Alexis OShaughnessy Presnell Engl. 1102 11 Apr. 2014 Chemotherapy: is it helping or harming elderly patients??

Mable Coxs Story My grandmother Mable Cox was diagnosed with brain cancer in November of 2013. Here is her story. The day I found out my grandmother had brain cancer, I was lost for words. I could not bare the thought of losing this wonderful woman. After we got the news, the doctors wanted to do an MRI scan to see where the cancer originated and what it looks like. From the scan they saw it originated in her lungs. They began treatment immediately. It was as if they just wanted her to get on chemotherapy and radiation as soon as possible even though they gave her 2 months to live. My thought was that it made no sense to make a poor woman suffer these harsh treatments when she was already going to pass away. Why not let her go peacefully? I then realized that doctors treat every patient differently and the best decision for her according to them was to take a week of chemo and a week of radiation for 20 weeks and see where the cancer ends up. After about 2 weeks of chemo and radiation my grandma looked HORRIBLE. I thought for sure that chemo was to blame for her horrible condition. She could not do anything herself and was starting to forget everything. She always had the most incredible memory but this treatment was causing her to have some dementia. This made me very angry and confused because I thought that whole point of treating the cancer was to make her feel better, not become worse!. I didnt know why the doctors put such a weak old woman through this harsh treatment that they normally give to functioning younger patients. As the weeks went by the chemotherapy had really done my grandmother in. She was incredible feeble and was not herself at all. One day she started up this really bad cough which eventually led her into the hospital. That cough had turned into pneumonia because of her low white blood cell count. The chemotherapy had made her body so vulnerable to any illness in the air. Her immune system had been totally destroyed and my uncle who was taking care of her passed his cold to her. After that incident my family took precaution in visiting her and made sure no one was sick or had been sick if they were to see her.

Things finally started looking up in February, she had an MRI scan to see where the cancer was at the time and wanted to see if it had drunken or gotten larger. To everyones surprise, the cancer was virtually gone. The doctor said that in his exact words. All this time I thought my grandma was going to pass away not from cancer, but from this horrible treatment that broke her body down to almost nothing. I now have a different view on chemotherapy and I now believe it provides miracles. March 31, 2014 was her last day of chemotherapy. I am extremely grateful for chemotherapy, but at the same time it still has left her with some bad side effects. Her body is still so weak that she cannot do anything herself anymore, she is constantly in pain, and her dementia has gotten a lot worse. I am torn on whether I think chemotherapy is a good way to treat cancer or if it has too many risks.

What is chemotherapy anyway? The Mayo Clinic is a nonprofit worldwide leader of medical care, research, and education. According to their website, Chemotherapy is a drug treatment that uses powerful chemicals to kill fast-growing cells in your body. Chemotherapy is most often used to treat cancer, since cancer cells grow and multiply much more quickly than most cells in the body. Many different chemotherapy drugs are available. Chemotherapy drugs can be used alone or in combination to treat a wide variety of cancers. Though chemotherapy is an effective way to treat many types of cancer, chemotherapy treatment also carries a risk of side effects. Some chemotherapy side effects are mild and treatable, while others can cause serious complications.(Mayo) To the right is a picture of an elderly cancer patient who is going through a round of chemotherapy. This picture shows pain that the patient is going through. I questioned whether or not the side effects were even worth giving to these elder patients since their bodies are in a much weaker state than a younger persons. The elderly have a weaker body because of aging of the bones and bodily organs, which makes them more vulnerable to chemotherapy. Some of the side effects that occur while taking the drug include, vomiting, diarrhea, hair loss, fatigue, mouth sores, pain, and easy bruising. Some of the more serious long term effects are, damage to lung tissue, heart problems, infertility, kidney problems, nerve damage, and risk of a second cancer. These side effects seem to make chemotherapy out to be this scary horrible drug, but in reality it has been proven to kill or shrink the cancer cells in the body. Before I knew much about chemotherapy I always thought it was a nasty way of treating cancer patients because it just seemed like they would get worse from the chemo and eventually die. That is why whenever I found out my grandmother had cancer I didnt have much hope of her making it. Even the doctor gave her only 2 months to live. However, now that I have done more research I have found that many tests and procedures are done before giving patients this drug, many precautions are taken before deciding on the dosages as well.

History of chemotherapy According to Cancer.org, Chemotherapy was actually not used to treat cancer in the first place. It was actually used in mustard gas during World War 1 and was studied more in World War 2. In a military operation in WW2, a group was accidentally exposed to this mustard gas. Later on they found that these men had an extremely low white blood cell count and had a very low immune system. Doctors looked into this more and figured it would have a similar effect of cancer. They found its outcomes to be remarkable. Not long after nitrogen mustard gas was discovered, a man named Sidney Farber of Boston found that a compound related to vitamin folic acid called aminopterin produced remissions in children that had suffered with acute leukemia. This compound aminopterin made it impossible for DNA to be replicated. Over the years, chemotherapy drugs (chemo) have successfully treated many people with cancer. Longterm remissions and even cures of many patients with Hodgkin disease and childhood ALL (acute lymphoblastic leukemia) with chemo were first reported during the 1960s. Cures of testicular cancer were seen during the next decade. Many other cancers can be controlled with chemo for long periods of time, even if they are not cured. (AmericanCancerSociety) Such as my grandmas cancer, although it is not completely gone, she has outlived the two months the doctor gave her and it had drastically shrunk the cancer down to almost nothing. Although chemo isnt a sure cure, it still drags out the amount of time left that patient has with their family and friends.

