Cancer Care Decisions for Older Adults

Approved by the Cancer.Net Editorial Board, 05/2018

Cancer treatment can be more challenging and complicated for older adults. This is because older adults are more likely to have chronic health conditions, such as diabetes or heart disease. Even when you are healthy, your body will most likely respond differently to treatment than a younger person’s body. For example, older adults are more likely to have serious side effects from chemotherapy.

But age should not be the only factor in your treatment decisions. Cancer treatment can help people of any age. This article helps you think about treatment decisions and make choices.

Why your decisions matter

In the past, doctors sometimes made decisions without talking with patients. Today, the situation is different. Your health care team wants to know your concerns and answer your questions. They also believe that you have the right to make your own decisions. Working with your health care team to make a treatment plan can help you feel more in control.

What to consider

Before making any treatment decisions, talk with your health care team about:

  • The type of cancer, if it has spread, and how far.

  • All your treatment options, and the risks and benefits of each one.

  • Any other medical conditions that might cause problems with treatment or increase your risk of side effects.

  • How cancer treatment can affect your physical health, emotional health, and lifestyle.

Thinking about your personal situation is also very important. You might want to consider:

  • Possible emotional and social challenges. Who can help with your care and provide emotional support? If you live alone, will you feel lonely or cut off from other people? How can you get support during treatment?

  • Financial challenges. Older adults are more likely to have a limited budget, live on a fixed income, or both. But costs of treatment vary based on several factors. Resources exist to help patients with the costs of care. Ask your health care team about ways to get financial help with cancer treatment.

Also consider what your life will be like physically, emotionally, and socially. These factors put together are called quality of life. Think about each of the areas listed below:

  • Physical comfort

  • Relationships

  • Nutrition

  • Ability to keep taking care of yourself, do usual activities, or live independently

  • Financial security

  • Having a meaningful life

  • Your ideas about a dignified or peaceful death

It is important to talk honestly with your health care team about what quality of life means to you. Sometimes, managing side effects from treatment can make an important difference to your quality of life.

Learn more about making cancer treatment decisions.

Your cancer treatment goals

Your cancer treatment goals depend on many factors. For example, the type of cancer and whether it has spread will factor into your goals.

Treatment goals include:

  • Being cancer free

  • Living longer, even with cancer

  • Having fewer symptoms from cancer and side effects from treatment

  • Maintaining your physical and emotional abilities

  • Having a certain quality of life

Your goals might be different from a younger person’s. For example, a healthy younger person's goal might be to cure the cancer even if treatment is very difficult. Some patients are able to have aggressive treatment. This might not be true for you.

Depending on your age and health, you might care more about feeling well than curing cancer permanently. This might be especially true if your spouse or partner already died, you have a chronic health condition, or you feel that your quality of life is poor.

But if you are very healthy and enjoy many activities, you might want aggressive treatment. You might have plans many years in the future. If so, you might want your health care team to do everything possible for a cure.

If you and your family do not agree

Family members, friends, and caregivers might have different ideas about your treatment. They might want you to have more aggressive treatment. Or they might try to keep you from having certain treatments.

If this happens, your health care team can help you talk with your family and friends. Sometimes, it is best if your family and closest friends meet with you and your doctor to talk about the best treatment plan. Remember that you always have the right to make your own treatment decisions.

Cancer treatment options for older adults

You may have just one type of treatment or a combination of treatments. The main cancer treatments for people of all ages are:

  • Surgery

  • Chemotherapy or targeted therapy

  • Radiation therapy

How cancer surgery can affect older adults

Like other treatments, surgery has risks. The risks can be higher when you are older because your body does not always work as well as it did. Before surgery, you and your doctor should think about the following:

Heart function. Surgery may make heart problems worse. It is important to consider your heart function before you have surgery. Older adults have heart disease or an irregular heartbeat more often than younger people. Also, your heart might not tolerate changes in blood pressure as well. This can happen during surgery.

Kidney function. Surgery can involve many drugs. You might also get a lot of fluids to keep your body working. Your kidneys need to process the drugs and fluids. If your kidneys do not work as well as they used to, surgery can cause problems.

Liver function. As you get older, less blood flows to your liver to help it work. Your liver breaks down drugs. If it does not work as well as it should, you are more likely to have a reaction to the drugs needed for surgery.

Lung function. As you get older, your lungs do not hold as much air. And they might not work as well to move air in and out of your body. If you have a lung condition such as emphysema or chronic obstructive pulmonary disease (COPD), you may have problems recovering from anesthesia. This includes medications you get before and during surgery. Lung problems increase your risk of getting pneumonia after surgery, which can be very serious.

Considering surgery risks and benefits

It is important to talk with your health care team about the risks and benefits of cancer surgery. If surgery is risky for you, talk about other treatments.

If you have any health problems, or your doctor is concerned about the risks, you may need to have other tests done before your surgery. These may include blood tests, electrocardiograms (called an ECG or EKG), lung function tests, and x-rays.

You might also want to see a type of doctor called a geriatrician. This is a specialist who cares for older adults. This doctor can check your general health and talk with you about surgery risks and benefits.

Learn more about cancer surgery.

