Ask the expert

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Chemotherapy

Question

My mother has just been diagnosed with cancer of the lymph nodes, they are not sure yet if it is the slow progressing one or the fast. What I want to know is, my mother is 83 is she considered too old for chemo. She has always been a fighter, having a double heart by-pass two and a half years ago and came through that with flying colours. Is there a cut off age for treatment.

Answer

It sounds as though your mother has been diagnosed with a lymphoma, of which there are several types. They are broadly grouped into either high-grade types (‘fast progressing’) or low-grade types (‘slow progressing’).

Treatment depends on which type of lymphoma is diagnosed and also on the stage of the illness, or how many lymph-node groups are involved. If it is an early stage then sometimes chemotherapy is not required and the patient can be treated with radiotherapy alone. However chemotherapy is often required to treat lymphoma and your mother’s cancer specialist will take many factors into consideration when deciding if it would be the right thing for your mother.

Advancing age per se will not prevent her from being offered chemotherapy and there is no age cut-off. However with advancing years specific problems can occur which can make chemotherapy difficult or even hazardous. An important consideration is your mothers general level of fitness and activity levels. The sorts of questions to be taken into account in this regard are for example:

• Is she able to look after herself on a day to day basis with minimal help?
• Is she reasonably active or does she spend most of the day sitting or in bed?
• Does she have lots of other medical problems which may make it harder for her to cope with chemotherapy side effects?

It is well known that patients who are reasonably self-caring and active tend to cope better with chemotherapy side-effects than those who are more dependent on others.

In order to minimise the risks to patients undergoing chemotherapy there are certain requirements to be met regarding the body’s ability to deal with the drugs. These include adequate kidney function and adequate blood counts which can be measured with blood tests. It is fairly common in elderly patients to have some impairment of kidney function which may be due to high blood pressure or diabetes for example. Your mothers cancer specialist will make an assessment of her ability to tolerate chemotherapy taking these measurements into account.

The type of lymphoma also determines which treatment needs to be used and this will influence the decision. Some lymphomas require high doses of quite intense chemotherapy whereas others may be contolled with better tolerated tablet chemotherapy or steroids.

It is important to discuss treatment options thoroughly with your mother’s cancer specialist when the final diagnosis has been made. If the specialist feels that chemotherapy would not be in your mothers best interests it may be because the specific type of lymphoma doesn’t require it at that time. However it may be that taking all of the factors into consideration the risks of the treatment would outweigh the benefits and discussing the reasons with the specialist would help you and your mother understand the decision.

Similarly if your mother is offered chemotherapy have a full discussion of the potential side effects and problems associated with the treatment so that you are both well prepared before the treatment starts.