Multiple Health Concerns in Older Adults

Approved by the Cancer.Net Editorial Board, 09/2016

People age 65 and older are more likely to have one or more chronic (long-lasting) health problems in addition to cancer. Some of these include:

  • High blood pressure

  • Heart disease

  • Lung disease

  • Diabetes

  • Kidney disease

  • Arthritis

Doctors call these other health problems co-existing conditions when you also have cancer. Another name is chronic conditions.

When you are coping with cancer, it can be easy to ignore your other health conditions. For example, taking care of your high blood pressure or diabetes can seem much less important than getting cancer treatment. But the success of your cancer treatment partly depends on your general health, including how you take care of other health conditions.

You can have a health problem like diabetes or depression at any age. But if you are an older adult, you may be at higher risk for side effects and longer recovery times because of these chronic health problems. So taking care of your other health conditions is especially important as an older adult.

Cancer treatment risks if you have another health problem

It is important to understand how a chronic health problem can affect cancer treatment. The risks include:

  • Reactions between your cancer drugs and other medications

  • Cancer or cancer treatment making your chronic health problem worse

  • Your chronic health problem interrupting cancer treatment – Or having to change cancer treatment because of your health problem

  • Slower recovery from cancer treatment because of your health problem

Your cancer care team will work with you and your other health care providers to lower these risks.

Preventing reactions with other drugs

If you take medication for any chronic health problem, your doctor might ask you to stop some of these medications during cancer treatment. This is because some drugs can react with cancer treatments or side effect medications. Or it might not be safe to take some of your regular medications, because of cancer treatment side effects. If you are not sure which medications you should take, talk with your doctor or pharmacist. Make sure your doctor and pharmacist know about your regular medications, plus any cancer medications.

Managing your other health problems during cancer treatment

Heart disease. Your doctor will test your heart function and blood pressure regularly during cancer treatment. Some cancer drugs can make heart problems worse, increase the risk of congestive heart failure, or increase blood pressure. Congestive heart failure occurs when the heart muscle grows weaker. When this happens, your heart has a harder time pumping blood around the body. Congestive heart failure, high blood pressure, and arrhythmia (irregular heartbeat) are more common in older adults.

Radiation therapy near your heart can cause heart problems, as can having chemotherapy and radiation therapy together. A cardiologist (heart doctor) may prescribe medications to help protect your heart.

If you have a heart condition, it is important to work with your oncologist and cardiologist to protect your heart as well as treating your cancer.

Lung disease. Some chemotherapy drugs can affect how well your lungs work. If you have a chronic lung condition like emphysema or chronic obstructive pulmonary disease (COPD), make sure your doctor knows this before you start cancer treatment. Older adults are more likely to have lung problems than younger people.

Smoking. Smoking raises your risk of lung problems after surgery. It can also make recovery take longer. You probably know smoking is bad for your general health. It causes shorter life and a worse quality of life. But, stopping tobacco use has immediate health benefits. Learn about stopping tobacco use after a cancer diagnosis.

Diabetes. If you have diabetes, you need to monitor your blood glucose (blood sugar) levels closely during cancer treatment. Some chemotherapy and medications used to lower side effects (such as steroids) can raise your blood sugar levels. These levels might also go up because you are less physically active or under stress. Side effects like nausea and vomiting also affect your blood sugar.

Your doctor might also recommend:

  • Taking low-sugar food supplements

  • Taking different anti-nausea medications

  • Using fast-acting insulin at times during cancer treatment

  • Keeping a record of your blood sugar levels. You and your doctor can look at them during clinic visits. Controlling your blood sugar will help make sure you can stay on your cancer treatment schedule.

Kidney disease. Your kidneys might not work as well as you get older. So adults over 65 might have more problems with some types of chemotherapy. The drugs can be difficult for your kidneys to handle. This can raise your risk of kidney problems. How well your kidneys work might determine the type of chemotherapy you can have, or how often you have it.  

If you are on dialysis, talk with your oncologist. Dialysis cleans your blood when your kidneys do not work well enough to do it. But dialysis may also clean the chemotherapy drugs out of your body before they can work.

