Co-existing conditions are medical illnesses or problematic conditions that a person has along with cancer, such as high blood pressure, diabetes, or depression. These conditions often influence how a person responds to treatment, including:
- Prognosis (chance of recovery)
- Ability to undergo treatment
- Recovery from treatment
Recognizing co-existing conditions is a crucial part of the treatment decision-making process.
Common co-existing conditions and how they can affect treatment and recovery
Co-existing medical conditions can place an older adult at an increased risk for treatment-induced side effects and a slowed recovery time. The following conditions should be taken into consideration when cancer treatment decisions are being made. This is a partial list, and all co-existing conditions should be discussed with your doctor before treatment begins:
Heart conditions. Congestive heart failure, high blood pressure, arrhythmias (irregular heart beat), and a decrease in heart function may reduce the older adult’s ability to undergo therapy. Moreover, many cancer drugs can have a harmless effect on the heart; some medications that are taken for a heart condition may interact with certain cancer drugs.
Lung conditions. Emphysema (a lung disease characterized by difficulty breathing on exertion), chronic obstructive pulmonary disease (loss of lung function), and decreased lung function affect how well older adults with cancer tolerate certain cancer drugs.
Kidney failure or decreased kidney function. As the body ages, there is a decreased ability of the kidney to get rid of certain substances. Many cancer drugs are excreted by the kidney, thus placing the older adult with cancer at an increased risk for kidney dysfunction because of the inability to eliminate the drugs normally. Kidney problems may prevent the older adult from receiving intense therapy.
Stomach problems. A decrease in stomach function and malabsorption problems (difficulty absorbing nutrients from food) can be made worse by certain cancer drugs, especially those that cause nausea, vomiting, or diarrhea.
Inadequate nutrition. Poor nutrition is often associated with a decrease in the ability to consume food, perhaps due in part to loss of teeth, new dentures, or certain medications. These factors may also contribute to a decreased appetite or weight loss. Talk to your doctor or a registered dietitian (RD) for more information on maintaining adequate nutrition during cancer treatment.
Smoking. Smoking can increase the risk of developing lung complications after surgery and may interfere with recovery.
Alcoholism. A dependency on alcohol or any other mind-altering substance can interfere with informed consent, treatment compliance, and recovery from certain therapies.
Anemia. Anemia, a condition characterized by a decrease in red blood cell count, may worsen with cancer treatment. Patients may need medications to treat anemia or require blood transfusions during treatment. Although anemia may not change the course of treatment, it can lead to delays in treatment if the individual takes longer to recover.
Depression and anxiety. Depression and anxiety are common psychologic complaints of older adults. Feelings of social isolation from the loss of a spouse or from family or friends moving away can make an older adult feel alone, contributing to feelings of depression. Many older adults may already be taking antidepressants or anti-anxiety medications. Co-existing mental health challenges and any associated medication needs to be taken into consideration, especially as certain medications used during cancer treatment can cause fatigue, dizziness, and other neurologic side effects. Depression, anxiety, and other mental health issues may also interfere with an individual’s ability to participate actively in medical decision-making.
Pain and immobility. Pain and decreased mobility (ability to move around) are common complaints among older adults. Causes include underlying illnesses, such as arthritis or pain. Lack of mobility may affect an individual’s ability to receive treatment and may increase the risk of treatment complications.
It is important to identify these conditions because they may interfere with a person’s ability to choose or undergo treatment for their cancer.
What to discuss with your doctor
- An accurate list of medications that you are currently taking and any side effects you are experiencing from these medications
- A complete medical history, including any co-existing illnesses and how they affect your everyday functioning
- Any issues that may affect your ability to undergo treatment, such as living alone, not having adequate means of transportation, and any financial barriers
- A list of names and phone numbers of any other doctors that are taking care of you
While this information is important to the doctor, there may be questions that you have that are important for you to have answered before you can make an informed decision. These issues can include:
- What is my prognosis?
- What can I expect to gain or lose with treatment?
- Will treatment require me to be in the hospital, or will I be treated as an outpatient?
- How long will the treatments last?
- What are all of my treatment options?