- Older adults, their families, and their health care team need to make cancer treatment decisions based on factors other than age alone.
- Cancer treatment options may include surgery, radiation therapy, and/or chemotherapy. Each of these may cause side effects and other risks for older adults with cancer.
- Before beginning cancer treatment, an older adult and his or her family should plan for the person's needs and services after treatment is over.
Although cancer treatment for older adults can sometimes be complicated and challenging, treatment can be just as helpful for them as for younger patients. The goals of cancer treatment for older adults may include:
- Getting rid of the cancer
- Helping a person live longer
- Reducing any signs and symptoms related to cancer
- Maintaining physical and emotional abilities and a person’s quality of life
Older adults and cancer treatment decisions
Decisions about cancer treatment in the older person should be made in the same way that decisions about cancer treatment are made for younger adults and should not focus on the person’s age alone. Treatment discussions and decisions, made between the health care team and the older adult with cancer and their family, should be based on:
- The type of cancer and extent it has spread (if applicable)
- Available treatment options
- The risks and benefits of each treatment option
- The person’s assessment of his or her goals of treatment (such as curing the cancer, managing symptoms, or both) and tolerance of risk, including side effects
- The presence of medical conditions other than cancer that may put the older adult with cancer at an increased risk for treatment-related side effects or complications
- The effect of intensive treatment on the physical, emotional, and social well-being of the older adult
- The person’s concept of quality of life. Older people living with cancer often make treatment choices based on what they value most in their lives and their level of physical, emotional, and social well-being. These perceptions and decisions may differ from those of family members, friends, and caregivers.
- Emotional and social limitations, including the level of caregiver support and feelings of social connection or isolation for people with cancer who are living alone
- Financial limitations, as older adults are more likely to have limited resources and live on a fixed income, which may cause them to refuse procedures or treatment due to cost. There are ways to help relieve financial concerns.
- Spiritual beliefs, as many older adults have already come to terms with death and dying due to chronic illnesses, the loss of a spouse, or advanced age
Cancer treatment options for older adults
Cancer treatment may consist of a single therapy or a combination of therapies. The most common cancer treatment options are surgery, chemotherapy, and radiation therapy. Palliative care, also called supportive care, is treatment to relieve a person’s symptoms, improve a person’s quality of life, and provide support to patients and their families. Palliative care is an important part of cancer treatment for an older adult with cancer and may be given along with the standard treatment. Learn more about palliative care and other types of cancer treatment.
In some cases, surgery to completely remove the cancer may be an option. Or, surgery may be used to remove as much of the cancer as possible or make chemotherapy or radiation therapy more effective. Like other treatment options, surgery in older adults involves risks. In some cases, this risk is increased because the functioning of various organs and body systems decreases due to age. Before surgery, consider:
Heart function. Surgery may make existing heart problems worse. Because older people may experience heart disease and arrhythmia (irregular heartbeat) as they age, and the heart’s ability to tolerate excessive changes in pressure is reduced as people age, it is important to consider heart function before having surgery.
Kidney function. Some types of drugs are more difficult for the kidneys to process. During surgery, patients may be exposed to many drugs and receive large volumes of fluids, which can cause problems for older adults whose kidneys are not functioning well.
Liver function. The amount of blood flow to the liver decreases with age, which can place the older adult at increased risk for drug reactions, especially with some drugs that are used in surgery.
Lung function. Along with other organs, the lungs lose volume as people age. Chronic (long-term) conditions, such as emphysema (a lung disease that causes difficulty breathing) or chronic obstructive pulmonary disease (COPD, loss of lung function), occur more often in older adults and can complicate recovery from anesthesia (medication given before and during surgery). Decreased lung function and capacity can increase the risk of developing pneumonia after surgery.
It is important to discuss the risks and benefits of cancer surgery with your doctor and whether other treatments could be used instead of surgery. Some patients may need additional tests before surgery, including blood tests, electrocardiograms (ECG or EKG), lung function tests, and x-rays, and patients and families should factor these tests and their preparation in to the decision of whether to have surgery.
In addition, older adults are encouraged to discuss post-surgery care with their health care team before deciding on surgery as a treatment option. A geriatrician (a doctor who specializes in the care of people 65 and older) can assess patients who have other significant medical problems before surgery and help talk through the risks and benefits of surgery. Learn more about cancer surgery, what to expect when undergoing surgery, and side effects.
Discharge from the hospital following surgery
Older adults with cancer may have additional needs after completing surgery and being sent home, or discharged, from the hospital. Discharge plans should be made before surgery to ensure the patient’s safety and physical and emotional functioning at home. Discharge planning includes identifying the needs of the older adult after cancer surgery to determine whether the person will require any of the following support services:
- A home health aide
- A visiting nurse
- Physical therapy
- Social work
- Support groups
- Community resource referrals
It is important to discuss these issues in detail before undergoing surgery to increase the likelihood of a successful recovery.
