Do treatment options change as you get older?

There are many different treatment options for lymphoma. Does your age impact which is the most suitable for you, or how you might respond to treatment?

The treatment you have for lymphoma depends on your individual circumstances. Your medical team plans the most appropriate treatment for you based on several factors. These include the type of lymphoma you have, how quickly it’s growing, your general health and what’s important to you. In the UK, the cost of treatment is not a factor when making decisions between available options.

Age is one of the many factors that your medical team will take into consideration. Although age itself will not necessarily impact your response to treatment, older age is often associated with other things that do influence treatment choice. For example, although long-term health conditions can affect people of any age, they become more common as you get older.

As you get older, your organs might not work as well as they used to even if you don’t have any other health conditions. For example, your liver, kidneys, immune system, bone marrow or heart might not work as well as they did when you were younger. This makes you more likely than a younger person to experience side effects of treatment. However, this varies a lot from person-to-person. Age on its own cannot tell you how well your organs work.

Age is therefore only used as an indicator – it is more important to understand your ‘fitness’ in terms of being able to cope with a specific treatment and any potential side-effects. If you are fit enough, you are likely to be recommended the same treatment options as for a younger person. If there are concerns about your fitness or the health of your organs, extra tests might be used. Treatment will be adapted to suit your individual needs based on your test results.

Treatment choice is always a balance between the potential outcome and possible side-effects. Treatment can be adapted in many ways to suit your needs:

• Type of treatment: For some types of lymphoma, it might be possible to avoid the use of chemotherapy. Other treatment options, such as targeted drugs or radiotherapy often have fewer side effects.
• Specific drugs: You might not be able to have certain drugs if you have heart or lung problems. If this is the case, some drugs might be swapped for different options, or left out of your treatment altogether. For example, doxorubicin might be swapped for a different drug for those with heart conditions.
• Monotherapy: Your medical team might recommend treatment with just one drug instead of a combination of several. This is called monotherapy. It could be a chemotherapy drug that can be given on its own, or an antibody therapy such as rituximab.
• Dose: If you can’t have the standard dose of treatment, you might be able to have the same drugs but at a lower dose. For example, CHOP (a combination of chemotherapy drugs often used to treat lymphoma) can be given in lower doses if necessary. This is sometimes called ‘mini-CHOP’.
• Cycles of treatment: If you are not able to tolerate the standard course of treatment, your medical team might suggest that you have a treatment that requires fewer cycles. This might be followed by radiotherapy instead of the extra cycles of chemotherapy. Some people might have a longer interval between treatment cycles to give their body longer to recover.
• Administration: Treatment with chemotherapy tablets you take at home might be an option for some people.
• Additional treatments: You might be offered additional treatments to support your body through your lymphoma treatment, such as growth factor injections to keep your blood counts healthy.

It is important that you are comfortable with the treatment plan your medical team makes with you. Regardless of your age, they need to understand your personal circumstances and your thoughts on treatment.

Your medical team will closely monitor how well treatment is tolerated as changes can be made even once treatment has started. Doctors have a number of strategies when it comes to the treatment of lymphoma and they will be making choices based on the individual, ensuring they deliver the best option for you. Age is only one of the many factors taken into account.