Former President Joe Biden has sharply reduced his public schedule while undergoing treatment for Stage 4 prostate cancer that has spread to his bones, according to a Washington Post report published Sunday. Eighteen months after leaving the White House, the 83-year-old now spends most of his time with relatives, longtime friends and former aides.

People close to Biden said the treatment appears to be working, but the illness and accompanying procedures have left him visibly frail and frequently exhausted. Biden said earlier this month that his treatment was going “really well,” while his office declined to answer detailed questions about his daily routine, medical care or prognosis.

Unlike several recent former presidents who established large foundations or maintained active public schedules, Biden has kept a limited profile. His foundation expects to raise roughly $11 million by the end of 2027, far below the amounts typically associated with major presidential libraries. His days are reportedly organized around treatment, family and efforts to shape his legacy.

Biden is scheduled to release a memoir, Promise Me, America, on November 17, two weeks after the midterm elections. Some Democratic advisers fear the book tour could revive questions about his age and fitness that dominated the end of his 2024 campaign. Democratic strategist Sawyer Hackett said candidates were still working to overcome “the political damage he left behind.”

The controversy may intensify after Biden dropped his effort to block the release of recordings and transcripts from interviews used in Special Counsel Robert Hur’s classified-documents investigation. Hur previously described Biden as “a well-meaning, elderly man with a poor memory,” a phrase that became central to Republican attacks and Democratic concerns over his decision to seek a second term.