Pain and problems moving around. You can have these problems at any age. But they are more common in older adults than younger people. For example, arthritis is a common cause of pain and movement problems. Older adults are more likely to have arthritis than younger people. These problems can affect your ability to do your daily activities or get to doctors’ appointments. Pain and movement problems can also raise the risk of side effects.

Depression and anxiety. Depression and anxiety often happen when you learn you have cancer. They can make it difficult to:

  • Make decisions about treatment

  • Take medication on time or have important tests

  • Ask for support from your family and others

Depression and anxiety can occur in patients of any age. If you are older, you are more likely to have a spouse or partner, other family members, or friends die. You might move or have friends or family move away. These life changes can make you anxious or depressed. But depression and anxiety are not a normal part of getting older or a normal part of having cancer. They are a health condition that can be treated.

Medication for depression, anxiety, or other mental health conditions can be helpful. But during cancer treatment, your doctor might ask you to change your medication. You might even need to stop taking it during treatment. This is because the medication could react with cancer drugs or side effect medications. Before stopping any medications for depression or anxiety, first ask your doctor or psychiatrist. Many people find cancer support groups helpful as well.

Problems with your mouth and teeth. Tell your dentist and dental hygienist about all your cancer treatments. This is especially important if you have any problems with your mouth or teeth. Also, make sure your oncologist knows about the mouth or tooth problems. Some chemotherapy can raise your risk of infection or bleeding. It can also cause sores in your mouth or throat. Chemotherapy can also raise your risk of other mouth problems. For example, drugs called bisphosphonates that help strengthen bones can raise your risk of a rare jaw disease.

Radiation treatment to the head and neck can also cause mouth sores and tooth decay.

Some drugs and injections used to keep your bones strong during treatment can also cause damage to your jaw bone. Be sure to let your dentist know if you are receiving this type of treatment.

If possible, try to have dental work done before you start cancer treatment. Or schedule it for after treatment. Depending on how healthy your mouth and teeth are, you might need to see an oncologic dentist before cancer treatment. This is a dentist experienced in treating people with cancer. Learn more about dental and oral health.

Stomach and nutrition problems. When you have cancer and treatment, you might not feel like eating. Also, your body might have problems getting enough nutrition from your food. So you might lose weight without trying, or when you do not need to. Chemotherapy can make these problems worse, especially if it causes nausea, vomiting, or diarrhea.

Some older adults might not be able to eat easily. This can be from missing teeth, new dentures, or certain medications. If you have problems eating, tell your doctor or another health care team member.

Your doctor or a registered dietitian (RD) can help you make sure you are eating enough. They can help you get the nutrition you need during treatment.

Anemia. Anemia is more common in older adults than younger people. It can get worse during chemotherapy. Having anemia might not change your cancer treatment plan. But it can slow down treatment if you need longer to recover between treatments than most people. You might also need blood transfusions (donated blood) or medication for anemia.

Memory loss and mental confusion. Older adults are more likely to have these problems before treatment starts. Problems can include memory loss (difficulty remembering things), confusion, or changes in thinking. If you have any concerns, your doctor can test your memory by asking you to answer a few short questions. Certain cancer drugs can cause memory and thinking problems at any age. Some patients call these problems “chemo brain.” If you are experiencing these symptoms, let your doctor know.

Alcohol overuse. Alcohol and other drugs can change your ability to make treatment decisions. Using too much can also make it difficult to do daily activities such as taking medication and having important screenings or tests. Using alcohol or other drugs can also make recovery take longer. Talk with your doctor about alcohol and other drugs during cancer treatment.

Talking with your doctor

When you talk about cancer treatment with your doctor, bring your personal medical record. This helps your doctor lower your risk of reactions and other problems from treatment. Your medical record should include information about:

  • Any chronic health problems

  • Your medications – Including how much you take, how often, and any side effects it causes

  • Drug allergies – Including what happened when you took a medication you are allergic to

  • Earlier surgeries or medical procedures

  • Medical tests and results

  • Names of your other doctors, with contact information

More Information

Organizing Your Cancer Care

The Importance of Taking Your Medication Correctly

Cancer in Older Adults