Weighing the Pros and Cons: Should Chemotherapy be Given to Elderly Patients?
There are many challenging views on ethical dilemmas in the medical community, all of which take into account several interpretations and considerations that vary from one individual to another. In the world of cancer treatment, elderly patients are quickly becoming the most imperious mass due to their controversial stance in chemotherapy. It is essential to consider alterations and adverse effects while providing treatment to these patients, as they experience many physiological changes while going through chemotherapeutic treatment.
Chemotherapy has highly cytotoxic effects which inhibit the growth and multiplication of cancerous cells as well as normal cells. Decisions in these situations are generally made by the physician and the family members together; a variety of concerns and attitudes may be expressed by the individual in question. As Matti (2005) concluded, the effectiveness and well-being of an elderly patient in the middle of chemotherapy is different from that in any other treatment. The side-effects of chemotherapy often overshadow its benefits.
In oncology patients age is the major risk-factor for chemotherapy-induced complications because it causes disorders such as neutropenia, myelosuppression, cardiac toxicity, peripheral neuropathy, pulmonary fibrosis, and thrombocytopenia. These complications can further worsen the patient’s quality of life and reduce the survival period.
However, in my perspective, this treatment should be withheld from elderly patients in order to avoid a painful induction death because of its adverse biological and psychological impact on human life. In addition, its high cost would make one’s life miserable due to socioeconomic unrest. Circumstances in which the success rate is low and the patient’s quality of life is deteriorated, the futility of this option must be considered in the opinion of the patient, family, and healthcare team members.
My clinical experience reflects that the psychological health of oncology patients diminishes when they are on chemotherapy. For one, it produces a range of biological disturbances in the human body, and from the psychological point-of-view, it induces signs and symptoms like irritability, anxiety, low self-esteem, mood swings, etc. in the patient. Some of these patients even become fully dependent on anti-psychotics and anti-depressants. In addition to this, their family continues to suffer the burden of unsuccessful chemotherapy.
A specific intervention with the objective of doing well (beneficence) may mitigate much of the suffering for the patient. It upturns the extreme effects of ‘do not harm the patient’, a principle known as non-maleficence. In regard to chemotherapy administration to elderly patients, the harm outweighs the benefit and paradoxically increases suffering in life; the role of healing ultimately reinforces the pain brought initially by the disease.
With this current narrow focus of curing disease, ethical issues regarding quality of life and suffering of the disease are mostly neglected. In a nutshell, age is an important determinant to consider while providing treatment (chemotherapy) to cancer patients. In my opinion, this treatment should be discouraged in elderly patients due to its unbearable effects on physical as well as psychological health.
The other most important point in regard to administration of chemotherapy to elderly patients is its inaccessibility and lack of affordability to all social classes. The prime reason for avoiding this treatment are resultant physiological changes in elderly patients, who are highly susceptible to developing rapid cytotoxicity. If chemotherapy is provided to the elderly patients, it may have many undesired and serious complications and may even lead to death. The decision to pursue chemotherapy should rest in the hands of the patients and family members after careful consideration of these factors, while palliative-care physicians and nurses should be provided with clinical guidelines addressing the existing deficits of this treatment modality.
Matti S.A., Claus H.K., Harvey J.C., & Martine E.A. 2005. Never too old? age should not be a barrier to enrollment in cancer clinical trials. The American Journal of Medical Oncology,10(3),198-204.
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