Chemotherapy at 84 - is that possible?

Elisabeth Matter* was 84 years old when she was diagnosed with breast cancer. After the operation, the oncologist recommended chemotherapy. "She was the oldest patient we treated with chemotherapy," says Dr Cathrin Balmelli, oncologist at the Basel Bethesda Hospital Breast Centre. The senior underwent this therapy with scalp cooling very well, did not lose her hair and says she would do it again. "She is a patient who has clearly benefited from this therapy." The fact that everything went so well is due to Mrs Matter's good general health.

She lives independently, is mobile and active. She also has a good social network and has no limiting concomitant illnesses. "Because of these conditions, she had a life expectancy of a good ten years at the time of chemotherapy," the oncologist calculates. Before prescribing chemotherapy to an elderly person, she weighs up the options carefully: How fit is the patient, how much medication is she taking, is she at risk of falling and how good are her cognitive abilities and socialisation? If someone has incipient dementia, it is important to consult with relatives and the family doctor before starting treatment. "It is important that the patient is able to behave appropriately in an emergency situation and report if, for example, a fever occurs. If someone is unable to do this, it can be very dangerous," explains Dr Balmelli.

Careful consideration and close monitoring

When deciding in favour of chemotherapy, it is important to weigh up the risk of the disease worsening on the one hand and the effects of the side effects on the other. "We work with various scores, i.e. measurements that we can use to estimate how good the general condition is and how high the expected toxicity of chemotherapy is." In the case of the elderly, we are cautious with so-called polychemotherapy, in which several active substances are used. "I'm cautious with over 75-year-olds and carefully weigh up the risk/benefit depending on their biology." However, the dose is the same for everyone and is adapted to the patient's height and body weight. Older patients can also undergo this therapy on an outpatient basis. Dr Balmelli follows the patients closely to see what reactions occur.

Certain side effects can be limiting for older people, such as neuropathies, which can cause tingling or numbness in the fingertips and toes. This can impair gait safety. "You have to monitor the side effects closely and adjust the dose in good time."

At Bethesda Hospital, breast cancer patients can also utilise the services of the Breast Care Nurse and the psycho-oncology department. This support can be particularly helpful for single senior women so that they can also get through chemotherapy well "It is feasible and it also protects an elderly woman from a relapse or recurrence of the cancer," Dr Balmelli sums up.