Discussing and agreeing on treatment for older people
The aim of cancer treatment is either to cure the cancer or to control it and relieve its symptoms.
Treatments can include surgery, radiotherapy, chemotherapy, hormonal therapy and targeted treatments (that target specific molecules within cancer cells).
It’s important to discuss your treatment options and what treatment may involve. Some people find that learning more about their treatment helps them feel prepared. It can also allow you to think ahead and identify the needs of anyone you have caring responsibilities for.
Access to treatment and your rights
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Your age should not stop you from being offered many of the available treatments for cancer. However, some types of treatment, particularly some chemotherapy drugs, are effective in younger people but don’t work as well for some older people. The side effects of some treatments may also be more severe if you have other health problems and are taking other medicines.
If your doctor does not recommend a particular treatment, it may be because it is unlikely to be helpful and not because of your age. Or it may be because they believe the side effects will be too severe.
If you have other health conditions, for example lung or kidney disease, it may prevent you from being offered certain types of treatment. If this is the case, your doctor should explain the range of treatments that are available and why particular treatments may not be effective.
Like all patients, you have the right to:
be treated with dignity and respect
see your medical records
be given information about any proposed treatment, including its aims and side effects
ask for a second opinion
make a complaint.
Protection against discrimination
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In England, Scotland and Wales, the Equality Act 2010 protects anyone who has, or has had, cancer. Even if a person who had cancer in the past has been successfully treated and is now cured, they will still be covered by the act.
This act protects you from being unfairly treated (discriminated against), harassed, or victimised on the basis of your disability or your age.
The act means it is no longer lawful, without good and sufficient reason, to provide inferior services or refuse to provide them at all because of a person’s perceived age. This includes NHS services but not those in the financial services sector (such as travel insurance).
The act also protects anyone who is caring for someone who is elderly or has cancer from discrimination, harassment or victimisation because of their caring responsibilities.
People with a disability in Northern Ireland are protected by the Disability Discrimination Act 1995. Carers who are also employees are also protected from direct discrimination and harassment in the workplace in Northern Ireland.
For detailed information about your rights under the Equality Act or Disability Discrimination Act, contact the Equality Advisory and Support Service. In Northern Ireland, contact the Equality Commission for Northern Ireland.
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There is no single treatment that is right for everyone, and it may be difficult for you and your doctors to decide which is best for you. Doctors should personalise your treatment. This means planning treatment to suit your particular situation.
They should consider your general health and your biological age (how well your body is working) rather than just how old you are in years (your actual age).
They should also be sensitive towards any religious or spiritual beliefs that you may have shared with them. For example, this could mean providing you with information about therapies that could improve your spiritual well-being, such as meditation.
NHS services should be provided equally to everyone, regardless of age, gender, race, disability, sexual orientation, religion or belief.
There are official national guidelines and standards that explain what should happen when someone receives cancer treatment. These guidelines and standards may differ depending on where you live in the UK. You can ask your healthcare team to show you these documents.
Respecting your dignity
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You have a right to expect that the people caring for you will respect your privacy and be sensitive to your needs.
This may be as simple as them asking you what you would like to be called, rather than assuming that they can call you by your first name. It also means giving you privacy during physical examinations. If you find a situation embarrassing or distressing, then let the doctor or nurse know so that they can help to make things more comfortable for you.
If a drug isn’t available
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If a treatment that may help control your cancer isn’t available to you, it can be difficult to know what to do. To begin with, it’s important to talk to your cancer specialist. You can then both decide if it really is the best treatment for you.
You may decide that you want to apply to your local health body for a treatment. If so, you’ll need to follow the procedures it sets. This can differ from region to region. Some local health bodies have leaflets or information on their websites explaining what you should do. Your specialist will also explain the local process to you.
If you live in England and are denied a particular drug because it is too expensive, you may be able to access it through the Cancer Drugs Fund. This is a special fund set up by the government. It is only available after all other sources of NHS funding have been investigated. If you think you may be eligible for the fund, you can discuss it with your specialist.
The governments in Scotland, Northern Ireland and Wales decide separately how they spend their money on health. All three have chosen not to create a Cancer Drugs Fund, but are looking at different ways to improve access to cancer drugs.
We have more information about access to treatment, with information specifically for the region you live in.
