Cancer treatment choices

For some older people, cancer treatment can cause considerable side-effects and recovery may be slow. Some older people may not be able to return to the same level of health that they had before treatment.

So having open and honest discussions with your cancer team about the possible short and long-term effects of treatment is very important. 

When you understand the risks and benefits of your treatment options you can make better decisions.

While the cancer team will always do their best to make sure you have the best health outcomes, this does not always happen. Planning for a range of outcomes allows you and the cancer team to be prepared for what may happen during and after treatment. 

This video explains what can happen when a patient does and does not share in decision about their care. It follows Doug, who has co-existing lung and kidney problems, who then gets a diagnosis of bowel cancer. 

The video helps with understanding why it is so important to understand risks and tell your health care team about your health and your wishes so that you can have the care that is right for you. 

Your treatment decision  

We all have different needs and priorities.  

Some older people will want to try all treatments available to help control their cancer. They may have plans for many years ahead and want active treatment to achieve a possible cure.  

Some older people may not want to have treatments which will impact their quality of life. You may prefer to feel as well as possible rather than make a treatment decision with likely side effects. 

However, many older people decide to go ahead with treatment which aims to cure or control their cancer, even if there is risk of side effects. 

A small number of older people decide not to have any active cancer treatment. If this is your choice you still have the right to receive care and support from the health care team. It is very important that the palliative care team, who are experts in pain and symptom management lead or are partners in your care at this time. Read more information about Palliative Care.

Sometimes people need to think for a while before making a decision, and may change their mind at a later date, and that’s okay too. These are big and often stressful, complex decisions. Support from carers, loved ones and health professionals at this time, is crucial. 

All older people with a cancer diagnosis should have a detailed conversation with their cancer team about the care and treatment options available to them. Understanding options and possible consequences helps people make good decisions. 

What is important to me?

To help with making decisions about cancer treatment it may be helpful to ask yourself: 

What is most important to me?  

Is it my quality of life  
extending the length of life that I have left 

These are decisions that many people with cancer think about.  

Quality of life includes all of the factors listed below: 

  • Physical comfort and nutrition  
  • Relationships  
  • Emotional health and wellbeing 
  • Ability to take care of yourself, do usual activities or live independently
  • Financial security 
  • Spiritual wellbeing 
  • Social interactions 
  • Having a meaningful life.

Think about:  

  • Who was I before I had cancer?  
  • What things do I love and want to still be able to do?   
  • What matters most to me? 

Your answers will help guide your decisions related to your treatment choices.  

You might love looking after your grandchildren every week, travelling often or living in your own home independently. Losing independence is a very important consideration for many older people. 

Asking your cancer team whether you will be able to continue to do these things while you are having treatment, or when the treatment is over, is important to help you make the right decision for you.  

Explain all of your wishes to your family and your doctors to help make the best treatment decisions for you and to help people understand why you have made the decisions you have. This will help them to better support you. 

Read these contrasting stories that show different responses to having cancer treatment.

I was asked to have chemotherapy. I have got to 85yrs, I don’t want to go in that direction. Why would I want to put up with 12 months of hell, being sick, my hair is going to fall out. I am happy, I have got music – you must have something to latch on to. 

I am not afraid of death at all. Here I am 12 months later and I have not been sick. We are under doctors and we think they know better than us and that we will go along with whatever they say. I felt pressured but I think my doctor in the end, went along with the way I was thinking. 

Graham with dementia and bowel cancer. 
Postscript: 18 months later Graham continues to be positive, play music and go on driving holidays.

They said you have got leukaemia. It was instant relief to know what I had. I was in hospital and I knew I could get better. 

I have had all kinds of chemo and now I am on a trial. The professor said: John I would have the treatment – so I grabbed it with both hands. 

I trusted the doctors and trusted god – that got me through. I knew they would fix me up. 

I have maintained a positive attitude all the way through.

John, 77yrs, cancer patient for 17 years

The steps:

Have a detailed conversation with your cancer team.

Consider your options and what is important to you.

Together you can make the right decision for you.