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.