Long-term health conditions can affect people of any age, but they become more likely as you get older. As you age, you are also more likely to develop cancer, including many types of lymphoma. As people now live longer than ever, an increasing number of people are living with cancer and other health conditions together. Some of the most common conditions that could affect your treatment for lymphoma include:
- Problems with organs, such as your heart or lungs. These could affect how well your organs are working and might mean you could have more serious side effects than usual with some lymphoma treatments.
- Problems that mean you have to monitor your health regularly and take medications. These include conditions such as diabetes, high blood pressure or HIV, among many others. Your medical team consider whether you need to change any medication or need more monitoring and care if you have another condition for which you are taking medication.
Your medical team plan your treatment for lymphoma specifically for you. They take into account any other health conditions you have and assess how fit you are. They want to recommend the best treatment suitable for your situation, so they have to consider what other conditions you have and balance the risk of treatment side effects with how effective it is. It is important that your other health conditions are managed well, and you are as fit as possible before you start to receive your lymphoma treatment. Tell your medical team about any conditions you have and all the medications you are taking, including vitamins and supplements.
This is important because:
- If you have other health conditions, or are frail or unwell, you might be at higher risk of serious side effects, such as infection.
- Some treatments for lymphoma could make your other health conditions worse or cause other long-term problems.
- You might need extra tests to find out if you are fit enough to receive certain treatments, for example tests to see how well your organs are working.
- You might need to change the way you manage your other conditions. Some medications can cause serious problems if they are given together.
Your medical team will talk to you about your treatment options, and discuss with you their risks and their benefits.
As you age, your body becomes less able to repair itself and your organs might not work as well as they used to. For example, your kidneys and liver might not be able to break down drugs in the same way as they would in a younger person. This makes side effects of treatment more likely. Your medical team take this into account when planning your treatment.
Your choice of treatment should not be based just on your age. Your medical team consider all of your individual circumstances, including how active you are and the health of your organs. If your medical team have concerns, for example about the health of your heart, they can do extra tests to find out if your organs are working well.
Older people are more likely to have practical issues, too, such as difficulty getting to and from the hospital. You might need someone around to care for you and keep an eye on you, which can be difficult if you live alone. Tell your medical team about your circumstances so they can help you find appropriate support.
This section explains how treatment can be adapted for people with lymphoma and other conditions. Our webpages on different types of lymphoma have more specific information on different treatment options for each type of lymphoma.
Goals of treatment
Your medical team consider your goals when making a treatment plan. Some people want – and can tolerate – strong treatments that are more likely to cure the lymphoma. Other people prefer to have gentler treatments that keep the lymphoma under control for a time with fewer side effects but are unlikely to cure the lymphoma. If you have a slow-growing lymphoma, you might have active monitoring (watch and wait), where your lymphoma is monitored until it gets worse and needs treatment. Many slow-growing lymphomas are kept under control for many years with active monitoring and gentle treatments when they are needed.
Some people with aggressive (fast-growing) lymphoma that hasn’t responded to treatment may prefer to control their symptoms rather than undergo more intensive treatments, even if this means their lymphoma can’t be cured. This might be called ‘palliative care’.
Your medical team will discuss all your options with you.
How can treatment be adapted?
Standard treatment can often be adapted or different treatment used for people who can’t have standard treatment.
- Reduced doses: CHOP is a very common chemotherapy regimen (combination of drugs) used for people with lymphoma. If you can’t have the usual doses because you are too frail or you have other health conditions, you might be able to have the same drugs at a lower dose – ‘Mini-CHOP’. Many people have CHOP or mini-CHOP with the antibody treatment rituximab. It is then known as ‘R-CHOP’ or ‘mini-R-CHOP’.
- Fewer or different drugs: You might not be able to have certain drugs if you have heart or lung problems. Some chemotherapy regimens can be adapted. For example, bleomycin is often omitted from the ABVD chemotherapy regimen for older people with lung conditions.
- Gentler treatment options: There are many different chemotherapy options, and your doctor might suggest a gentle option as the most suitable for you if you have other health conditions. Treatment with chemotherapy tablets you take at home can be an option for some people.
- Targeted drugs: There are sometimes clinical trials running which test newer targeted drugs (or ‘novel therapies’) for people who are older or who are less fit and unable to receive the usual chemotherapy treatments.
Some people can have the usual treatments, but might need to make other adjustments. For example:
- medications you are on for your other health conditions might be changed or temporarily stopped
- your lymphoma treatment might be changed or temporarily stopped if you have side effects
- you might receive additional treatments to support your body through your lymphoma treatment, for example, blood transfusions or growth factors to keep your blood counts healthy
- you may need to be admitted to hospital for your treatment, or monitored more regularly than usual.
Reserving treatment until you need it
People whose lymphoma is not causing problems do not always need treatment straightaway, even if they are fit and well. Many people with low-grade (slow-growing) lymphomas that are not causing troublesome symptoms or problems with have periods where they can be monitored without treatment. This is known as ‘active monitoring’ or ‘watch and wait’.
When your doctor suggests this approach, it is because there is no benefit in treating you immediately before the lymphoma is causing problems. It allows you to avoid the side effects of treatment for now, and saves the treatment for when it is needed. Ask your doctor to explain why they recommend ‘watch and wait’ and what the plan will be if your lymphoma gets worse.
Some people do not need changes to their treatment, but may require other types of support.
- If you live alone or care for someone else, ask what practical support is available to help you manage.
- Some people find counselling helpful during this difficult time.
- If you are caring for someone who has difficulty understanding what is going on, ask their medical team for information that is easy to understand, or ask for someone to explain the information.
Macmillan Cancer Support have educational resources for those caring for people with dementia and cancer.
It is important that you are comfortable with the treatment plan your medical team makes with you. Ask all the questions you need, to make sure you understand all the risks and benefits of your treatment. If you are concerned that the treatment might not be effective or are worried about potential side effects of treatment, please share your concerns.
You might find it helpful to take someone with you to appointments so you can discuss what happened or to have someone who can take notes and ask questions if you forget them. You could ask a family member or friend to come with you. If you don’t have anyone to come with you, ask the doctor or nurse to write things down for you or ask if you can record the conversation.
Remember that your medical team need to understand your personal circumstances and your thoughts on treatment. Tell them about the medicines you are taking, any health problems you have, any support you might need and what is important to you. They can also help you talk to your family or friends if their views on treatment are different to yours.