prevent crises. Occupational therapists are central to this process. We notice the functional and cognitive changes that aren’t always visible at first glance.
Real-Life Support for Real-Life Challenges
Here are just a few examples of how we’ve supported people with dementia or cognitive concerns:
- Medication support: Helping someone create a daily routine using visual reminders and carer prompts, preventing missed doses or duplication.
- Safe discharge: Recommending home adaptations and equipment to reduce fall risks for a person with poor memory returning home post-treatment.
- Emotional support: Helping someone manage anxiety through fatigue pacing and relaxation techniques, reducing distress in busy clinic environments.
- Family coaching: Supporting relatives to understand changes in their loved one’s behaviour and how to communicate clearly and compassionately.
This kind of support doesn’t just help the person, it often prevents avoidable hospital admissions, reduces treatment disruptions, and gives families more confidence in what lies ahead.
The Value of Seeing the Whole Person
A cancer diagnosis doesn’t erase the person underneath. Neither does dementia. When we see these labels, we can support people to remain active in decision-making and retain control over their care.
In our team, we see every person as an expert in their own life. Our job is to ask the right questions, notice the small changes, and make adjustments that let someone continue to live with dignity, comfort, and purpose, whether that means returning to their garden, making a family meal, or just getting to their next appointment.
Let’s Keep the Conversation Going
Occupational therapy is often a “hidden treasure” in dementia care and it’s time we brought it into the light. In cancer services, we have a powerful role to play in shaping care that’s realistic, person-centred, and dementia-inclusive.
If you’re in the cancer care world and living with dementia, supporting someone who is, or working in health or social care, I’d love to hear from you.
Tell us what you think:
Have you or someone you know experienced cancer and dementia together?
What kinds of support made a difference?
What else should we be talking about?
Let’s keep learning, sharing, and working together to create care that sees the whole person, not just the diagnosis.
Please feel free to reach out to our team at ggc.cops@nhs.scot or call us on 0141 301 7137 / 9926. We’re always happy to chat, listen, and learn.
Contributor. Carly Rolston, Advanced Practitioner Occupational Therapist, Cancer Older People’s Service, Beatson West of Scotland Cancer Centre