78 year old deciding to have chemo or not

[betterchoicesnexttime]

Hello, I was hoping to get an understanding of other people’s experience regarding chemotherapy. My mother is 78 and has just had a mastectomy. The operation went well and removed the tumour and 6 lymph nodes - one of which contained cancer. Her care team have advised that as the cancer is hormonal (?) she should have chemo but have suggested she think about it given the impact chemo has on your body. She is having another test to check how effective (?) it will be, but I was hoping to get an understanding from other people about how it may impact her (given her age) so I can support her with her decision whether to go ahead or not. She doesn’t smoke and is very healthy and fit and has no other medical conditions.

Hopefully this all makes sense.

thanks in advance

Ideally the medical team should be able to give her all the info she needs to make an k formed decision, including what is the likely prognosis if she doesn't have the chemo.
My late OH had a very frank conversation with the oncologist about the possibilities around chemo for liver cancer. The oncologist was very open about the probable side-effects and OH decided against it. He was in his early 60s at the time but each case and each cancer is different.

My Father chose not to have chemo, he was 84 and was unfortunately also quite immobile by that age after an op on his back made a condition a bit worse when he was 79.

He was very happy with his decision, knew he had enjoyed a long life and though not religious at all, he asked for no religious stuff of any description at his funeral he believed he would see the sister that died as a tiny child in the late 1930’s.

He was happy with his decision, in reality it would have extended his life by maybe a year.

I sorry you are both facing such a difficult time but I think it cna be the right decision. His hospice nurse said I wish more people would choose your Fathers path. Absolutely lovely woman his nursing home accommodated it all as he had lived there since the old went wrong and I was so glad he didn’t have to move again.

My 79 year old dad was diagnosed with bile duct cancer earlier in the year.
He has just finished his 3rd round of chemo following surgery back in April.

He is coping really well with the chemo - he has tablets rather than IV.
The only side effects so far have been tiredness and occasional nausea but not actual vomiting.

The cancer markers in his blood have lowered considerably since beginning the chemo.

But I know it affects everybody differently, just wanted to let you know his experience so far.

All the best to you and your mum.

I would look first of all at her quality of life right now. If, apart from the surgery she is doing well for her age, then she should consider treatment. If, on the other hand, she is weak, unwell, suffering from other illnesses aswell, then you can discuss with oncology the best way forward.

It is her decision, but it should be made with the best possible information for and against. Best of luck in the journey together, it is not easy.

Thanks everyone so far. I know each experience will be down to the individual circumstances but this is all new for me so any experience is really helpful.

She’s doing very well for her age so could cope with mild symptoms but doesn’t want to lose 12 months to awful symptoms.

Hard one Op. very much depends on the chemo protocols they use, and your DM’s tolerance.

I had ‘heavy ‘ chemo several years ago, in my 50s. It has left its mark. But at that age, and going in very fit , it was totally worth it. But the road back can be long.

Her medical team need to be very open with her, she does not need them to be hero’s. She needs them to be honest.

Breast cancer chemo is often about long term survival rates. Your oncologist should give you a % of how much difference it will make. At age 50 5% improvement in long term survival might be worth it at 78 it’s very much not worth it. The % difference to survival is often not massive, people don’t understand that. They think chemo is giving you a 50% better chance of surviving, with breast cancer it is often a lot lower.
Have you used the NHS predict tool, this will give you a % of how much difference it will make.
Ask what type of chemo they are planning to use, there are different protocols.
Having been through chemo for breast cancer if I was offered it again I would refuse BUT chemo is very different for different people. Some people sailed through with no issue. I didn’t, so I am very prejudice. Breast cancer chemo usually takes 6 months. That’s a long time to be ill.

From what understand (which is not a lot at this stage) the chemo is to prevent it coming back, rather than to kill off any cancer.

What is her survival time with or without? If it's likely she can be cured and live a few more good years go for it, if it may or may not give more comfortable years then it's more debateable.

Not gonna lie I wouldn't. Not at that age. (Probably not at any age over 55 to be honest.) Chemo is brutal and nasty. It ravages your body, it makes you ill, and most of the time, it just gives you 2 or 3 extra years if you're lucky. And those extra (few) years are just pretty miserable. Far better to not have the chemo and just enjoy the time you have left, and deal with palliative care/end of life care when the time comes.

Definitely get all the info you can from the doctors about her likely regime, chances and known side effects. I've a got a few people on cancer regimes in my family and the responses vary so much to the treatment.