Chemotherapy is the use of drugs to kill cancer cells. It may be used alone or in combination with other treatments, such as surgery and radiation therapy, depending on the tumor type and extent of disease. Unlike surgery, treatment with chemotherapy can be a long-term process with multiple courses of therapy given over time. This schedule can lead to longer periods of weakness and may affect the older adult with cancer in different ways than younger people. For example, older adults are at greater risk for experiencing physical side effects from chemotherapy, which influences their quality of life. Learn more about chemotherapy, what to expect during treatment, and side effects.
Side effects of chemotherapy
Unlike radiation therapy and surgery, chemotherapy affects the entire body, which increases the risk of side effects. Not all drugs have the same side effects. Although the types of side effects experienced by older and younger patients are similar, they occur more often in older adults. Harmful reactions from chemotherapy are the only reason for about 10% of all hospital admissions for older people with cancer.
Side effects may include:
- Lowered white blood cell, red blood cell, and platelet counts, which can increase the risk for infection, anemia (a decrease in red blood cells), bleeding, and bruising
- Stomach and intestinal problems, such as nausea, vomiting, diarrhea, and dehydration
- Damage to the nervous system that may further weaken a person’s mental capacity (such as thinking or judgment abilities), increase memory loss, and cause fatigue and nerve damage
Screening for any health problems before starting treatment and adjusting the dose or type of drug during treatment often minimizes these side effects.
Chemotherapy and drug interactions
An older adult is more likely to be taking multiple medications for health conditions other than cancer, which increases the likelihood of an interaction between chemotherapy and other drugs. With the help of a friend or family member, create a complete list of the medications you are taking and discuss it with your doctor. Or, take all of your medications to your doctor, including the ones that do not require a prescription.
Radiation therapy can be given separately or before or after surgery and chemotherapy. Most people are not hospitalized for this treatment, but it can require frequent, sometimes daily, visits to the radiation oncology department for several weeks. Radiation therapy can be external, meaning it is given by a machine outside of the body. Or, it can be internal, meaning that small “seeds” containing radioactivity are implanted near the tumor. Find out more about radiation therapy, what to expect during treatment, and potential side effects.
Older adults need to discuss with the doctor the cost of treatment, whether they need to be away from home, the treatment schedule, and how to maintain nutrition during treatment. In some cases, a shorter, less intense course of therapy may be better.
Older adults usually handle radiation therapy well. The side effects of radiation therapy depend on the type and dose of radiation and location of the cancer being treated. For instance, radiation therapy for prostate cancer can cause different side effects than radiation therapy for head and neck cancer. Learn more about radiation therapy for specific cancer types.
Advanced cancer care
Advanced cancer, also called end-stage or terminal cancer, is cancer that cannot be cured. However, incurable does not mean untreatable. Older adults with advanced cancer continue to have options for treatment and can maintain a good quality of life.
Care options include:
- Standard treatment. The current or most effective treatment available for a cancer
- Clinical trials. Research studies that test new drugs and treatments to find out whether they are safe, effective, and possibly better than standard treatments
- Palliative/supportive care. Care that focuses on helping people with all stages of cancer, including advanced cancer, live as comfortably as possible for weeks, months, or years
- Hospice/home care. Care that focuses on helping patients who are no longer receiving disease-directed treatment and their families cope with the physical and emotional effects of death and dying
Understanding the types of care available can help you and your doctor develop a personalized treatment plan that takes into account your individual needs, goals, and preferences. Learn more about advanced cancer care planning.
Quality of life
Concerns about the effect of treatment on quality-of-life issues may influence an older adult’s decision about treatment. Some of these concerns include:
- Physical comfort
- Ability to continue self-care
- Financial security
- Meaningful life
- Preservation of function and independence
- Personal ideas regarding a dignified or peaceful death
It is important that you have an honest discussion with your doctor about your definition of a good quality of life. Find information on managing common side effects of cancer treatment.
Talking with your doctor about treatment
You may need more information about your health and treatment options before you can make an informed decision. Consider asking your doctor the following questions:
- What is my chance of recovery?
- What are all of my treatment options?
- What is the goal of each treatment?
- What treatment do you recommend? Why?
- How does this treatment help me?
- What are some risks and potential side effects of this treatment?
- Will I need to be in the hospital for treatment, or will I be treated as an outpatient?
- How long will each treatment last?
- How will this treatment affect my daily life? Will I be able to perform my usual activities?
- If I am worried about managing the costs related to my cancer care, who can help me with these concerns?
- How can I keep myself as healthy as possible during treatment?
- Whom do I call with questions or problems?
- What support services are available to me? To my family?
Find additional questions to ask your doctor.