The older you are, the more likely it is that you'll be diagnosed with cancer. The average age at diagnosis is now 66 and it's increasingly common for people in their late 80s and even older to consider cancer treatment.
Is this a good thing?
I think it's great when an 85-year-old says, "I want to aggressively treat my cancer. Give me chemo, give me whatever."
But I cringe when the relatives of an 85-year-old say, "We want to aggressively treat our father's cancer. Give him chemo, give him whatever."
The distinction, of course, is in who's making the request.
Treatment decisions are based on the likely benefits (e.g., extending one's life) and the likely costs (e.g., unpleasant side effects) of that treatment. Neither is known with certainty because there is so much individual variation, but doctors can provide some general guidance. They might say, "This treatment is relatively easy to tolerate and may extend your life for a few months, but no one knows for sure."
It's then up to the patient to decide if the treatment is worth pursuing. I'm very wary if I sense the family is more interested in aggressive treatment than is the patient. This is sometimes communicated quite subtly, "Oh Dad. I don't know if Mom can manage without you."
I also think some people pursue aggressive treatment because they "don't want to disappoint their doctors." Please don't worry about disappointing your doctors. They almost always have one more drug to try and they're trained to keep trying.
I said I love it when an 85 year old wants to aggressively treat his cancer. I also love it when an 85 year old says, "I've had a good life and now I want to focus on the quality of my remaining life. Don't give me drugs to extend my life if those drugs will make me feel worse."
There may be less aggressive treatment options worth considering. In the United States, we tend to assume that the most aggressive treatment is always the "best" treatment. This isn't always the case, especially when factoring in quality of life. Perhaps there's another chemotherapy protocol that's easier to tolerate and still beneficial.
And be cautious if deciding on no additional treatment. Sometimes people say, "No more treatment" when they mean to say, "No more life-extending treatment." Radiation therapy is often given to reduce pain. Even some surgical procedures and chemotherapy treatments are designed not to extend life, but to provide comfort. Keep these options open.
Physicians and family members also should realize that age is not a good predictor of what others might decide. A few decades ago, some doctors automatically performed mastectomies on older patients with breast cancer (rather than considering less extensive surgery) because they assumed that older women wouldn't mind losing a breast. A word of advice I freely share with my readers: Never, ever make assumptions about anyone else's body parts.
Bob is the Executive Director of the Cancer Resource Center. His articles about living with cancer appear regularly in the Ithaca Journal. He can be reached at firstname.lastname@example.org
Reprinted with Permission of the Ithaca Journal
Original publication date: January 22, 2011.
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