Key Messages:

• 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.

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 may include:

• Eliminating 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 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 (such as curing the cancer, managing symptoms, or both) and tolerance of risk, including side effects
  
  
• 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
  
  
• The effect of “aggressive" or "intensive" treatment on the functional, 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 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. Read about other types of cancer treatment.

Surgery

In some cases, surgery to completely remove the cancer may be an option. Or, surgery may be used to 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 because the functioning of various organs and body systems decreases due to age. Possible effects of surgery include the following:

Heart function. Older people may experience 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. 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 an older adult if the 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 also lose volume as people age. Chronic 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. 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. A geriatrician (a doctor who specializes in the care of people 65 and older) can assess patients who are frail and have other significant medical problems before surgery.

Discharge from the hospital following surgery

Older adults with cancer may have additional needs after completing surgery and being discharged from the hospital. Start planning your discharge before surgery to ensure your 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 support services:

• Home health aide services
  
  
• A 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

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 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 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 can affect 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. Side effects of chemotherapy are the sole reason for approximately 10% of all hospital admissions for older people with cancer. Side effects may include the following:

• Lowered white blood cell, red blood cell, and platelet counts, which can increase the risk for infection, anemia, and bleeding and bruising
  
  
• Stomach and intestinal problems, such as nausea, vomiting, diarrhea, and dehydration
  
  
• Damage to the nervous system that may worsen dementia (decline in mental abilities, such as thinking or judgment), increase memory loss, and cause fatigue and nerve damage

Screening for any problems before starting treatment and adjusting the dose of 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 co-existing conditions, which increases the likelihood of interaction between chemotherapy and other drugs. Create a complete list of the medications you are talking and discuss it with your doctor. Learn more about taking medications correctly.

Radiation treatment

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 and what to expect during treatment, and potential side effects.

There is little evidence that age is related to the side effects of radiation therapy. However, other issues need to be considered, including the cost of treatment, being away from home, the inconveniences of daily treatments over many 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 whether 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 the location of the body being treated. For example, radiation therapy for prostate cancer can cause different side effects than radiation therapy for esophageal cancer. Learn more about radiation therapy for specific cancer types.

Quality of life

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

• 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.

More Information

Clinical Trials in Older Adults

Managing Side Effects

Cancer in Older Adults