Immunotherapy in Elderly Frail Patients

[Theonlyoneiknow]

My darling dad (age 83). He finished 7 weeks of radiotherapy 2 years ago for throat cancer. It was horrendous at the time, but he pulled through and has had one year of being fit and well and off the feeding tube. He's struggled to chew but kept spirits up and has been self-sufficient.

There has now been a complete turnaround. In the space of four weeks he has lost a lot of weight and is very frail and weak, needing to walk with a stick. An emergency CT scan has shown cancer is now in his lungs, bones and liver. I feel like I am in a dream as I write this.

The consultant has recommended he try immunotherapy. My dad is pretty stoic, he will take it as it comes. However the last two weeks of radiotherapy nearly broke him and he was admitted to hospital.

He lives on his own (about 3km walk away so fortunately near by). I have made up the spare bed in his room incase I need to stay over.

I was just wondering if anyone had experience of an elderly family member going through immunology treatment and how they fared? I know it's hard to predict what the side effects will be.

My dad didn't fully comprehend what the consultant was saying about how much the cancer has spread as he was asking me afterwards where the tumour was, I don't know how much to tell him to be honest :( The reality of this being his last Christmas is a hard thought. I just want to do what I can to best support him. He has two teenage grandkids who he loves to bits, and a surprise 6 month old grand-daughter (my niece) so I know he wants to try whatever treatment he can.

My dad is 77 and has been having immunotherapy for approx 18 months. He had a single dose of medication for the first 12 months but the cancer has spread so he has been on a double dose since then.
He has minimal side effects with the single dose but the double dose has had brutal side effects that have put him in hospital 3 times in 4 months and have nearly killed him as he has been so ill.
They told us that some people have no side effects and other people have very severe side effects and they never know how people will respond.

I think if your dad is already frail then I would suggest speaking to another oncologist or nurse for further advice. Its a hard decision weighing up whether any benefits outweigh the risks from the side effects however it does not come without a risk of being significantly poorly.

My understanding of immunotherapy is that responsiveness varies widely by patient and the kind of cancer.
My father was diagnosed with stage four cancer in multiple organs, also in bones and liver amongst others, lost an incredible amount of weight in a short time and suddenly became very frail, but then he started immunotherapy and he completely turned around. He's now two years on and unless you knew what he'd gone through, you'd think he was in great health. He gets eczema as a side effect but not much else.
But we were incredibly fortunate in that he appears to be one of the people for whom it works wonders. I understand that for others, it's not always effective.
If his doctors are recommending it, then I assume its one of the cancers where immunotherapy is more responsive. I don't think you can know for sure how he will respond until it starts.
For us, it was a miracle. I hope your father is the same. Wishing you all the best. It's such a hard thing to go through ❤️

I had zero side effects with immunotherapy. It was also highly effective!

Thank you so much for your comments. The change in him is quite concerning. However, he is now on extra high-calorie supplements which have stabilised his weight (he lost 10kgs this year). His oncologist is great. My dad took part in a clinical trail during radiotherapy which meant 7 weeks instead of 6 weeks. He wouldn't hear anything of it when I told him how hard it was going to be, to have to do that extra week. I think it doesn't help that he hasn't been able to eat or drink properly since the initial treatment, and has no sense of taste anymore.

He is in on Thursday for the pre-assessment then has his first dose on the 23rd Dec (every 6 weeks - does that mean it's a double dose?) - it will be pembrolizumab, with 3 monthly CT scans.

My mum had immunotherapy after being diagnosed with lung cancer with brain mets. She reacted terribly to it, ended up in hospital 2 days after the first treatment with colitis. She couldn't have anymore than one dose as it made her so poorly and she died 4 months later, primary cause of death was a perforated bowel. Despite the horrendous side effects, that one treatment did reduce her brain mets. I have no idea whether the treatment gave us more time or less.

Edited to add that DM was clearly unwell, but not what you would call frail before starting treatment. She was mid 70s.

My dad was not allowed to have it despite being a very fit 90 year old, the drs argued between themselves as some said he could try it and others said no.He was told he has 6-12 months to live. My Dad says he’d rather have some time away from hospitals and enjoy the time he has left not going in and out of it either!
move had two goes at immunotherapy-first one was stopped after 6 rounds as I got so many sude effects but pneumonitis meant I had to stop. A year later with my last chance st getting cancer under control I tried a different double combination immunotherapy and after two doses not only did I get Addison’s Disease, I went on to get sarcoidosis in my lungs, which could have killed me anywsy.I’m soo lucky that the two doses did the trick and so far I’m cancer free and I’m in remission.
I d had chemotherapy in the past for a different cancer and got through it and it was tough but immunotherapy isnot to be taken lightly, as it left me cb with permanent effects afterwards

That sounds like just one dose, a single drug. It would have an additional medication listed for a double dose. .it does work brilliantly for lots of people and for some cancers it has doubled the 5 year survival rate so they wouldn't be offering it if they didn't think it would help your dad. I hope he gets on well.

My dad is 86 and had skin melanomas that spread to liver brain and lungs. He had several rounds of immunotherapy over about 18m. The good news is the brain tumours have vanished and the others are tiny and stable.

One of the main side-effects of immunotherapy is pneumonitis, which is lung inflammation that causes breathlessness. He was hospitalised twice for this, the second time he was in unnecessarily for 3 weeks with a cascade of hospital-induced problems and delays, complete nightmare. Pneumonitis is treated with high doses of steroids which themselves have side-effects. We didn’t think he’d pull through, but he did. He came home very weak and incapacitated. This was 9 months ago. He’s now fit and well again but exhausted all the time as a result of immunotherapy then steroids. We’re told this exhaustion should improve in time.

My Dad (84) had skin cancer last year which spread. He had 2 doses of Pembrolizumab but unfortunately experienced a lot of side effects which ultimately killed him. We were told he had a 1:8 chance of cardiac issues which he did get, also had very abnormal liver function. The Drs tried lots of meds to try and get on top of it but unfortunately there were too many problems and he died. He went downhill very quickly in the end.

I asked him if he regretted having the immunotherapy and he said ‘what choice do I have? Do nothing or try this’ But it has been really difficult. It’s a big decision to make but you need to be guided by the health care professionals who know his individual issues.

Sadly my dad only managed one round of treatment just before Xmas. He was in hospital twice after that, but didn't make it home after the third visit. He had aspirational pheumonia and bone fractures from the cancer and was in a bad way. My poor dad. x

I’m so very sorry to hear your update xx 💐

I’m so sorry to hear your update op. Thoughts and I am so sorry for your loss.

So sorry for your loss.