Accessing cancer information
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Information can help you make informed choices. You should be given as much information as you need to help you understand your diagnosis, treatments and possible side effects.
If your eyesight is poor, many organisations, including Macmillan, produce information in large print. We can produce Braille versions of our information resources on request. Some of our booklets are also available as audio CDs.
If you have hearing difficulties or are deaf, we have some videos with British Sign Language translation. We also have information in other languages, which you can access through the same page.
Before you have any treatment your doctor will explain its aims to you. They will ask you to sign a form saying that you give your permission (consent) for the hospital staff to give you the treatment. No medical treatment can be given without your consent. Before you are asked to sign the form, you should be given full information about:
the type and extent of the treatment
its advantages and disadvantages
any significant risks or side effects
any other treatments that may be available.
If you don’t understand what you’ve been told, let the staff know straight away, so they can explain again. Some cancer treatments are complex, so it’s not unusual to need repeated explanations. You are also free to choose not to have the treatment and should be told what will happen if you choose this option. You also have the right to choose a treatment that you think is the best option for you, even if the people treating you disagree.
Doctors and other health professionals aren’t allowed to share details of your diagnosis and treatment with family, friends or carers without your permission. They also have to involve you in any discussion about your care. Discussions are only allowed to take place without you if you have given permission; or if you are unable to make decisions about your care and have registered a lasting power of attorney (health and welfare), naming someone to make such decisions on your behalf.
Mental capacity is the ability to understand and retain information, and to make decisions based on that information. For example, a person may be unable to make a particular decision at a specific time about a proposed treatment because they lack mental capacity. If a person lacks mental capacity, a doctor must act in their best interests and attempt to get information about what they would want from those close to them.
Advanced decisions and lasting power of attorney
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Some people write down what treatments they would refuse and under what circumstances they would refuse them in advance. This is called an advanced decision to refuse treatment. You can also set up a lasting power of attorney (health and welfare). In Scotland, this is called a welfare power of attorney. You can also set up a power of attorney that relates to finances.
In Northern Ireland, there is no power of attorney to give someone the right to make decisions on your behalf.
You might find it helpful to read our information about putting your affairs in order.
When your healthcare is not as good as it should be - making a complaint
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Most of the time, treatment and care within the NHS goes well. However, this is not always the case and you may not be happy with the care you have received.
Discussing this with the healthcare professionals involved or another person on the team can often resolve the issue. It’s a good idea to raise any concerns you have at the time you notice them so that they can be addressed promptly. However, if this doesn’t work, or if you feel talking about the issue with the people involved won’t help, you may want to complain. Complaints can also be made by someone acting on your behalf, with your consent.
All hospitals and GP practices have someone who is responsible for dealing with complaints, usually called the complaints manager. Your local hospital or trust will have its own complaints leaflet that explains the national complaints procedure that they must follow. They can give you a copy.
A good place to get free advice about making a complaint is your local Citizens Advice. In England, you can also contact a Patient Advice and Liaison Service (PALS). PALS can usually help solve problems or they can put you in touch with the Independent Complaints and Advocacy Service (ICAS), which can give you advice about making a formal complaint.
The Older People's Advocacy Alliance (OPAAL) offers independent advocacy services which can help to ensure that all relevant procedures are used, all options explored, and sufficient attention is given to the circumstances of each individual cancer patient.
In Northern Ireland, you can get help and advice from the Patient and Client Council.
In Scotland, you can get advice from your local NHS Board.
Visit to find contact details for your local board. In Wales, help and advice is available from your Community Health Council.
We have more information about making a complaint.
Questions about treatment
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You can download this table of questions you may have about treatment and your rights [PDF, 139kb]. The table also suggests who may be able to answer each question.
Watchful waiting or active surveillance
Some cancers grow very slowly and may never cause any problems within a person’s lifetime. In this situation the doctors may feel that it’s better not to give any treatment, as this may cause side effects which would reduce the person’s quality of life. However, the doctors will still monitor the person very closely, usually by seeing them every few months to assess their condition. They will also do blood tests and scans, if necessary.
If the cancer begins to develop, the doctors will detect this early and offer appropriate treatment at that time. Some people find it difficult not to have treatment when they know that a cancer is there. It’s important to discuss the situation fully with your doctor so that you understand why no treatment is being given.