Older People: Wisely Navigating Safe and Effective Integrative Cancer Care
August 31, 2019
Remember the saying: “You’re not getting older. You’re getting better”? We are finally moving past our death- and age-denying mentality to embracing the possibilities of health and vitality into our elder years. We are getting older, as individuals and as a population, so best not to deny that truth. However, with healthy lifestyles and shifts in attitudes about aging, many of us stand to be vibrant and engaged in life for most of our senior years.
If you are older and are diagnosed with cancer, it may be counterproductive to languish too long in the “I’m too old to . . .“ (you fill in the blank with your favorite aging stereotype). Though there are some important considerations and adaptations, cancer treatment doesn’t have to be sub-optimal just because you are “old.”
Three issues often come up for older people and affect their decisions about cancer treatment:
- Having age-related physical changes, pre-existing conditions and treatments that could negatively affect your ability to safely and/or comfortably take conventional and/or complementary treatments.
- Being categorically labelled as a “poor candidate” for conventional treatment simply on the basis of older age.
- Being pushed (or feeling pushed) by loved ones and perhaps the medical community to take or to soldier on with aggressive treatments that have little chance for benefiting you and great chance of harming you.
Looking at all these issues through the lens of an integrative approach to cancer care may be useful.
The Case for Healthy Living
By far, cancer is more common in older people. New ACS/NCI statistics say nearly two-thirds of all those with cancer are 65 years or older.1 As we age, our immune systems don’t do their job of scouting and killing cancer cells like they used to. Plus we’ve had more years to be exposed to conditions that help cancer develop and thrive. On the flipside, we’ve had years to become wise as well as become conscious of what makes us healthy and what gives our lives meaning.
Many cancers are related to longstanding unhealthy lifestyle practices and exposures—so there’s good reason to do what you can to reduce these exposures and adopt a healthier lifestyle. Eating well, moving more, sleeping well, managing stress, sharing love and support, creating a healing environment and exploring what matters now are tried and true ways of fostering resilience and well-being. And it’s not too late to change, even if you are diagnosed with cancer—studies show that reducing unhealthy exposures and improving lifestyle results in better health outcomes for many diseases, including cancer.
A Pill for Every Ill
At least, that’s what the drug infomercials on TV promise. Let’s step back and look at the bigger picture here.
Because chronic diseases are far more common in older people, there is a preponderance of what we call polypharmacy (using a lot of drugs). And many older people have multiple chronic illnesses (called co-morbid conditions in “medicalese”). It’s not uncommon to see older people on nine or more drugs at any one time. Chronic illness as well as age-related declines in kidney and liver function put older people at greater risk for serious side effects from the drugs themselves and also from drug interactions. If you see multiple doctors without one running the show and monitoring this polypharmacy, the risk of problems is even greater.2
Big Users of Supplements
Compared to other age groups, older people tend to take the most nutritional herbs and supplements for disease prevention or to address health problems. The ease with which we can obtain supplements, the lack of regulation, and robust advertising contribute to a perfect storm for overuse. Some supplements can harm the liver or kidneys or otherwise interact with drugs, thereby increasing the chance of drug side effects or blocking the effects of drugs, including chemotherapy.3
Some supplements might even worsen whatever condition they were intended to help. For example, some supplements that people take because they think it will prevent cancer can actually increase cancer risk.4 At the very least, people could wind up wasting their money taking supplements that may not help.5
Complementary Therapies May Help
"Trimodal prehabilitation"—exercise, nutritional and psychological interventions before surgery—can improve treatment outcomes. In a small pooled analysis, researchers found that patients who participated in a month of prehabilitation before colorectal cancer surgery had a significantly higher disease-free survival than those not undergoing prehab. The researchers also point out that frail elderly who do not participate in prehab programs tend to have reduced ability to take care of themselves that can last up to 22 months.6
On the other hand, some complementary therapies—including herbs, supplements and off-label drugs—may be useful in enhancing your cancer treatment, reducing side effects, improving your quality of life and/or reducing the risk of recurrence. These therapies could possibly mean the difference between continuing to take your conventional treatment or stopping it because of harmful side effects. They may help improve your comfort, the quality of your life, and in some cases even help treat the cancer.
While your oncologist may or may not be knowledgeable or experienced in weaving complementary therapies into your treatment, reputable doctors and practitioners can work with your oncologist to tailor complementary therapies to your needs. See Centers, Clinics and Clinicians and Integrative Medical Systems in Practice in the US and Canada for information on finding providers knowledgeable about integrative cancer care.
