Colon cancer treatment for elderly

[Cb75]

My husbands 86 year old grandmother was recently diagnosed with colon cancer. I have limited information, but believe there is some lymph node involvement and perhaps some liver involvement as well. The doctors seem to be moving very slowly with her. How aggressively are older colon cancer patients typically treated. Do they do anything? Or just let it progress? I'm not sure she could handle chemo and or surgery. Although she is generally in pretty good health for her age.

[KarMel]

Elderly may have a harder time with chemo and treatment for CRC.
If grandma is mentally alert and competent to make decisions, she certainly should give her input. Does she have close relatives who will be able to help her at home, take her to appts, all that stuff?

I have known several folks in 80's or 90's who just said no to chemo because didn't want to spend rest of life feeling miserable. Whereas others say... Do everything.!
That's why grandma's input is important.

[Maia]

I've read that colon cancer in older patients tends to be slow moving so, often, treating aggressively doesn't make sense -because of quality of life and the immunosupressive effects, standard first line chemotherapy might be do more harm than good. If surgery is an option and she's fit for it, maybe doctors will propose it... On the other hand, capecitabine monotherapy (Xeloda only) would be an option to do something, without hospital visits for infusions and little side effects. Capecitabine monotherapy for frail or elderly patients is protocol, as per the NCCN guidelines, and I'm aware pyshicians in Canada respect that also. My friend refused first line treatments containing irinotecan a/o oxaliplatin, so her onc had to agree on a Xeloda only regimen --and she's 57.
In the case of someone 86 yo, maybe a really low dose capecitabine (500 mg /day) could be a good idea because it doesn't do much killing of the cells but acts mainly by creating a bad environment for the rough cells (so they can't grow new blood vessels and keep metastasizing). She shouldn't feel any side effect at that dose and there are chances that it'll slow the progression. Here you have a case --it's just a case and about other cancer, but there is an explanation there that might be of your interest, about low-dose chemotherapy on a metronomic schedule.
On the other hand, I've personally known a lady who was diagnosed with colon cancer at 84, advanced; doctors tried to operate her but stopped the surgery because they considered the cancer was too wide-spread. She went on with her life, not symptoms from that. She died at 91 after maybe two weeks of feeling not well enough to get out of bed.

Elderly may have a harder time with chemo and treatment for CRC.
If grandma is mentally alert and competent to make decisions, she certainly should give her input.

I agree with that!
Wish you and her the best.

[Maia]

Cb75, you can read alternatives here: Metastatic colorectal cancer in the elderly: An overview of the systemic treatment modalities (Review) (2011)
The rationale about Xeloda only ("Capacitabine monotherapy") is on page 5.

[MonaL]

Dad was about 78 when the two mets to his liver were identified. The onc told him that he was not a candidate for surgery and said that he would be ecstatic to get Dad 2 or 3 more years. Dad was pretty persistent, and got him to consult a surgeon who agreed to operate if the mets responded to chemo (he was on Xelox). I do believe that the once was not aggressive with him due to his age, and, in fact, actively tried to dissuade him.

It is absolutely true that the chemo took it's toll, and triggered Parkinson's disease, but he's been over 3 years NED now, and I believe that he wouldn't have done anything different.

My mom, 5 years older, I believe would not have wanted to got through chemo and the surgeries. With each 'bout of anesthesia, is now much tougher on them. I do not know what Dad would do if he has a recurrence.

[Laurettas]

This is a difficult topic, and one that I ponder from time to time since my dad had stage 3 colon cancer and the possibility of recurrence is always there. I think one of the things that makes decisions concerning the elderly more difficult is the fact that the thing that makes many older people more susceptible to scammers and charlatans makes it more difficult for them to make a reasoned decision about matters such as this as well.

A small example would be something that happened a couple of years ago with my dad. He had a growth on one eye for most of his life. The opthamologist talked him into having it removed but it caused him some vision problems after. He commented on the problem to the doctor who then wanted to prescribe contacts for my dad. Well, his hands are stiff and his touch is not good at all but he was just going to go along with what the doctor mentioned until I actually asked him if he thought he would want to bother with the issue of putting the contacts in and out given the condition of his hands. He thought briefly about it, said no, went home and has adjusted fine to the vision issues he was having. Never mentions it now. But if I hadn't brought up the reality of what contacts would mean to him, he would have spent several hundred dollars for something that he would have never used.

[hannahw]

Absent other medical conditions that might complicate treatment and make it less beneficial and less advisable, I think this really comes down to a matter of personal preference. As Mona indicated, her Dad wanted to press forward and he's done well. Her Mom might not make the same choice. And even now, a few years later, her Dad might not go through it all again if he experiences a recurrence. So it's really a case of the patients unique circumstances combined with their own values and expectations. There isn't a right or wrong answer.

It seems like, with older patients, docs tend to take a more conservative approach. In some respects, this could be very helpful to an older patient who doesn't want to make the decision on their own. In general, treatment does seem to take a higher toll as people age. Older patients probably should not press forward unless they really feel strongly about it. But, it's also not a decision the doctor should be making without first understanding the patient's goals and expectations. In providing guidance the doctor should combine their clinical knowledge with the goals of the patient to form a cohesive plan.

The doc should really sit down with your grandma and learn what she wants and values at this time in her life. Is her aim quality over quantity? Or something else? Only she can truly say. Would she want life saving measures such as CPR to be taken in the event she went into cardiac arrest? All people, regardless of age and healthy should have a plan put in writing regarding their wishes for life saving treatment. If you don't want EVERYTHING done, it's important to get it in writing and to make those wishes known to family and friends. One of the great stresses placed on family is when they have to make choices about whether to continue with life saving measures. What family generally wants is to be able to honor the wishes of their loved one. But they can only do that if they know what those wishes are.

I think the best thing you can do is talk to your grandma about what she wants. And make sure you're not influencing her with thoughts of you want for her. Find out what she wants and make sure it's communicated to her doctor.