Chemotherapy for the Elderly – When is it Time for Hospice?

geriatric patientBy Dawn Cranfield

Chemotherapy for the Elderly – When is it Time for Hospice?

A few weeks ago I wrote about the usage of medical marijuana for a 7-year-old leukemia patient in Oregon; it made me ponder how young is too young for this innovative practice, something that had not crossed my radar before.  Recently, I have started to think about the converse; how old is “too old” to treat a patient with chemotherapy?

Granted, death is a touchy subject; most people want to prolong life as long as possible, many at all costs.  When a loved one becomes terminally ill, it can be the greatest challenge a family faces; there are difficult decisions ahead to determine what the care plan will be.

If the stricken person is young, and otherwise healthy and vital, the decisions may be easier; chemotherapy, radiation, and palliative care are most likely choices for a course of action.  However, when a patient is elderly and the same choices are made, the results may not necessarily be as positive.

Often times, elderly people have multiple health issues creating co-morbidity problems; they may be taking other drugs which can react with the chemotherapeutic drugs negatively and increase toxicity.  Additionally, there is an increased risk of chemo-related toxicity in geriatric patients due to the natural aging process, such as the “ability to repair cell damage, accumulation of body fat, and a decline in organ function”.  (

What would be a common side effect in a younger patient becomes amplified in an older patient, often causing them to stop the treatment.  “Other problems, like decreased kidney function, make it difficult to excrete the drug, causing even more concern. All of these issues put the elderly individual at high risk for serious chemo-related reactions or even death.”  (

Dr. Herman Kattlove, a retired medical oncologist, writes on his blog about the misunderstandings between choosing between aggressive therapies and hospice care, “I’ve never understood why these can’t be combined,” he opines.  He states he used to direct hospice programs, andchemotherapy believes patients are referred to hospice too late in their diseases.  (

Kattlove describes a study done in Boston on patients with incurable lung cancer.  They were divided into two groups; one received standard care such as chemotherapy, and the other received the same as well as hospice.  The group getting the hospice care had pain relief, “discussions of dying as a normal process, both psychological and spiritual support, encouraging of an active life and help for the family with coping with the illness.” (

The measured results, improved quality of life and improvement of length; were surprising to the team.  The patients in hospice not only reported an improved quality of life, but they lived longer, too.  Another result of the study found that the group still lived longer even after electing not to have more chemotherapy, radiation, or surgeries once their initial aggressive therapies failed.

According to Kattlove, what does this mean, then for our elderly patients with terminal illnesses?  “It means that adding palliative care to standard treatment provides a greater benefit to the patient and we need to find some way of incorporating palliative care into the treatment of patients with advanced cancer along with their anti-cancer treatment.” (

hospiceThe medical industry is based on extending life; while some may be in the field for altruistic reasons, it is still a business.  If you or somebody you love is being offered an aggressive form of therapy to extend life, do some research on your own, get a second opinion (even a third), and take consideration of all of the factors.  We all want our loved ones to live forever, but hospice can be a wonderful and peaceful comfort when you need them to be.


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