Making decisions about treatment

Your age should not affect the treatments offered to you. When planning your treatment, your cancer doctor should consider your individual situation. This includes your general health, your biological age (how well your body is working) and any health conditions you have. Some treatment side effects may be worse if you have other health conditions or are taking other medicines.

The aim of cancer treatment may be to cure the cancer. Or it may be to control the cancer and relieve your symptoms. Ask your doctor about your treatment options. Your healthcare team should give you as much information as you need to make an informed choice. You may be able to get information in another format, such as large print or audiobooks.

If you are unable to make decisions about your treatment, your doctor will be responsible for your care. You can write down the type of treatments you would refuse in an Advanced Decision to Refuse Treatment. Or you may be able to set up a Lasting Power of Attorney to give someone power to make decisions on your behalf.

Making decisions about treatment

Cancer treatments

Your age should not stop you from being offered many of the available treatments for cancer. If your doctor does not recommend a particular treatment, it should be because the treatment is unlikely to be helpful and not because of your age.

The aim of cancer treatment may be to cure the cancer. Or it may be to control the cancer and relieve your symptoms.

Treatments can include:

  • surgery
  • radiotherapy
  • chemotherapy
  • hormonal therapy
  • targeted (biological) therapy.

Asking questions

It is important to talk to your doctor about your treatment options. You might want to ask some of the following questions:

  • What will treatment involve?
  • Where will I have treatment?
  • How often will I need to have treatment?
  • How long will the course of treatment last?
  • What will happen if I do not have treatment?

Some people find that learning more about their treatment helps them feel prepared. It can also make it easier to plan ahead. You could ask about how you may feel during and after treatment.

If you are a carer, you and the person you care for might need extra help during and after your treatment. Asking questions can help you plan for this. We have more information for carers with cancer.

Accessing cancer information

Your healthcare team should give you as much information as you need to understand your diagnosis, treatment and possible side effects. This can help you to make informed choices.

We have more information about different types of treatment and tests you may have. We also have information about making treatment decisions.

Some people may need information in a different format. If your eyesight is poor, Macmillan and many other organisations produce information in large print. We can also produce Braille versions of our information on request. Some of our information is available as audiobooks.

If you have hearing difficulties or are deaf, some of the videos on our website have British Sign Language translation. We also have information in other languages.

You can call our support line on 0808 808 00 00 to ask about different formats.

Clinical trials

Cancer research trials try to improve knowledge about cancer and cancer treatments. Trials that patients take part in are called clinical trials.

Some trials have an upper age limit. Other trials look at treatment for older people, so you may need to be over a certain age to take part.

You might be asked to take part in a clinical trial. If you choose to take part, you will be carefully monitored during and after the trial. If you decide not to take part, your decision will be respected. You won’t have to give a reason and you will be offered the standard treatment for your situation.

Your doctor or nurse can give you more information about the benefits and disadvantages of taking part in a trial.

Personalised treatment

Not all treatments work for everyone. It may be difficult for you and your doctors to decide which treatment is best for you. Doctors should plan your treatment to suit your individual situation. This is called personalising your treatment. They should consider:

  • your general health
  • your biological age (how well your body is working).

It is important that your doctor looks at your biological age, not just how old you are in years.

They should also be sensitive towards any religious or spiritual beliefs that you tell them about. For example, this could mean giving you information about therapies that may improve your spiritual well-being, such as meditation.


Access to treatment

Your age should not stop you being offered treatments for cancer if:

  • they are suitable for you
  • they are suitable for the type of cancer you have.

Research funded by Macmillan suggests that:

  • the outcomes of cancer treatment for older people are similar to the outcomes for younger people
  • older people who are relatively fit can safely have certain cancer treatments.

Some types of treatment are effective in younger people but are not suitable for some older people. This includes certain chemotherapy drugs. The side effects of some treatments may be worse if you have other health problems and are taking other medicines.

