While cancer treatment in the older person can sometimes be complicated and challenging, treatment can be just as helpful for older adults as for their younger counterparts. The goals of cancer treatment include:

• Curing disease
  
  
• Prolonging survival
  
  
• Reducing symptoms related to cancer
  
  
• Preserving function and 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 decisions, made between the health-care team and the person with cancer and their family, should be based on the following:

• The type of cancer and extent that is 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 and tolerance of risk
  
  
• The presence of pre-existing or co-existing medical conditions that may put the older adult with cancer at an increased risk for treatment-related side effects or complications
  
  
• How "aggressive" or "intensive" treatment may potentially affect 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 the value of 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 a lack of caregiver support and feelings of social 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
  
  
• 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.

Surgery and the older adult

In some cases, surgery may be an option to remove the cancer completely, or remove as much of the tumor as possible, and/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 due to a decrease in the functioning of various organs and body systems due to age. Possible effects of surgery include the following:

Heart function. Older people experience an increased incidence of heart disease and arrhythmia (irregular heartbeat) as they age. In addition, the heart's ability to tolerate excessive changes in pressure is reduced as people age.

Kidney function. Clearing certain drugs from the kidney can be more difficult for older adults due to loss of kidney function over time and a decreased ability to filter certain substances. During surgery, patients may be exposed to many drugs and receive large volumes of fluids, which can cause problems for an older adult if the kidney is 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 for surgery.

Lung function. Along with other organs, the lungs also lose volume as people age. Chronic conditions, such as emphysema or chronic obstructive pulmonary disease (COPD), occur more often in older adults and can complicate recovery from anesthesia. Decreased lung function and capacity can make it more difficult to get rid of secretions after surgery, which increases the risk of developing postoperative pneumonia.

It is important to discuss the risks and benefits of cancer surgery with your doctor. There may be additional tests that need to be completed before surgery, including blood tests, electrocardiograms (ECG or EKG), lung function tests, and x-rays. In addition, patients are encouraged to discuss post-surgery care with their health-care team before deciding on surgery as a treatment option.

Discharge from the hospital following surgery

Older adults with cancer may have additional needs after completing surgery and being discharged from the hospital. Discharge planning should be started before surgery to help ensure the person'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 the following supportive services:

• Home health aide services
  
  
• Visiting nurse
  
  
• Physical therapy
  
  
• Social work
  
  
• Support groups
  
  
• Community resource referrals

It is important to discuss these issues in detail before undergoing treatment to increase the likelihood of a successful recovery from surgery.

Chemotherapy and the older adult

Chemotherapy 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 become a long-term event with multiple courses of therapy given over time. This schedule can lead to longer periods of debilitation and may affect the older adult with cancer in different ways than younger people. For example, older adults are at greater risk for experiencing unwanted physical and psychosocial (emotional and social) side effects from chemotherapy, which influences their quality of life.

Side effects of chemotherapy on the older adult

Unlike radiation therapy and surgery, chemotherapy affects the entire body, which increases the risk of side effects. While the types of side effects experienced by older and younger patients are similar, they occur more often in older adults. These side effects are the sole reason for approximately 10% of all hospital admissions in the older patient population. Side effects may be more severe and debilitating in the older person with cancer and commonly include the following:

• Bone marrow suppression (changes to the white blood cell count, red blood cell count, and platelet count)
  
  
• Gastrointestinal (stomach and intestinal) problems, such as nausea, vomiting, diarrhea, and dehydration
  
  
• Cardiac (heart) toxicity, such as abnormalities in heart function
  
  
• Neurotoxicity (nervous system), such as fatigue (extreme tiredness), worsening dementia (decline in mental abilities, such as thinking or judgment), and memory loss

Screening for any problems before starting treatment and adjusting the dose of type of drug during treatment often minimizes these side effects.

Chemotherapy in the older adult and possible drug interactions

The older adult is more likely to be taking multiple medications for other conditions, which increases the likelihood of interaction between chemotherapy and other drugs. A comprehensive list of current medications will give the doctor a better idea of any potential problems that could arise during treatment.

Radiation therapy and the older adult

Radiation therapy can be given separately or after surgery and chemotherapy. It is done mainly as an outpatient procedure (the person is not hospitalized) but can require frequent (sometimes daily) visits to the radiation oncology department, sometimes for a period of several weeks. First, the person undergoes a simulation, where the area to receive the radiation therapy is identified. Then, the person receives a treatment, similar to undergoing an x-ray, which takes several minutes to complete.

There is little evidence that radiation therapy influences the ability of the older adult with cancer to withstand treatment. However, other issues need to be considered, including the cost of treatment, being away from home, the inconveniences of daily treatments over a period of several weeks, and maintaining nutrition during treatment. These issues may be more common in the older person with cancer. It is important to determine what barriers are present and if a less intense, shorter course of therapy may be better.

Radiation therapy is generally well tolerated in the older person. The side effects of radiation therapy depend on the type, dose, and location of the radiation therapy. For example, radiation therapy for prostate cancer can cause different side effects than radiation therapy for esophageal cancer. More information on radiation therapy for specific cancers can be found in the Cancer Type section on Cancer.Net.

Quality of life

Concerns about the impact of treatment on quality-of-life issues can also influence an older adult's decision about treatment. Some of these concerns include worries about:

• Physical comfort
  
  
• Relationships
  
  
• Nutrition
  
  
• 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 an honest discussion between the doctor and older adult with cancer include the person's own evaluation of quality of life.