Health Assessment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2012

Key Messages

  • A health assessment is a process that checks a person's physical, mental, and emotional well-being before and during cancer treatment.
  • An accurate assessment helps ensure the treatment plan is as safe and successful as possible.
  • A health assessment also gives older adults an opportunity to share their opinions on treatment options with their health care team.

Before cancer treatment begins, a health assessment can help you and your doctor make the decisions that are best for you. A health assessment evaluates your physical, mental, and emotional well-being, as well as your ability to make treatment decisions. The assessment helps your doctor predict how well you can tolerate cancer treatment and what supportive care you may need during treatment. The assessment also gives you the opportunity to express your opinion on treatment options and enables the doctor to individualize your treatment as much as possible.

Having a health assessment before cancer treatment begins makes it easier to notice any health changes that occur during treatment. Health assessments conducted during treatment can help ensure your treatment plan is as safe and successful as possible. Because it is important that the assessments be as accurate as possible, some older adults choose to have their family members or caregivers with them to provide additional information.

Information collected during of a health assessment includes:

Co-existing medical conditions. Health problems older adults have in addition to cancer (co-existing conditions), such as heart disease, arthritis, and diabetes, may affect treatment decisions. Co-existing medical conditions often increase the risk of complications after surgery, chemotherapy, and radiation treatment. Also, you may need to consider additional factors such as life expectancy and drug interactions. Conditions that are potentially reversible, such as depression, can be treated before or during cancer treatment.

Physical examination. A thorough physical examination and laboratory tests are usually done to check your general health.

Functional status. It is important to know how well an older adult can function independently. In other words, how well can you perform activities of daily living, such as eating, dressing, going to the toilet, and bathing, as well as manage slightly more complex skills, such as shopping, using the telephone, and managing medications? As people age, these activities can become harder to do and may cause cancer treatment to be interrupted or stopped. For example, can you seek medical attention in an emergency? Will you remember to take medications at the right time at the right dose? It is important to recognize any functional issues before treatment begins to make sure it is safe for you. In addition, the doctor may evaluate areas such as balance, walking speed, and strength.

Medications. A review of all of your medications and supplements you are already taking will help identify any potential interactions with cancer treatments.

The ability to think, reason, and recall facts. To make treatment choices, people with cancer need to be able to make informed decisions. Because older adults often have varying cognitive (mental) abilities, doctors may do certain tests for some older adults, depending on individual circumstances. For example, some older adults have dementia, meaning they have a decline in the ability to recall events, concentrate, or be aware of specific times, places, and people. Dementia does not necessarily mean a person cannot make informed decisions, but the doctor will do a careful assessment to evaluate what the patient can understand.

Vision. Many older adults have some type of vision loss. It is important to check for vision problems before treatment because chemotherapy can cause fatigue and dizziness, which increase the chance of falling. In addition, if you are unable to read a prescription or the doctor’s instructions, the health care team needs to take special care to find another way to provide this information to you.

Hearing. To make informed treatment choices you need to be able to hear and understand what is being said, but many older adults have trouble hearing. Also, because some types of chemotherapy contribute to hearing loss, the doctor needs to know if you have hearing loss before treatment.

Difficulty walking and balancing. Difficulty walking increases an older adult’s risk of falling and other related injuries, and the side effects of chemotherapy can increase this risk.

Nutrition. Looking at what and how much you eat is important. Involuntary weight loss is common in older adults, and cancer treatment may make this worse. A registered dietitian (RD) or nutritionist can help provide suggestions for balanced meals.

Emotional status. Depression and anxiety can be common for older adults, and all people have different reactions when hearing that they have cancer. Depression and anxiety can cause weight loss and fatigue and lower a person’s quality of life. In addition, mental health issues may interfere with the ability to make treatment choices.

Continence (controlling bowel or bladder function). Many older adults with cancer have continence problems from the use of diuretics (pills that promote urination), bladder conditions unrelated to cancer, or a brain or spinal cord disease, including metastatic cancer (cancer that has spread). It is important to talk with the doctor about continence problems, as these conditions are managed differently during treatment depending on your individual circumstances.

Social support. Regardless of age, all people with cancer need social and emotional support. It is important to know what kind of support an older adult with cancer will have during treatment, and who will be caring for him or her. A social worker can help older adults who live alone or those who do not have family members or friends nearby.

Treatment preferences. How you feel about treatment matters. For example, some older patients may prefer not to have intensive treatment if it could reduce their independence or cause hospitalization. A health assessment is a good time to share your treatment preferences and any personal values that pertain to treatment with your doctor.

More Information

Resources for Older Adults

Chronic Conditions: When Cancer is Not Your Only Health Concern

Cancer in Older Adults