Deciding on Treatment Options
Choosing More Aggressive Treatments
Underrepresentation in Clinical Trials
Though cancer is most prevalent in older people, this group is greatly underrepresented in clinical trials of conventional treatment or complementary therapies.7 That means many miss out on a potentially helpful treatment. It also means that when the treatment is evaluated and approved for use, people who are older are not factored into the outcome data. This could have serious implications for dosing and safety.
In some circumstances, older people have been steered away from taking certain conventional treatments for cancer by virtue of their chronological age. The concern is that the treatment will more likely be harmful, or the older person will not likely tolerate the full dose and/or course of treatment. The research and conventional wisdom is now shifting, as we recognize that a person’s functional and general health status, not age, is better at predicting risks for serious complications and/or intolerance of a treatment regimen. For example, “older women with breast cancer who are in good health tolerate chemotherapy about as well as younger patients.”9 Another study found immunotherapy to be well-tolerated by and more effective in older people with melanoma than younger patients.10
Integrating certain complementary therapies may help make you more resilient and able to more comfortably and safely complete your treatment. Therapies such as acupuncture, mind-body approaches, diet, exercise, and others can all help build resilience and/or prevent or lessen treatment side effects.
Novel ways of scheduling treatments may reduce the side effects and, in some cases, improve the treatment effectiveness. Chronomudulation involves administering chemotherapy or radiation at a time of day when the drug or radiation is usually more effective at killing cancer cells or less toxic to normal cells. Metronomic chemotherapy—administering prolonged, repetitive and more frequent low doses of chemotherapy drugs—also shows benefit. See more on Timing of Therapies: Chronomodulation and Metronomic Dosing.
When Age and Wisdom Say to Forego Aggressive Treatment
We commonly hear of older people saying that their loved ones are “pushing” them to “do everything” to stop the cancer, including taking very aggressive chemotherapy that seems likely to do more harm than good. Or they are urged to try every alternative therapy that shows up in an internet search or suggested by a well-intentioned friend or family member. We also hear of physicians having a hard time saying there are no more good anticancer treatment options and continuing to prescribe unhelpful and sometimes harmful treatments. Of course, the best of intentions and love often underlie these urgings to leave no stone unturned.
Especially when cancer is advanced, many health care professionals and loved ones don’t know how to elicit your values and goals and help you figure out how to align these with your care. But these conversations, preferably before a crisis, are absolutely essential in making sure you can live into what matters most to you now.
Engaging a palliative/supportive care team can help with these goals of care conversations. The team will include your loved ones in these talks and will care for them as much as for you. Good palliative care will use the best evidence-based therapies to support your comfort and quality of life, including many complementary therapies. It is not unusual to find that when people are more comfortable and paying attention to what matters now, they live longer than those who continue on with unhelpful aggressive treatment.
- Recognize that though you can’t stop the passage of time, you can influence your health as you age.
- Take a look at unhealthy exposures and lifestyles that are undermining your health.
- Explore healing practices that will keep you from getting sick or improve your health if you do get sick.
- If you take multiple drugs, have your doctor or pharmacist evaluate what you’re taking and look for red flags like contraindications or drug-drug or drug-supplement interactions.
- In general, do not take supplements for cancer prevention. When possible, try to meet your nutritional needs through diet.11
- If you are thinking about taking natural products such as nutritional supplements or herbs, consult your doctor or a registered oncology dietician. If possible, seek guidance from a licensed professional with expertise in prescribing natural products. See Natural Products and Other Therapies, Quality and Sources of Herbs, Supplements and Other Natural Products and What Can You Trust?
- When discussing your cancer treatment plan with your doctor, ask if he/she intends to offer you the standard treatment at standard doses. If you are being offered “less aggressive” treatment than the standard, ask why. If you are older, but are in good health otherwise, ask your doctor why he/she is not recommending standard treatment.
- If you take conventional treatment, consider integrating complementary approaches to enhance the treatment, reduce side effects and improve your quality of life.
- If you are older and have a cancer for which there is no safe, effective standard treatment, you might consider enrolling in a clinical trial. Even if safe, effective standard treatment is available, you may want to look into participating in a clinical trial of a promising conventional or complementary therapy that is likely to enhance the effects or manage the side effects of your standard treatment or improve the quality of your life. See Clinical Trials and Other Experimental Therapies.
- If choosing standard treatment is counter to your values, goals and intention to explore what matters most to you now, have a conversation with your doctor and your loved ones. You can find help with these conversations and with expert comfort care through palliative/supportive care services.
Don’t let myths, misconceptions and misinformation about aging and cancer prevent you from receiving the best integrative cancer care for you, whether your include or forego aggressive treatment. You are getting older and hopefully wiser as you explore your options for going Beyond Conventional Cancer Therapies.