Good luck with her decision.

If it's in her lymph nodes it will travel to other parts of her body unless she has chemo. That means secondary cancers in other places like brain, liver etc and eventual death.

The chemo is brutal to go through, my mother had 12 weeks of it and it totally clobbered her. But she was in her 40s and after it, she lived until her mid 70s. However it did cause heart issues and require surgery for that later on.

It will depend on how healthy your mother is, how strong her immune system and how willful she feels about it.

Best of luck.

I urge you to check https://breast.predict.cam/tool this gives you an idea of how much benefit she will get. I had chemo in my 50s for what sounds like similar cancer. No way would I do it in my late 70s.

Thanks so much everyone. It’s all very helpful. X

I don’t think that’s everyone’s experience and is very dependent on the type of chemo.

Some people have relatively few side effects and lead normal lives. For others it’s debilitating.

What I will say is just because she starts the chemo, doesn’t mean she has to continue with it OP.

Also, there’s a big difference between 3 months worth and 12 months.

OP - you don’t have enough facts yet I don’t think.

My DGM is 80 and has been having chemo + surgery and has just started radiotherapy for breast cancer. In her case, the chemo and surgery has cleared all the cancerous cells completely. She is having the radiotherapy to be sure but has opted not to take the tablet for the 5ys afterwards. It has been hard on her, but she had a really good quality of life beforehand. She made the decision alone and didnt ask for our input but im so pleased she opted for the chemo given the cancerous cells have been removed. I hope she'll be with us for many more happy years now.

Sort out Power of Attorney for health ( and finance) if you haven't already. You need to make sure her wishes are not overruled by overzealous health officials who think any deviation from their prescribed plan is a sign of mental impairment.
POA will allow you to advocate for her when she is at her weakest.

I assume she’s having an oncotype test. That will give a figure on how much chemo will be of benefit. In general, I think she should try the chemo. They will be treating her with curable intent.

Just wanted to add.
My dad was told with the bile duct cancer he had 3 months left if he didn’t have surgery. - major op removing a 3rd of his pancreas, bile duct and all lower intestine.
With surgery and no chemo - he was told he had approx 12 months.
Surgery + chemo as long as the chemo worked 5+ years, dads cancer had not spread to his lymph nodes and as I said earlier he is coping ok so far. He has another 6 rounds to go. He does 2 weeks on chemo, 1 week off and repeat.

Dads sister had breast cancer in her late 60’s double mastectomy and chemo (tablets) for 2 years - she experienced joint pain on the chemo and is currently 76 and loving life.

it is so hard, don’t be afraid to ask all the questions you need to.

All the best.

My 80 year old mil sailed through 6 weeks of chemo after having half her lung removed, is now full of life and off exploring the world. If I was religious I would use the term reborn to describe her. Only your mum can decide.

My df had chemo in his early 70s and it was very brutal we nearly lost him. It was succcessful but I know he wouldn’t do it again.

a friend’s dad died at a similar age during chemo.

sorry your dm finds herself in this situation but hopefully she gets all the info she needs to make the best decision.

My parents both died of cancer in late 70’s and they both had very different experiences of chemo. For 1, the chemo was unbearable, they stopped due to the side effects. For the other, it was ovarian and they did chemo on off for 5 years and had a great experience of it. Her cancer, as with most ovarian, was diagnosed late so her 1 years survival rate was horrific. The chemo gave her 5 comfortable extra years which we all were so thankful for. Best wishes for you and your mum x

I'm 75 and have stage 4 lung cancer . I've had chemo for the last 6 years . 4 rounds of traditional chemo and 4 years of immunotherapy every 3 weeks on a trial . The chemo reduced the tumour by half and the trial has kept it stable , no change and no progression. I have some side effects which can be difficult at times but I do lots of things I enjoy and still work 2 short days a week . Chemo was not bad , I felt rough on day 5 and 6 after so rested on those days . The trial has been amazing , the side effects are mainly skin issues and a little fatigue sometimes . I'm generally a very positive person and consider the last 6 years a gift . Hope your Dad goes for the chemo and enjoys the rest of his life .

Sorry. I meant your Mum not Dad !

It sounds like what is being offered is adjuvant (preventative) treatment. I don’t have breast cancer, but when I was offered adjuvant treatment my oncology team gave me leaflets to show the risk of recurrence and 5 year survival rates for people with my exact type and stage of cancer if I took the adjuvant treatment and if I didn’t. It was very helpful to see the numbers in black and white for the two options.