Concern is growing among those close to former President Joe Biden as he faces health challenges while maintaining a public schedule. At 83, Biden is dealing with the effects of cancer treatment, which insiders say are taking a toll. He is set to visit South Carolina on Friday in an effort to preserve the state’s status as the first in the nation to hold a Democratic primary. This comes after his victory there in 2020 significantly boosted his path to the Democratic nomination. According to a report by The Washington Post, citing two former Biden officials and an elected Democrat, the former President has recently appeared more fatigued during private interactions.

Biden’s health concerns stem from his diagnosis of Stage 4 prostate cancer, which has spread to his bones, a condition deemed ‘incurable’ by medical experts. His office announced the diagnosis in May, and by October, Biden had completed a radiation treatment course at Penn Medicine Radiation Oncology in Philadelphia. This milestone was celebrated by his daughter Ashley, who shared that her father had rung the ceremonial bell, marking progress in his battle against the disease. Initially, the cancer was given a Gleason score of 9 out of 10, indicating it is highly aggressive and likely to spread, with the spine being a common area for metastasis.

Gerald Denis, a professor of prostate cancer research at Boston University, highlighted the severity of Biden’s condition in comments to The Post. Although not involved in Biden’s treatment, Denis expressed sympathy for the former President and his family, noting the difficulty and pain associated with this stage of the illness. Friends of Biden have told The Post they have not received recent updates on his health, but sources close to him suggest he remains optimistic about his prognosis, encouraged by his response to treatment.

Aides of Biden told the paper that the 83-year-old is doing well – he’s working on his memoir and building out his foundation and presidential library. Last week, Ashley Biden shared photographs of her father attending a fundraising dinner for the Biden Presidential Library Board at Longwood Gardens, a botanical garden located outside of Philadelphia. The former President was also captured riding Amtrak between Washington, D.C., and Wilmington, Delaware, last week. Throughout his political career, Biden was dubbed ‘Amtrak Joe’ for riding the train between those two locales serving as a U.S. senator while raising sons, Beau and Hunter, after his first wife and baby daughter were killed in a Christmastime car crash in 1972.

Due to his age – and regardless of his cancer diagnosis – the former President doesn’t have much time to cement his legacy. He left office handing the keys back to President Donald Trump – with many Democrats angry that he didn’t drop out of the 2024 presidential race sooner to give Democratic nominee, Vice President Kamala Harris, a fighting chance. The announcement of his cancer diagnosis stoked speculation that there was a broader cover-up about his health, as whole books – namely Jake Tapper and Alex Thompson’s Original Sin – had chronicled his physical and mental decline while in office. Other presidents from recent decades who left office with bad poll numbers had time to turn public perception around.

Another one-term president, Democrat Jimmy Carter, who died at age 100 in 2024, had what’s considered one of the most successful post-presidencies. Republican President George W. Bush, who left office under immense criticism due to the Iraq War, is known presently for his work with War on Terror veterans, his paintings and his chummy relationship with First Lady Michelle Obama. Barbara Perry, a presidential scholar at the University of Virginia’s Miller Center, told the Post: ‘We don’t know how long President Biden will have to correct for the way things ended, which by all accounts was not positive for him.’ ‘The other element of this in political and historical terms, is what’s happening to him now raises questions about what was happening to him in the White House with his health,’ she added. Biden is picking small battles – but even some of those might not be winnable.

While Biden might want to see South Carolina keep its first-in-the-nation primary in 2028, 12 states are vying for the honor, which previously was bestowed on New Hampshire, directly after the Iowa caucuses. And with everything the ex-President touches, there’s controversy – with Axios reporting Sunday that many on Biden’s team now acknowledge that South Carolina was chosen in 2024 to discourage other Democrats from challenging Biden. Biden had won the 2020 primary in the first-in-the-south primary easily, aided by the important endorsement from Representative Jim Clyburn. Now, some Democrats are resisting South Carolina’s bid to keep the first primary due to that lasting bitterness. A spokesperson for Biden did not return the Daily Mail’s request for comment.