Members of former President Joe Biden's inner circle are concerned that the 83-year-old Democrat is showing the strain of cancer treatment while still appearing publicly.
Biden is slated to travel to South Carolina on Friday to try and save the Palmetto State's first-in-the-nation Democratic primary, something the ex-President lobbied for after a win there in 2020 propelled him to the Democratic nomination.
But the Washington Post reported Monday, citing two former Biden officials and an elected Democrat, that the former President at times has appeared more fatigued in private interactions in recent weeks.
They attribute that to Biden's diagnosis of Stage 4 prostate cancer, which has metastasized to the bone - something medical experts consider 'incurable.'
Biden's office announced in May that he was diagnosed with cancer - and in October, the Democrat finished a course of radiation at Penn Medicine Radiation Oncology in Philadelphia that was part of the treatment.
At the time, daughter Ashley posted that her father had gotten to ring the ceremonial bell, a small celebration in the larger fight against the disease.
During the initial announcement, his office said the cancer was given a Gleason score of 9 - on a scale of 6 to 10 - which means it's among the most aggressive and could spread to other parts of his body - commonly the spine.
'If the spine has been degraded by the tumor metastasis, it's entirely possible to break your back simply by getting out of bed the wrong way,' one expert told the Post.
Last week, daughter Ashley Biden posted a picture of former President Joe Biden (center) and First Lady Jill Biden (left) at a Biden Presidential Library Board dinner held at Longwood Gardens outside of Philadelphia
Former President Joe Biden is captured departing the funeral of Tatiana Schlossberg, a member of the Kennedy family, in January after she died of cancer at age 35. Friends told the Washington Post they fear Biden's own cancer diagnosis is taking a toll on him
That expert, Gerald Denis, a Shipley Prostate Cancer Research professor at Boston University Chobanian & Avedisian School of Medicine, said he wasn't treating the former President but said he was 'very sad for him and his family.'
'This is a very painful and difficult stage of the terminal illness,' Denis offered.
Friends interviewed by the Post said the ex-President hasn't given them an update on his health.
Another source told the Post that Biden remains 'encouraged and positive about his prognosis given his positive 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.
Ashley Biden (left) posted a picture in October of (from second left) former President Joe Biden, former First Lady Jill Biden, granddaughter Finnegan and grandson Hunter, as the former President wrapped up his radiation treatment for cancer in Philadelphia
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.
Former President Joe Biden (left) and First Lady Jill Biden (right), with cat Willow, in a photo they shared after Biden's office announced that he was battling Stage 4 prostate cancer in May 2025
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.