Do the risks outweigh the benefits? Sophie Calleau has a PHD and wrote an article on Cancer.org about Pain that elderly patients go through when given chemotherapy treatments. In this article she wrote that today, one fourth of the world population is over age 70. Over the next two decades, that proportion will rise to one-third. As the population ages, the incidence of malignant tumors also rises, not only because there is more time for cancer to develop but also because older tissues may be more susceptible to environmental carcinogens. (Colleau) Elderly patients with advanced cancer seem to not do very well with the harsh treatment of chemotherapy. This is an advancing problem because most elder patients often have comorbid illnesses and are taking multiple drugs. The decision whether to use cytotoxic anticancer chemotherapy is difficult because the elderly are very under-represented in clinical trials. For each patient there are potential benefits and adverse effects. From the older perspective, short term quality of life and the ability to continue managing their activities are more important than modest survival when deciding on chemotherapy treatment. In addition, half of the patients with cancer experience moderate to severe pain at the time of diagnosis and at least 80 percent of elderly patients will have significant pain when cancer is advanced. (Colleau) The elderly take more drugs than a

younger patient would and this places the elderly at risk for drug-drug and drug-disease interactions. Much of the elderly patients with cancer and not treated for the cancer pain. (To the left is a picture of my grandma smelling a flower from her garden that we now take care of for her.) A study of elderly nursing home residents with cancer showed that daily pain is widespread and often untreated, especially among older and minority patients. In that study, 1 in 4 patients with cancer in a nursing home did not receive any analgesia for daily pain. The study examined data collected on 13,625 cancer patients aged 65 and older discharged from hospitals to nursing homes from 1992 to 1995. In total, 4,003 patients reported daily pain. Of those, 16 percent received a simple analgesic such as aspirin or acetaminophen. Thirty-two percent were given codeine or other weak opioids, and 26 percent received morphine. However, 26 percent of patients with daily pain received no analgesics, not even an aspirin or acetaminophen tablet. Patients older than 85 years in daily pain were about 50 percent less likely to receive any analgesic than those aged 65 to 74 years. Only 13 percent of patients aged 85 years and older received codeine or other weak opioids or morphine, compared to 38 percent of those aged 65 to 74 years. (Colleau) This study shows that the older patients with cancer receive an inadequate amount of medical treatment. It is sad that these older cancer patients have to go through this excruciating pain when they already have to deal with the fact of having cancer. It makes me sick to know that the elderly are not as much of a priority as the younger patients are. Patients should be treated equally, no matter the age. People think that because they are older they dont need to have the best treatment like a younger person would receive. I enjoyed reading about this case because it made me realize that the elderly are the minorities when it comes to cancer treatment. It upsets me because these older patients do not seem to react to the chemotherapy as well as it should and I personally do not the point in making someone suffer more than they have to. The statistics are not high enough for chemotherapy to be worth giving to the elderly. From everything I have read about, the websites just talk about all of the high risks that chemo puts the elderly in. It is all about the quality of life someone has, and if they are diagnosed with cancer I do not think that they should have to suffer more than they have to, only to be let down. The National Cancer Institute is a government website featuring all sorts of cancer related information and articles, one saying, Chemotherapy causes long-term side effects that do not go away. These may include damage to your heart, lungs, nerves, kidneys, or reproductive organs. Some types of chemotherapy may cause a second cancer years later. (Bethesda) This article made me realize all the dangerous risks that chemotherapy carries with it. This is an extremely harsh drug that will ruin your body of all the good tissue that it has left. It leaves the body with almost nothing left and although the cancer may shrink, it usually reoccurs. With that being said, I do not think that chemotherapy is worth all the risks that it comes with. Especially to an elder patient who cannot handle that type of suffering.

Thank you Chemo I have to say that after this project I have learned more about chemo than I ever would. I am so ecstatic that I had the opportunity to write about my grandmothers story in my paper because she is a woman who has such a huge impact on my life. In the beginning I was very skeptical about chemotherapy, now I know it has good intentions. However, I still believe that its too harsh on the elderly. I believe there is a better cure out there that just needs to accidentally be found. I am so grateful that my grandmothers cancer has shrunk but it is still in her body and if it goes untreated then it will just continue to grow. Cancer is an extremely difficult illness to cure within a short time period. It usually comes back and with more force. I am just happy that I dug into the side effects, and the procedures done to help these patients with their cancer. Although it may not have cured my grandmothers cancer completely, it still bought me more time with her than I originally had and I have chemotherapy to thank for that.

This picture is to show you all how chemotherapy has transformed her physically and how her attitude still remains so sweet.

Works Cited: American Cancer Society. "Evolution of cancer treatments: Chemotherapy." Evolution of cancer treatments: Chemotherapy. American Cancer Society, 8 June 2012. Web. 9 Apr. 2014. <http://www.cancer.org/cancer/cancerbasics/thehistoryofcancer/the-history-of-cancer-cancertreatment-chemo>.

Colleau, Sophie M. . "PAIN IN THE ELDERLY WITH CANCER." Welcome. Cancer Pain

Release, 2 Nov. 2000. Web. 9 Apr. 2014. <http://www.whocancerpain.wisc.edu/?q=node/206>.

Mayo Clinic Staff. "Chemotherapy." Definition. Mayo Clinic, 5 May 2011. Web. 8 Apr. 2014. <http://www.mayoclinic.org/tests-procedures/chemotherapy/basics/definition/prc-20023578>.

National Cancer Institute: PDQ Small Cell Lung Cancer Treatment. Bethesda, MD: National Cancer Institute. Date last modified <10/18/2013>. Available at: http://cancer.gov/cancertopics/pdq/treatment/small-cell-lung/Patient. Accessed <03/23/2014>.