Q: My friend has an elderly relative in his late 70s who was recently diagnosed with leukaemia. He has high blood pressure and she is worried that chemotherapy might not be the most suitable option for him.
Are there risks for elderly patients with high blood pressure who need to undergo chemotherapy?
Are there other better options?
A: There are different types of leukaemia. It would be useful to know which type of leukaemia your friend's relative has.
In general, it is always challenging to treat leukaemia in elderly people, because of their co-existing illnesses or reduced physical fitness.
Many elderly people have one or more common chronic diseases such as high blood pressure, high cholesterol and diabetes.
They may still be considered suitable to undergo chemotherapy for leukaemia.
A thorough assessment by a specialist is required to determine if the patient is suitable to receive chemotherapy.
The recommendation of treatment will be based on the type of leukaemia, any co-existing illness, the physical fitness and the age of the patient, which influences the treatment success rate and the treatment-related risks.
The type and the severity of side effects vary between different chemotherapy regimens.
Common side effects of chemotherapy include loss of appetite, nausea, vomiting, hair loss, diarrhoea or constipation, sore mouth, fever, skin rash and fatigue.
More serious side effects may occur. These include anaemia (the deficiency of oxygen-bearing red blood cells), bleeding, infection and organ dysfunction.
Frequent monitoring is required after chemotherapy.
Generally, elderly people tend to experience more side effects from chemotherapy. I think this is what your friend is worried about.
But side effects and serious complications related to chemotherapy may still occur even in younger patients who are deemed fit to receive intensive chemotherapy for acute leukaemia.
DRUGS WITH LOWER TOXICITIES
Elderly patients will usually need individualised treatment recommendations.
With advancing medical therapy, some less intensive chemotherapy drugs with lower toxicities are now available and are better tolerated by elderly patients.
However, the less intensive chemotherapy drugs are useful only for certain types of leukaemia and may not be suitable or effective for every individual.
Do not forget that quality of life is a very important factor to consider in cancer treatment for elderly patients.
Occasionally, I have to suggest measures to ensure good quality of life, rather than to offer treatment which worsens the quality of life but does not guarantee cures for elderly patients with leukaemia.
Sometimes, I invite other physicians who are specialised in palliative care to help in relieving a patient's symptoms.
However, if chemotherapy can potentially improve the patient's symptoms and quality of life, I would not hesitate to recommend it.
Certainly, the benefits and risks of a treatment method need to be weighed carefully.
FAMILY, SOCIAL SUPPORT NEEDED
One important thing I have realised from my years of experience is that we must try to involve the patient himself in the decision-making of cancer therapy, unless the patient deliberately does not wish to be told of the cancer diagnosis.
Patient autonomy must always be respected and this is vital in the management of leukaemia.
I would therefore encourage your friend and her elderly relative to discuss with his physician the pros and cons of the different treatment options.
Last but not least, family and social support are essential to patients with leukaemia.
Emotional support from family and friends who have positive attitudes often help patients to better endure the discomfort caused by the disease and its treatment.
DR RICHARD YIU, consultant at the department of haematology at the Singapore General Hospital
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