Oncologist-approved cancer information from the American Society of Clinical Oncology
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Care Management

This section has been reviewed and approved by the Cancer.Net Editorial Board, 8/2012

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Key Messages

  • Older adults living with cancer may need additional support organizing and accessing health care.
  • Being prepared and organized can help older adults make informed decisions about treatment and better communicate their wishes to friends, family members, and their health care team.
  • Medicare is available for people 65 and older, but you may need other insurance to cover related costs of cancer care.

Facing a diagnosis of cancer at any age is difficult, and the amount of information that comes with it can feel overwhelming. To manage your care, as well as the challenges older patients often face, it helps to learn about your disease, explore all of your treatment options, and communicate your opinions and concerns to your family members and health care team. By effectively managing your care, you can make informed decisions that are right for you. Some tips include:

Seeking help. Absorbing the news of cancer and all of its unfamiliar language is often difficult. It may be helpful to enlist a family member or friend to help you understand and organize the information you get from the doctor. For example, this person could go with you to doctors’ appointments to take notes or think of additional questions.

Communicating with your health care team. Having an open and trusting relationship with your doctors, nurses, and other health care providers is important. Being able to talk with the health care team and ask questions may make you feel more in control. Additionally, being an informed, involved patient and voicing your opinions and concerns is helpful to you and your health care team members in forming a care partnership. If you have concerns about practical issues, such as transportation or finances, speak up. Oftentimes your health care team can refer you to these services.

Being prepared. It is helpful to bring a list of questions to your appointments so you get all the information you need. If you do not have a friend or family member with you, consider bringing a tape recorder to capture the conversation. Repeat information back to the doctor to make sure you clearly understand it.

Getting organized. Good organization allows you to make the best decisions you can about cancer treatment and recovery and gives you a sense of control. Many people find it helpful to put together a medical binder that is divided into different sections so information can easily be found.

A medical binder could include:

  • A monthly chart or calendar to record appointments, keep notes about phone calls, or track symptoms and side effects
  • Copies of important tests and records
  • A current list of all your medications so each doctor will know exactly what you are taking
  • Phone numbers and addresses of each doctor, doctor’s office, and any other health care providers
  • Your insurance information, including Medicare and any supplemental insurance policies

Read more tips about organizing your cancer care.

Considering transportation. Transportation back and forth from doctors’ appointments and treatment sessions may require the assistance of another person. If friends or family members are not available to help, talk with your doctor, nurse, or social worker about arranging other means of transportation.

Creating or updating legal medical documents. While no one at any age wants to discuss death or dying, it is important to be prepared. Advance directives are legal documents, such as a living will or durable power of attorney for health care, that explain the kind of medical treatment you want and do not want if you become unable to make decisions for yourself. It is important to have these documents so there is no confusion about your wishes if you are unable to communicate them. Find out more about advance directives.

Planning for follow-up care. After you finish treatment, your doctor will continue to see you to help ensure you stay as healthy as possible. This is especially important because older adult cancer survivors have an increased risk of getting cancer again.

Financial concerns

Older adults, especially those on a fixed income, commonly have limited financial resources. Depending on a person’s age and insurance coverage, treatment for cancer and other related costs, including transportation, over-the-counter medications, and extra support (such as nursing or housekeeping services) can be expensive. It is important to familiarize yourself with your insurance policy and what out-of-pocket expenses it covers. Usually a social worker or a person in your doctor’s office can help answer your questions.

Medicare

Since its start in 1965, Medicare has been the primary insurance resource for people age 65 and older. Medicare has different “parts” that serve different, sometimes complementary, purposes.

  • Medicare Part A covers inpatient care (such as hospital care), skilled nursing care, hospice care, and a limited scope of home care services.
  • Medicare Part B provides financial coverage for doctor services, outpatient care, physical and occupational therapy, and certain medically necessary supplies.
  • Medicare Part C, also called Medicare Advantage plans, provides access to insurance plans managed by private Medicare-approved companies. It combines Medicare Parts A and B and may include prescription drug coverage.
  • Medicare Part D is a benefit people can enroll in that covers prescription drugs.

Medicare may not cover all of your health care costs. Over the past several years, many changes to Medicare laws have been made that determine the coverage of treatments that take place outside of the hospital. Depending on a patient’s Medicare plan, he or she may be responsible for a 20% co-payment (a fixed fee for medical service) if no other insurance is available. For some types of cancer care, this 20% co-payment can be very costly.

Some people have supplemental insurance to cover co-payments. Supplemental insurance also helps cover expenses not covered by Medicare, such as deductibles (the amount of money you are responsible for before insurance begins paying), co-insurance (the amount of a health care bill you are responsible for paying), co-payments, and other out-of-pocket expenses.

In addition, the passage of the Patient Protection and Affordable Care Act in 2010 included changes that may affect older adults with cancer. You can find the most current information at www.HealthCare.gov.

For more information about Medicare’s coverage of costs, visit www.medicare.gov or call 800-633-4227.

Other insurance

Medicaid, a federally funded, state-run health insurance program, is available to people over age 65 who have limited financial resources and low incomes, including those who live in nursing homes. Other types of insurance, such as disability insurance and long-term care insurance coverage, may cover a person’s needs not met by health insurance.

If you do not have any supplemental insurance or prescription drug coverage, financial counseling or help from a social worker may be necessary. Discuss this with your doctor or nurse. Local service organizations may have grants available to cover costs associated with treatment. Find out more about managing the cost of cancer care.

Questions to ask the doctor after a cancer diagnosis

If you are meeting with a doctor for the first time after a cancer diagnosis, consider asking the following questions:

  • What is the exact type and name of the cancer I have?
  • How was it diagnosed?
  • What tests were taken, and what did they show?
  • Will I need more tests?
  • What stage is the cancer, and what does that mean?
  • What are my treatment options?
  • What clinical trials are open to me?
  • What treatment plan do you recommend and why?
  • Who will be coordinating my overall treatment and follow-up care?
  • Who will be part of my health care team, and what does each member do?
  • What are the possible side effects of this treatment option, both in the short term and in the long term?
  • If I am worried about managing the costs related to my cancer care, who can help me with these concerns?
  • What are the next steps?
  • What support services are available to me and my family?

More Information

Managing Your Care

Resources for Older Adults

Cancer in Older Adults

© 2005-2014 American Society of Clinical Oncology (ASCO). All rights reserved worldwide.

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