Cancer

Unique to Older Adults

This section provides information to help older adults and their caregivers consider their disease or condition in conjunction with other health issues.

As older adults live longer, they may have more than one chronic disease.  Or, they may have a health problem that can lead to another condition or injury if not properly managed.   The older adult may also experience healthcare in various settings, such as the hospital, assisted living facility, or at home. These situations can affect the health and function of the older adult and therefore require careful management to ensure proper care and improve or maintain quality of life.

Though many cancers are becoming curable if caught early, older adults with cancer are more likely to experience certain conditions. Below is some information about these conditions and how you can work with your healthcare team to manage them. 

Fatigue

Fatigue is the feeling of being exhausted. It is the most common complaint of older adults with cancer. Many people report feeling weak, unusually “slow,” and not having any energy. These problems may improve after radiation or chemotherapy treatment ends. However, it can often take a while for you to feel that your energy level is back to normal.

There can be numerous reasons for fatigue, including:

  • the cancer itself
  • the cancer treatment (such as medications, radiation, or surgery)
  • anemia (low red blood cell count)
  • poor appetite or treatment side effects like nausea that make it difficult to eat or get enough nutrition
  • stress
  • disturbed sleep
  • lack of physical activity or exercise
  • breathing problems causing low oxygen levels in your blood
  • nerve and muscle weakness
  • pain
  • infection

Fatigue from cancer can affect your daily functions and quality of life. You may not feel refreshed even after sleeping well. Activities you could do easily in the past may now seem exhausting.  Because of this fatigue, you may have problems with:

  • relationships and social interactions
  • mood
  • ability to concentrate or think clearly
  • your general feeling of well-being

Managing Fatigue

Tell your healthcare team if you are feeling unusually tired, and having problems performing daily activities. They can evaluate you to find out if there are specific problems contributing to the fatigue. Many causes can be treated once they are identified.  

Some approaches that may be beneficial include:

  • blood transfusions, iron supplements, and other medications that help your body to make new blood cells if you have anemia
  • exercise programs to improve energy
  • working with a dietician to develop a healthy eating plan to give you more energy
  • relaxation techniques such as meditation programs and yoga
  • having your healthcare provider review the medications you are taking to see if any of them may be causing fatigue
  • using appetite stimulants to improve your appetite and mood
  • antidepressant medications

Depression

When facing a serious illness such as cancer, many people sometimes feel overwhelmed or hopeless. Older adults are often handling difficult changes of aging. These can include physical limitations, chronic diseases, or the death of friends or a spouse. These changes may make it harder for older adults to cope with the diagnosis of cancer.

When older adults with cancer are depressed, they often report more problems with their health, relationships, and general outlook. They are more likely to feel that they are a burden to their families, friends, and caregivers. You may not realize that these feelings are a sign of depression. Your healthcare providers or family may not notice the depression either.

It is helpful to discuss your feelings of low mood, irritability, or lack of hope in the future with your healthcare provider. Depression has been found to last longer in older people. Therefore, it is important to tell your healthcare provider about your depression symptoms early. Remember that there is no shame in seeking help in a difficult situation such as having cancer. You can still achieve a healthy and positive attitude and quality of life. Depression can and should be treated.

Factors specific to cancer patients that can increase the chances of depression include:

  • an advanced stage of cancer
  • pain that is not well controlled
  • physical limitations
  • treatment with certain chemotherapy medication

Treatment for depression in older cancer patients  

Older cancer patients who are depressed have a number of treatment options. They may include one or a combination of the following.

  • Medications: Antidepressant medications work well in older people, but you may need to take a lower dose to avoid possible side effects. Also, your healthcare provider must be careful in choosing an antidepressant medication. It is important that the antidepressant does not interact negatively with chemotherapy or other medications you are taking. It is also important to try to avoid side effects such as drowsiness or dizziness.
  • Counseling:  Talking to a professional counselor or psychotherapist about your depression is one of the best ways to understand and cope with your feelings, improve your outlook, and enjoy your life again. Psychotherapy is especially effective when antidepressants are taken at the same time. It is also helpful for people who cannot take antidepressants because of side effects or interaction with other medications.
  • Support groups: Many older people with cancer are helped by attending a support group with other older people with the same type of cancer. Researchers have found that support groups can improve morale, help you cope with your diagnosis, and improve your mood and quality of life. There are many options for finding support groups. Check with your healthcare provider, the American Cancer Society, social work departments of hospitals or clinics in your area, or community centers or places of worship.
  • Suicide prevention:  Cancer patients have a higher suicide rate than the general population. Therefore, it is extremely important to talk to your healthcare team, family, or caregivers if you are having suicidal thoughts.
If you need immediate help, you can call the National Suicide Prevention Lifeline at 1-800-273-8255 at any time. 

Changes in Thinking or Memory

Some people undergoing treatment for cancer may experience episodes of “fuzzy” thinking or confusion, particularly if being treated with chemotherapy. This condition is known as chemotherapy-associated cognitive impairment or “chemo brain.” Older cancer patients may be more likely to experience changes in thinking during cancer treatment.

Most of these effects do not last long, are not serious, and often get better on their own. However, for some older people, this “fuzzy thinking” can make it harder to carry out daily activities, such as balancing a checkbook or grocery shopping. 