Having some health conditions might mean that certain types of treatment are not suitable for you. These conditions include lung or kidney disease.

Your cancer doctor might not recommend a particular treatment. This may be because:

  • it is unlikely to be helpful
  • they believe the side effects will be too severe.

Your cancer doctor should explain the range of treatments that are available. They should also talk to you about why particular treatments may not be effective or right for you.

You can ask your doctor how other conditions you have can be managed during any cancer treatment they suggest.

If a drug is not available

The NHS offers most treatments and services that patients need. But sometimes treatment is not available for patients with a particular need.

If a treatment that could be an option for you is not available on the NHS, talk to your cancer doctor. It is important to understand the treatment and whether it is right for you.

We have more information about what you can do if a drug is not available.

Consent

Before you have any tests or treatment, your doctor will explain the aims of that test or treatment 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. Nobody can give you medical treatment without your consent. Before you sign the form, you should be given full information about:

  • the type of treatment
  • how long the treatment will take
  • advantages and disadvantages of the treatment
  • any significant risks or side effects
  • any other treatments that may be available.

If you do not understand what your doctor has told you, tell them straight away. Some cancer treatments are complicated, so you may need them to repeat the information.

You can choose not to have the treatment. You should be told what will happen if you choose this option. You also have the right to suggest a treatment that you think is the best option for you, even if the people treating you disagree. But your doctor does not have to provide a treatment if they do not think it is suitable for you.

Mental capacity

Mental capacity is the ability to:

  • understand and retain information
  • make decisions based on that information
  • communicate the decision.

A person may not be able to make a particular decision at a specific time about a treatment, even with support, because they do not have mental capacity. In this situation, a doctor must act in that person’s best interests. To do this, they must try to find out what the person would want. They may ask people who are close to the person about what they believe that person would want.

You can find out more about mental capacity on the NHS Choices website.

Confidentiality

Healthcare professionals are not allowed to share details of your diagnosis and treatment with your family, friends or carers without your permission. They also have to involve you in any discussion about your care. Discussions can only happen without you if you have given permission.

Advance Decisions and Power of Attorney

Some people choose to write down which treatments they would refuse and when they would refuse them. This can be included in their medical notes. This information is helpful if a time comes when they cannot make or communicate decisions about their treatment. It is called an Advance Decision to Refuse Treatment. It can also be called an Advance Directive or Living Will. An Advance Decision is legally binding.

The charity Compassion in Dying provides a free Advance Decision form that you can fill in online or on paper.

You can allow someone to make decisions about your treatment or care on your behalf if a time comes when you are unable to make them yourself. This is called a Lasting Power of Attorney (health and care) if you live in England, Scotland or Wales. It must be set up when you have mental capacity. In Northern Ireland, you can say how you would like to be cared for using documents such as an Advance Care Plan.

In every country in the UK, you can set up a long-term Power of Attorney that allows someone to make decisions about your finances and property on your behalf.

We have more information about planning your future care in England and Wales, Scotland and Northern Ireland. We also have information about planning your financial affairs.


Making a complaint

Most of the time, people are happy with the treatment and care they get from healthcare professionals. But sometimes people make mistakes and this can be very upsetting. You can often sort out a problem by talking to the healthcare professionals involved. Or you may be able to talk to another person in the team. But if this does not work, or if you feel it won’t help, you may want to make a formal complaint. Someone can also make a complaint on your behalf, if you agree to this.


Looking after yourself

It can take a while to recover from the effects of treatment. You might also feel overwhelmed by different feelings. It is important to look after yourself at this time. We have information about how to cope with the physical and emotional effects of cancer and its treatment.

You can call the Macmillan Support Line on 0808 808 00 00 to talk to a cancer information nurse specialist. You can find support in your area with a local cancer support group. Or you could visit one of our local information and support centres. You can also share your experiences, ask questions and get support from others through our Online Community.

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