Oral Chemotherapy for Stage II Colon Cancer: Risks and Benefits for Elderly Patients

Oral chemotherapy drugs

Hello Dr.
Chen, my mother is 86 years old and underwent a right hemicolectomy for a tumor at the end of March.
She has now been discharged and is back home.
However, the pathology report indicates that although it is stage II, the cell differentiation is poor, and the doctor has recommended oral chemotherapy.
Our family is concerned about potential side effects, such as leukopenia or mucosal ulcers in the oral and gastrointestinal tract, which could cause discomfort and loss of appetite for my mother.
She already has poor dental health and, given her age, we worry that any impact on her eating could lead to long-term malnutrition.
We would like to ask the doctor about the differences between not taking oral chemotherapy and taking it for a stage II colorectal cancer patient post-surgery.
Our family feels that at 86 years old, after undergoing surgery, the side effects of additional medication could cause significant distress for her, which is not something we want to see as her children.
However, we are also concerned that our considerations may not be appropriate.
We kindly request your professional advice.
Thank you!

Mr. Zhang, 40~49 year old female. Ask Date: 2017/04/21

Dr. Chen Sirong reply Oncology

Mr.
Zhang / 47 years old / Male
Hello,
1.
I would like to ask the doctor about the differences between not taking oral chemotherapy drugs and taking them for a stage II colorectal cancer postoperative patient.

A: Personally, I believe that the differences in taking or not taking the medication are not the primary concern.
The doctor has already determined that taking the medication reduces the risk of recurrence.
The family is more concerned about the side effects.
2.
We kindly request the doctor to provide us with professional advice.

A: I suggest trying the medication first.
The same drug can have different side effects for each individual, and not every patient will experience side effects.
The probability of experiencing side effects is not 100%.
Give it a try, maintain it for a period, and then reassess the actual side effects.
There is no need to overthink it, as the anticipated side effects may not be as severe as expected.
Wishing you a speedy recovery and good health.
Taoyuan Hospital
Dr.
Chen Si-Rong

Reply Date: 2017/04/21

More Info

When considering oral chemotherapy for an 86-year-old patient with Stage II colon cancer, it is essential to weigh the potential benefits against the risks, especially given the patient's age and overall health status. Stage II colon cancer typically indicates that the cancer has not spread to the lymph nodes or distant sites, but the quality of the tumor cells (in this case, poorly differentiated) can influence treatment decisions.

Benefits of Oral Chemotherapy
1. Reduced Recurrence Risk: The primary benefit of adjuvant chemotherapy, including oral options, is the potential reduction in the risk of cancer recurrence. For Stage II colon cancer, particularly with poorly differentiated cells, chemotherapy may help eliminate any microscopic disease that could lead to recurrence.

2. Convenience: Oral chemotherapy can be more convenient than intravenous options, allowing patients to take medications at home without frequent hospital visits.

3. Quality of Life: For some patients, oral chemotherapy may allow them to maintain a better quality of life compared to more aggressive treatments, as they can often continue with daily activities.

Risks and Concerns
1. Side Effects: The side effects of oral chemotherapy can include nausea, vomiting, diarrhea, fatigue, and myelosuppression (decreased blood cell production), which can lead to complications such as infections due to low white blood cell counts. For an elderly patient, these side effects can be particularly concerning, as they may exacerbate existing health issues or lead to hospitalization.

2. Nutritional Impact: As you mentioned, your mother already has dental issues, which may complicate her ability to eat if she experiences oral mucositis (painful inflammation and ulceration of the mucous membranes). This could lead to nutritional deficiencies, which are particularly detrimental in older adults.

3. Overall Health: The decision to proceed with chemotherapy should also consider your mother's overall health, including any comorbidities she may have. Elderly patients often have a different physiological response to chemotherapy, which can increase the risk of severe side effects.

Considerations for Decision-Making
1. Consultation with Oncologist: It is crucial to have a detailed discussion with your mother's oncologist about the specific chemotherapy regimen recommended, including the expected benefits and potential side effects. The oncologist can provide insights into how the treatment may impact her quality of life and overall prognosis.

2. Trial Period: Some oncologists may suggest a trial period for the chemotherapy to monitor how well your mother tolerates it. If side effects become unmanageable, adjustments can be made, or the treatment can be discontinued.

3. Supportive Care: If chemotherapy is initiated, consider integrating supportive care measures to help manage side effects. This may include nutritional support, medications to prevent nausea, and regular monitoring of blood counts.

4. Family Involvement: It is essential for family members to be involved in discussions with healthcare providers. Expressing your concerns about your mother’s quality of life and potential side effects can help the medical team tailor the treatment plan to her needs.

Conclusion
In summary, the decision to use oral chemotherapy for your mother should be made collaboratively with her healthcare team, considering her specific cancer characteristics, overall health, and personal preferences. While the potential benefits of reducing recurrence risk are significant, the risks, particularly in an elderly patient, must be carefully evaluated. It is essential to prioritize her comfort and quality of life in this decision-making process.

Similar Q&A

Managing Chemotherapy Side Effects in Elderly Patients with Rectal Cancer

Dear Director, My father is 84 years old. After the Lunar New Year, he was diagnosed with stage 2B rectal cancer (the tumor is 4 cm from the anal opening). The attending physician assessed that the tumor is too large and recommended six cycles of chemotherapy along with five wee...

Dr. Lai Yicheng reply Oncology
Dear Miss Hsiao-Yun, Thank you for your letter. Here is my response: Your father has a stage 2B malignant tumor in the lower rectum, and there is a possibility for "sphincter-preserving treatment." Based on our experience, preoperative radiation combined with chemother...

Chemotherapy Choices for Stage 2B Colon Cancer: Traditional vs. Oral Options

For stage 2B colorectal cancer, is it better to use traditional chemotherapy or oral chemotherapy?

Dr. Chen Yunfang reply Oncology
Hello: Essentially, both types of medications are "5FU," with the difference being whether it is the original injectable form of 5FU or the later developed oral capsule form (marketed as Ufur). The efficacy of both is quite similar (as the active ingredient is nearly th...

Understanding Chemotherapy for Elderly Patients with Breast Cancer

Dear Director Lai, I apologize for the intrusion. My mother is 76 years old and was diagnosed with stage II breast cancer in February of this year (with a 2.5 cm tumor in the left breast; CT and bone scans showed no metastasis). She underwent surgery in March to remove the left ...

Dr. Lai Yicheng reply Oncology
Dear Mr. Huang, I understand from your letter that according to the National Health Insurance guidelines for targeted therapy, your mother must first complete chemotherapy before being eligible for "Hecancerping." If you wish to use the targeted medication directly, no...

Is Chemotherapy Safe for My 81-Year-Old with Stage III Colon Cancer?

My mother-in-law is 81 years old and has just undergone surgery for stage III colon cancer. She has a stent in her heart. Is chemotherapy suitable for her? If she undergoes it, will it pose a threat to her life? How long might it take for her condition to worsen?

Dr. Chen Junyi reply Oncology
Older individuals with poor health should consider the option of oral medications to reduce the risk of recurrence.