How Chemotherapy Affects People Age 65 and Older

Approved by the Cancer.Net Editorial Board, 07/2022

Many people with cancer are treated with chemotherapy. Chemotherapy is the use of medication to destroy cancer cells. It can be used in addition to other treatments, like surgery, radiation, targeted therapy, and immunotherapy, or it can be given as the only treatment.

Adults over age 65 with cancer can have a stronger reaction to chemotherapy treatments. This means that they may have worse side effects or take longer to recover after chemotherapy treatment ends.

It is important to remember that chemotherapy can be a treatment option for patients of any age. Older adults have distinct needs before, during, and after chemotherapy treatments. Being aware of these needs and planning for them can improve how chemotherapy affects you, prevent side effects, and help maintain quality of life.

Why can older adults have stronger side effects from chemotherapy treatment?

Older and younger patients have similar side effects to chemotherapy. But older adults may have a stronger reaction to a side effect or have a harder time recovering.

Chemotherapy not only affects tumor cells, but also your whole body. This increases the overall risk of side effects. There are several reasons why you can have worse side effects as you age. These include:

Coexisting conditions. A coexisting condition is any health concern that you have at the same time as cancer. Another medical term for this is comorbidity. Anyone at any age can have coexisting conditions along with their cancer, but older adults are more likely to have more than one coexisting conditions that can affect their cancer treatment. For instance, heart problems, lung problems, diabetes, and arthritis can all impact how chemotherapy affects you.

Multiple medications. Older adults are more likely to take regular medications for other health conditions. These medications might affect the chemotherapy you receive. Or chemotherapy might affect how your regular medications work.

To help prevent problems, make a list of all your medications. This includes those you take without a prescription (called "over the counter" medicine) as well as vitamins, supplements, and herbs. Be sure every medication is listed, even medications that are not taken daily. Share this list with your cancer care team.

Bone marrow changes. Some people have changes to their bone marrow as they age. This means their bodies produce less red blood cells, white blood cells, and platelets than younger adults do. Chemotherapy can make bone marrow problems worse in some older adults. This can lead to problems like infection, bleeding, and bruising.

Other physical changes. The body changes in many different ways as we age. Some of these can overlap with or impact the effects of chemotherapy. For example, hearing loss and balance problems become more common as you age. Some chemotherapy can also cause problems with hearing loss or balance and can make existing problems worse.

Other examples of physical problems that can affect the way chemotherapy affects you include bone loss and nerve problems.

Cognitive problems. Cognitive problems are problems with thinking, paying attention, and memory. Older adults are more likely to have existing cognitive problems. Some chemotherapy drugs can make cognitive problems worse.

Before chemotherapy treatment begins

Before chemotherapy begins, your doctor will want to learn as much about your health history as possible. They will review your medical history and talk to you about why they recommend this chemotherapy treatment. They will also discuss the possible risks and side effects of the recommended medication(s).

One way your health care team can learn more about your health and well-being before treatment is through a geriatric assessment. This is a set of tools that help your doctors recommend the best type of cancer treatments for you, including chemotherapy. ASCO and other international organizations recommend the use of geriatric assessments to tailor cancer treatment. They also recommend offering additional supportive care for all older adults with cancer before starting treatment.

A geriatric assessment will typically cover:

  • Daily living activities

  • Physical function

  • Risk of falls

  • Other medical conditions besides cancer

  • Mood, anxiety, and depression

  • Social activities and support network

  • Cognition and memory functioning

  • Nutrition

Your oncologist or another health care provider can do a geriatric assessment with you. These results should be shared with others on your health care team.

The results from a geriatric assessment can help your health care team plan the medical care and support you need before, during, and after chemotherapy. For example, the information learned during the assessment might show that you are at an increased risk of certain side effects. It can also help you and your health care team predict how much help you will need at home during your treatment.

Learn more about the importance of geriatric assessments and cancer care.

Common concerns during chemotherapy treatment for older adults

Unlike surgery, chemotherapy can take a long time. Chemotherapy is often given in many treatments spread over a few weeks or months. Then, there may be a break, with more treatments later.

Chemotherapy usually affects your whole body, instead of just one area, so this also increases your risk for side effects.

Common concerns during chemotherapy for older adults include:

Fewer blood cells, also called low blood counts. You may have fewer white blood cells, red blood cells, or a type of blood cell called platelets. Low blood counts increase your risk of infection, anemia, bleeding, and bruising. Anemia is when you have low levels of red blood cells. It can make you tired and cause other problems.

Stomach and digestive problems. These can include nausea, vomiting, and diarrhea.

Nutrition and hydration during chemotherapy. It is important that you get enough nutrition and hydration when you are during chemotherapy. Malnutrition, which is not having proper nutrition, is a common problem for older adults during chemotherapy, due to appetite changes and other challenges. Dehydration is when your body does not get enough water or other fluids, and it is also common.

Nervous system damage. This can affect a person's thinking or judgment. It can also increase memory loss, make you tired, and cause nerve damage.

Learn more about these and other side effects of chemotherapy and how they can be managed.

Your cancer care team can help by treating or preventing side effects. Be sure to tell them when you are experiencing a problem, or if a problem changes or gets worse. Relieving symptoms and side effects is an important part of cancer care. This is called palliative care or supportive care. This type of is especially important for older adults.

Palliative care also includes getting all the support you and your family need during cancer. Anyone can receive palliative care at any time.

Questions to ask the health care team

  • Is chemotherapy a part of my recommended treatment plan?

  • How will I receive chemotherapy, such as by pill or by IV? How often? For how long?

  • Where will I receive this chemotherapy?

  • If I need to come into the medical center for chemotherapy, how long will it take to give the treatment? How often will I need to travel to the center?

  • What are the common side effects of the type of chemotherapy I will receive?

  • How can side effects be prevented or treated?

  • Does my health history affect this chemotherapy treatment?

  • What side effects should I watch out for?

  • Who should I contact about any side effects I experience? How soon?

  • Are there side effects I should tell you about right away?

  • Would it be helpful for me to track my side effects over time, like keeping a diary? How can I do that?

  • What are the potential long-term effects of this type of chemotherapy?

  • Are there things I can do at home to help me feel better during chemotherapy? Such as nutrition, hydration, rest, and physical activity?

  • If I'm having side effects that affect my nutrition, can you recommend an oncology dietitian?

  • Who can I talk to if I'm feeling anxious or upset about having chemotherapy?

  • After chemotherapy is completed, what will my follow-up care plan be?

  • Are there patient services at the place I receive this treatment that can help me?

Related Resources

What is Chemotherapy?

What to Expect When Having Chemotherapy

Cancer Care Decisions for Older Adults

Fear of Treatment-Related Side Effects

How Symptom Tracking Makes Cancer Care Better