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

I’m not sure how old you are but at 55 there’s every chance that one year of misery could give you the chance for 30 more years of life - more than half of your life all over again. Many people have huge responsibilities to others at 55 too: children still in teens etc (or younger for many men).

That is a totally different prospect from the OP’s mother who has already had almost all of those years.

Agree this is the info that OP and her mum need to see while she’s considering it

Not my experience. Everyone reacts differently. Just because some is elderly doesn't mean they won't cope .

It depends on how old she is for her age and if she wants to go through it. Some 78 year olds sit at home all day. Some do marathons.

Wtf?

So a bloke of 55 shouldn't have chemo for a cancer that has been removed and the chemo is for 'mopping up'? Even if he could go on to live a very long and healthy life?

A 78 year old shouldn't have chemo because she might only have a couple of years left?

Chemo can be brutal. But it can be curative too. It may give a few years, it may not be recommended at all. That's for each individual patient to discuss with their oncology team and families.

Tell me you'd decline chemo after 55 @BatchCookBabe, seriously! You could have 25+ more healthy years ahead of you!

Agree with others about looking at the predict tool. I was in a very similar position last year with hormone positive and lymph node involvement and found the surgeons and oncologists explained the benefits and drawbacks of chemotherapy quite differently- which gave me food for thought.
Chemo for me was only 4 months and they monitored side effects very closely. I was only 41 though. Wishing your mum all the best with her treatment and recovery.

Completely agree with this.
I was offered adjunctive chemo when I had BC two years ago.
faced with the stats I decided it wasn’t worth it in my case, I think my figures suggested chemo would only give me a 3% increase in long term survival but because my chances of reoccurrence where worked out as 7% the numbers didn’t make sense for me.

i had previously had lumpectomy then mastectomy so decided to take the three weeks radio with tablets for seven years.
it’s a very personal choice.
had I been younger (am 55) with small kids (mine are young adults) I might well have gone for chemo.
Trust your mums oncologist and have a conversation when you have all the stats

Just to add, this was one appointment I wanted to attend on my own because I know DH and DDs would have strong armed me (or tried to!) to have the chemo.

I had breast cancer at 48 and had it in one lymph node and did chemo but if I had been 78 I definitely would not have done it. If they are giving her the oncotype test for free on the NHS that means she's borderline whether chemo is worth it or not but the results will give more info. I also had that test though in Predict Breast was in the you need chemo - the Predict Breast figures "benefit" means alive rather than dead. But it takes no account of quality of life. I had a shorter chemo which was still weekly for 12 sessions and it was awful and left long term effects like neuropathy and obviously lost hair. I don't regret doing it as I had 2 children, 1 asd who will need me for life. At 78 her life expectancy may not be that long anyway and I would prefer better quality of life for less. The chemo for most people has no impact on life expectancy my oncologist told me but for a small percentage (Predict Breast will tell you what percentage) it saves their lives. Some chemos can cause heart issues but the oncologist can advise.

At my hospital 3% or under they don't recommend chemo, 3% to 5% is borderline and goes to oncotype but they are veering towards stopping this group and over 5% is best to do chemo but obviously affected by age. I was 6%.

Unless she was frail, I’d absolutely encourage her to have chemo.

My aunt has recently recovered from breast cancer. She was a little younger- early 70s and otherwise healthy. She had a type which could be fully ‘cured’ with chemo and radiotherapy. I think it was a tough year or so but she’s now well and doesn’t regret it.

My 72 year old mum was told she was becoming chemo resistant after gruelling surgery and intense rounds of chemo which almost killed her itself. She made the decision to stop all treatment and is still alive 6 years on, very well in herself.
Chemo was very tough - maybe it did what it needed to but it’s made me think hard about it, should I ever be offered it.

