Should Older Patients be Treated in the Same Way as Younger Ones?

Posted by Heinz-Josef Lenz, MD on January 26th, 2009

Last week I had a consultation with an older gentleman who is 84 years old. Interestingly, the role of age in the treatment of colon cancer has changed. During my training in Germany in the nineteen eighties when someone came in with metastatic cancer and was older than 65, we rarely gave chemotherapy because we were afraid to make those patients sicker than cancer did.

We have a perception that when someone is old we should be much more gentle and we should adapt treatment not only using less aggressive chemotherapy cocktails but also lower doses.. These perceptions go back to the history of chemotherapy when chemotherapy drugs made most patients very sick and weak. With less toxic chemotherapeutic therapies and much better drugs against nausea and vomiting, our perception needs to be reevaluated.

We have come a long way. We all live longer We can treat many diseases that used to lead to death such as strokes and heart disease, and we have developed much more successful therapies which are often smart drugs not causing the same “old” side effects we often associate with chemotherapy. Many recent studies in Europe and the USA clearly show that patients over 65 or 70 or 75 have the same benefit from chemotherapy that younger patients do, and they do not have more side effects. This clearly shows that treatment options should be discussed with patients of any age.

More and more we talk about biological age. Some patients in their fifties with metastatic cancer are in as good shape as a 85- year- old patient with the same diagnosis. The problem with age is that patients are more likely to have comorbidities such as hypertension, diabetes, or coronary artery disease. These make treatment decisions more complicated, not the age alone. Many of my consultations reflect that patients in their seventies are treated less aggressively based on a perception which is no longer true. Our life expectancy has increased, our treatment options have changed, and we need to include this into our treatment recommendations.

My oldest patient, who was treated with aggressive chemotherapy,was 94 years old. He had no side effects and lived 2 years with controlled disease.

Don’t let age be a decision factor for therapy.

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6 Responses to “Should Older Patients be Treated in the Same Way as Younger Ones?”

  1. January 27, 2009 at 3:33 am, Darlene Jervis said:

    This is very encouraging information.
    Thank you

  2. January 27, 2009 at 12:53 pm, Heinz-Josef Lenz said:

    my pleasure want to make sure age is not an excuse to consider effective therapies HJL

  3. January 27, 2009 at 10:29 pm, Anne Larson said:

    My husband’s diagnosis almost 7 yrs. ago was colorectal cancer. He had surgery at that time and the oncologist began treating him with chemo and another medicine which I cannot recall right now.
    He had diarrhea sooooo bad and his oncologist kept saying ‘you gotta exchange one for the other’ meaning the diarrhea for the cancer. I insisted he lower the mg/dose and my husband doesn’t have it as bad now. The dr. tried the Vectibix on him and his face was so covered with red rash, you couldn’t even see one spot of skin on it!!!!!! He has been getting the chemo for 6 1/2 years with a couple remissions. Please give me your thoughts or medical advise/comments on this. Appreciate it so much.
    Mrs. Larson

  4. January 28, 2009 at 10:43 am, Heinz-Josef Lenz said:

    first of all to live almost 7 years with colon cancer is incredible, sorry to hear that he is battling with so many side effects, usually chemo for colon cancer in general is well tolerated, if for example diarrhea occurs (more than 7 times a day) we usually reduce the dose of the drugs which can cause it. you also have to make sure the diarrhea is not caused by infection or the cancer itself, for the vectibix, if the skin is all covered with acne and rash, typical advice is to reduce the dose if the antibiotics can not control it. talk to your doctor. hope this helps. HJL

  5. August 20, 2011 at 12:00 am, Norm Castillo said:

    That said, what dose of Zeloda do you recommend for a 64 year old individual with good laboratory numbers, a BSI of 2.1 , and a BMI of 26?

  6. August 25, 2011 at 9:59 am, Kate Murphy said:

    We at Fight Colorectal Cancer can’t provide medical advice. We do suggest you discuss the right dose for you, as an individual, with your doctor.

    Age, as Dr. Lenz says, depends more on overall health than on a number of years.

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