Some older people report problems such as:

  • forgetting things that they used to remember easily, such as dates, words, or events
  • trouble focusing or concentrating on tasks or conversations
  • being more disorganized and slow with routine tasks; having difficulty making plans
  • reacting more slowly
  • difficulty learning new things 

To help manage these problems, the American Cancer Society and other groups suggest the following tips:

  • Use a daily planner, with details about appointments and schedules.
  • Keep “to do” lists – even for movies you want to see or books you want to read.
  • Keep an easy-to-read list of addresses and phone numbers.
  • Engage in brain exercises such as taking a class, doing word puzzles, or using memory training activities on the internet.
  • Get enough sleep to feel rested.
  • Exercise regularly.
  • Eat a balanced diet, including a few servings of brightly colored vegetables a day (these contain vitamins and plant chemicals that promote health).
  • Avoid multi-tasking. Try to focus on and complete one task at a time.
  • Get help when you need it.
  • Keep a diary of problems you experience with memory or attention, so you can report them to your healthcare provider.
  • Write down questions about your problems as they occur to you so that you can check with your healthcare provider at your next appointment or phone call. 

If the problems do not improve, your healthcare provider may need to refer you to a specialist for further evaluation and recommendations for coping with your mental symptoms.

Weight Loss and Loss of Appetite

Most older people with cancer experience symptoms affecting appetite and nutrition. These symptoms can include loss of appetite, weight loss, nausea or vomiting, or problems with your sense of taste. These symptoms can lead to you not taking in enough protein and calories, which can result in weight loss and loss of muscle mass.

Before you start cancer treatment, it is important to work with your healthcare team to develop a plan to help improve your appetite and maintain your weight. Taking nutritional supplements may be helpful. There are also medications to help stimulate your appetite or manage your nausea. However, they may have limited benefits, and can have side effects, so your provider may prescribe them only for a short time.

Below are some helpful hints for a better diet:

  • Eat small but frequent meals
  • Focus on high-protein and high-calorie foods
  • Limit your intake of greasy or fatty food, to avoid nausea  
  • Add extra herbs and spices to improve the flavor of food
  • Avoid extremes in taste or smell because of changes in your senses
  • Whenever possible, eat in a pleasant environment with food presented in an appetizing way
  • Take supplements according to your healthcare provider’s recommendations 

Pain

If you have been diagnosed with cancer, you may worry that you will experience pain at some point during your illness. Pain is not inevitable, however, and if it does occur, there are many effective ways for your healthcare team to treat the pain. Keeping your pain under control is one of the most important things your healthcare team can do. 

If you do have pain, either from the cancer or from your treatment, it may vary from mild to severe, and change from day to day. It may be “acute” pain, which starts quickly and doesn’t last very long. Or it may be “chronic” pain, which is more constant and lasts longer.

Be sure to tell your healthcare provider if you start having any pain, so that they understand what you are feeling and can help you manage it. Treating pain early can prevent it from getting worse and keep it under control.

Opioids

Opioids, also referred to as narcotics, are the most commonly used medications for controlling cancer pain. They include medications such as codeine, morphine, and oxycodone. The most common side effect of opioids is constipation, particularly in older people. To prevent this problem, your healthcare provider may start with a lower dose of the medicine, or prescribe a stool softener or laxative along with your pain medicine. Also remember to drink plenty of fluids, eat fiber-rich foods, and get regular exercise. 

Make sure to take your pain medications exactly as directed by your healthcare provider, and tell your healthcare team about all side effects immediately. Do not break or crush your pills unless your provider tells you to do so.

You may feel drowsy or nauseated when you first take an opioid pain medication, but these side effects usually go away after a few days, once you are used to the medication.

Although many patients worry that they will become addicted to an opioid medication, this does not happen if it is taken according to your healthcare provider’s directions to treat your pain.

 Many patients develop a “tolerance” for their pain medication, which means that it seems to work less well as time goes on. Tell your healthcare provider if the pain medicine is no longer working as well as it used to. They can change the dosage, or switch you to a more effective medication.

Do not stop taking an opioid medication unless you are under a healthcare provider’s care and instruction. Stopping an opioid drug suddenly can cause dangerous withdrawal symptoms.

Other pain medications

Other types of medicine can also be helpful in pain control. Some of these treat causes of pain or increase the effect of your narcotic medications. These include:

  • antidepressants
  • anti-epileptic (anti-seizure) medications
  • steroids

Radiation for pain control

Radiation may be used to control pain by targeting specific areas where cancer is causing pain symptoms. This focused radiation therapy has been found to be effective for bone pain, in lymphomas, and cancers of the prostate, bladder, cervix, esophagus, breast, and head and neck. 

Alternative or complementary approaches

Many older people receive great benefit from non-medical approaches to their pain. Although scientists don’t yet understand why some of these treatments are effective, they often are very helpful in cancer pain. These include:

  • acupuncture
  • biofeedback
  • hypnosis
  • heat or cold applications
  • massage
  • imagery
  • meditation
  • relaxation methods
  • distraction techniques
  • gentle exercise such as Tai Chi, yoga, or gentle physical therapy

 

Last Updated February 2018