Patient, Not Family, Should Decide on Cancer Treatment

Bob Riter
Bob Riter

Ninety-year-old Jimmy Carter is beginning treatment for cancer.

Some people may wonder if age should be a factor when making treatment decisions. Can you be too old for treatment?

I think it’s great when an older person says, “I want to aggressively treat my cancer. Give me chemo, give me whatever.”

But I cringe when the relatives of an older person say, “We want to aggressively treat our father’s cancer. Give him chemo, give him whatever.”

The distinction, of course, is in who’s making the request.

Treatment decisions are based on the likely benefits (e.g., extending one’s life) and the likely costs (e.g., unpleasant side effects) of that treatment. Neither is known with certainty because there is so much variation between individuals, but doctors can provide some general guidance.

It’s then up to the patient to decide if the treatment is worth pursuing. I’m very wary if I sense the family is more interested in aggressive treatment than is the patient. This is sometimes communicated quite subtly, “Oh Dad. I don’t know if Mom can manage without you.”

I also think some people pursue aggressive treatment because they “don’t want to disappoint their doctors.” Please don’t worry about disappointing your doctors. They want to follow your wishes.

And be cautious if deciding on no additional treatment. Sometimes people say, “No more treatment” when they mean to say, “No more life-extending treatment.” Radiation therapy is often given to reduce pain. Even some surgical procedures and chemotherapy treatments are designed not to extend life, but to provide comfort. Keep these options open.

I caution people not to make blanket statements about treating cancer at advanced ages. Most of us recognize that not all 90 year olds are the same.

Chronological age is not nearly as important as functional well-being. (I hope that I’m as robust as Jimmy Carter when I’m 90). And what’s true for one type of cancer may not be true for another type of cancer.

I said I love it when an older person wants to aggressively treat his cancer. I also love it when he says, “I’ve had a good life and now I want to focus on the quality of my remaining life.”

Reprinted with permission of the Ithaca Journal.
This is a revised version of an article that originally appeared on February 28, 2014 in the Ithaca Times.

Bob Riter is the Executive Director of the Cancer Resource Center of the Finger Lakes. He can be reached at [email protected]


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