Planning for after surgery

Talk with your health care team about the care you need after surgery. Depending on your health, you might need different care than a younger person. Ask if you might need:

  • A home health aide

  • A visiting nurse

  • Physical therapy

  • A social worker

  • Support groups

  • Recommendations for help in your community

Planning for your after-surgery care is important. Having a detailed plan makes a successful recovery more likely.

How chemotherapy can affect older adults

Unlike surgery, chemotherapy can take a long time. Doctors often give chemotherapy in many treatments spread over a few weeks or months. Then, you might take a break and have more treatments later. Even with breaks, having many treatments can lead to longer periods of weakness. If you are an older adult, chemotherapy might affect you differently than someone younger. For example, older adults have a greater risk of physical side effects from chemotherapy. These side effects can affect your quality of life.

Side effects of chemotherapy

Unlike radiation therapy and surgery, chemotherapy affects your whole body. This increases the risk of side effects. Older and younger patients have similar side effects. But older adults usually get them more often. Sometimes older adults with cancer go to the hospital because of a reaction to chemotherapy.

Side effects may 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 a decrease in the number of red blood cells. It can make you tired and cause other problems.

  • Stomach and digestive problems. These can include nausea, vomiting, diarrhea, and dehydration. Dehydration is not having enough fluids for your body to work well.

  • 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.

To make these side effects less severe, or less likely, your doctor can:

  • Check for health problems before you start chemotherapy

  • Adjust the dose or type of drug

Chemotherapy and your other medications

Older adults are more likely than younger people to take regular medications for other health conditions. These medications might affect the chemotherapy drugs. Or chemotherapy might affect how your regular medications work.

To help prevent problems, make a list of all your medications. This includes those that are taken without a prescription 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 health care team.

Learn more about chemotherapy.

How radiation therapy can affect older adults

Radiation therapy might be your only treatment. Or you might have it before or after surgery or chemotherapy. You usually do not stay in the hospital for radiation therapy. But you might need to go for treatment often, sometimes every day for several weeks.

Radiation therapy can come from a machine outside the body. Or your doctor may put tiny pieces of radioactive material inside your body, near the tumor.

Learn more about radiation therapy.

Considering radiation risks and benefits

Talk with your health care team about:

  • The cost of treatment

  • If you need to be away from home

  • Treatment schedule

  • How to keep a healthy diet during treatment

Depending on your health, your doctor might recommend less intense treatment for a shorter time than for someone younger.

Older adults usually do well with radiation therapy. The side effects depend on the type and dose of radiation therapy and where the cancer is. For example, radiation therapy for prostate cancer can cause different side effects than radiation therapy for head and neck cancer. Learn more about radiation therapy for specific types of cancer types.

Clinical trials

Clinical trials are research studies that involve people. The people in clinical trials volunteer to help researchers learn more about new drugs and treatments.

Because 60% of people with cancer are older than 65, it is very important for research studies to include older adults. Doctors need to learn which treatments work best in older adults. They also need to learn if those treatments might work differently than in younger people. Talk with your health care team about available clinical trials and how they differ from standard treatment.

Learn more about clinical trials.

Other types of cancer treatment

Relieving a person’s symptoms and side effects is an important part of cancer care. This is called palliative care or supportive care. It can be especially important for older adults. This is because older adults can have more side effects, especially from chemotherapy. Or your body may not recover as quickly from surgery as someone younger, which can cause more symptoms.

Palliative care also includes getting all the support you and your family need during cancer diagnosis and treatment. Anyone can receive palliative care at any time. It is important to ask for support when you need it.

Advanced cancer care

Advanced cancer is cancer that doctors cannot cure. It is also called end-stage cancer or terminal cancer. Even though your health care team cannot cure advanced cancer, they can treat it. And you can still have a good quality of life.

Advanced cancer treatment options include:

  • Standard treatment. The current or most effective treatment available.

  • Clinical trials. Research studies that test new drugs and treatments.

  • Palliative care. Care that helps you live as comfortably as possible.

  • Hospice Care. This is care to help you and your family cope with death and dying. This care is available when you are no longer having treatment to cure your cancer.

Understanding these types of care can help you and your health care team plan for your needs, goals, and wishes. Learn more about advanced cancer.

Questions to ask your health care team

After you learn about your treatment options and your health, you might need more information. Here are some questions you can ask your health care team.

  • Is my cancer curable?

  • What is my chance of recovery?

  • What are all of my treatment options?

  • What is the goal of each treatment?

  • What treatment do you recommend? Why?

  • How does this treatment help me?

  • What are some risks and potential side effects of this treatment?

  • Will I need to be in the hospital for treatment? Or can I stay home and come to the hospital or clinic during the day?

  • How long will each treatment last?

  • How will this treatment affect my daily life? Will I be able to perform my usual activities?

  • If I am worried about managing the costs related to my cancer care, who can help me with these concerns?

  • How can I keep myself as healthy as possible during treatment?

  • Whom should I call with questions or problems?

  • What support services are available to me and my family?

Find more questions to ask your health care team

Related Resources

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The Importance of Taking Your Medication Correctly

Cancer in Older Adults

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