Mum has just finished her second lot of chemo - first when she was 73 and now when she is 77 (ovarian cancer). Chemo took 6 months each time and was miserable for her, life pauses and you spend the weeks following the chemo feeling awful, as soon as you start feeling ok it’s time for another round. But she is now back golfing, seeing friends, going away abroad and visiting family. I think she would say it was worth it.

My Mum had surgery for bowel cancer at the age of 79. She was really frail, GP had diagnosed IBS and she deteriorated very quickly. After her surgery she refused chemo, made an excellent recovery and died two years ago, one week short of her 93rd birthday.

For her I think the decision to refuse chemo was the right one, but I would have supported her whatever she decided and it had to be her decision.

The way it prevents it coming back is by killing any bits of cancer (could be single cells) that have been missed or have spread beyond the site of the surgery.

I also think it should be her decision and would support her either way and not put pressure on though its good to be as informed as possible. As she has a free oncotype its highly likely that chemo for 3-4 people in 100 would mean they survive 10 years, for the other 95-97 it makes no difference to life expectancy according to my oncologist.

The chemo is called preventative but its incase anything has survived they can't see on scans which could come back and then its stage 4 and with breast that's an average life expectancy of 3 years.

I looked up her general life expectancy at 78 for whole population female and its 11 years.

Thanks again everyone, it’s all really helpful.
It is absolutely her decision and I will support her with whatever she chooses but she is still working out what to do and likes talking things through. I am in the very fortunate position where I have no experience at all with chemo (I don’t even understand how it is given) so I am just keen to understand the range of other people’s experiences. It would be very easy (and naive) for me to say “I want you around for as long as possible and chemo will definitely make that happen so do what you like but please do that…” and I really don’t want to do that and I especially don’t want to do that when I know zero about anything. She will do what she wants and likes her doctors but if I am a sounding board then I want to be a slightly informed one.

Chemo is different for everyone and every cancer. The Predict tool I linked earlier will give you a benefit % based on her specific cancer. Often with stage 1pr 2 breast cancer the % benefit is really quite small.

I would say as someone that has undergone chemo for breast cancer. To be advises by the oncologist. They really do understand the big picture

Would suggest she speak to Mcmillan to explore the implications.

Having watched a friend support her DH through chemo with only a statistical prognosis of ‘5 years’ life expectancy. The last 2 years of those have been hellish with surgery, immunotherapy and chemo [to now be cancer free, but still require treatments immunotherapy]. At 64 he is relatively young and now has a longer life expectancy, but he has been so ill for the last 2 years that I can understand why many choose not to bother. My DH’s BF died of a brain tumour just after covid era. He was given a 3m prognosis and treatment gave him 3 more years, which his BFs, mum and siblings were selfishly grateful for - but the quality of his life and the toll it took on his wife is something she has never recovered from. And she was a specialist theatre nurse. It destroyed her.

So, I would encourage her to speak to a cancer advice service and her cancer care team to make an informed decision. Treatment is a harrowing and arduous path and deciding to take it takes as much bravery and resilience as deciding not to. I’d have no problem supporting someone in deciding not to have treatment having seen the impact it has.

It's a personal choice - there's no right answer. I'm 61, and I'm inclined to think I'd be saying "no" to chemo but, of course, it would depend on the exact circumstances. Having good information and an open mind is all we can ask.

This. Chemo is often erroneously referred to as preventative or mop up. In fact, the percentage improvement in outcome can be very minor. I was quite shaken and disappointed by that but still went ahead as I felt inclined to throw everything at it. I was late 50s.

Of course, each case is different and not all cancers are the same, likewise chemotherapies.

One more set of data points that might be helpful, is type your question into ChatGPT or another version. Give all the details of your Mum, the cancer, what they have done so far, the tumor staging and receptor status, and ask what the pros and cons are for doing chemo, hormone blockers and chemo, just hormone blockers or nothing. Also ask for predicted life expectancy and ask it to separate answers into those based on clinical information from peer review studies and general non medical guidance from sites that support women with the disease.

And also tell the AI you are in the UK as that makes a difference